HB2784 102ND GENERAL ASSEMBLY

LRB102 14976 RLC 20331 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2784

Introduced 2/19/2021, by Rep. Kelly M. Cassidy

SYNOPSIS AS INTRODUCED:

New Act
50 ILCS 750/4	from Ch. 134, par. 34

Creates the Community Emergency Services and Supports Act. Provides that the Act applies to every unit of local government that provides or coordinates ambulance or similar emergency medical response or transportation services for individuals with emergency medical needs. A home rule unit may not respond to or provide services for a mental or behavioral health emergency, or create a transportation plan or other regulation, relating to the provision of mental or behavioral health services in a manner inconsistent with this Act. Provides that one plan shall describe how the EMS Region will provide mobile emergency mental and behavioral health services to individuals who do not present as a threat to the responders, and are not involved in criminal activity at the time of the response. Provides that the plan shall conform to the requirements of the Act and, recognizing the variety of systems, services, and needs across the State, provide the specific requirements and guidance appropriate for that region. Provides that the plan shall be identified as the region's community emergency services and supports plan. Provides that the second plan shall describe the manner and extent to which responders operating under the region's Community Emergency Services and Supports Plan coordinate with law enforcement when responding to individuals who appear to be in a mental or behavioral health emergency while engaged in conduct alleged to constitute a non-violent misdemeanor. Provides that the plan shall be identified as the region's Non-Violent Misdemeanor Coordination Plan. Amends the Emergency Telephone System Act to make conforming changes. Effective immediately.

FISCAL NOTE ACT MAY APPLY

HOME RULE NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning health.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Community Emergency Services and Supports Act.

Section 1.5. This Act may be referred to as the Stephon Edward Watts Act.

Section 5. Findings. The General Assembly recognizes that many cities and some states have successfully established mobile emergency mental and behavioral health services to support people who need that support and do not present a threat of physical violence to the responders. In light of that experience, the General Assembly finds that in order to promote and protect the health, safety, and welfare of the public, it is necessary and in the public interest to provide emergency response, with or without medical transportation, to individuals requiring mental health or behavioral health services in a manner that is substantially equivalent to the response already provided to individuals who require emergency physical health care.

Section 10. Applicability; home rule. This Act applies to every unit of local government that provides or coordinates ambulance or similar emergency medical response or transportation services for individuals with emergency medical needs. A home rule unit may not respond to or provide services for a mental or behavioral health emergency, or create a transportation plan or other regulation, relating to the provision of mental or behavioral health services in a manner inconsistent with this Act. This Act is a limitation under subsection (i) of Section 6 of Article VII of the Illinois Constitution on the concurrent exercise by home rule units of powers and functions exercised by the State.

Section 15. Definitions. In this Act:

"Emergency" means an emergent circumstance caused by a health condition, regardless of whether it is perceived as physical, mental, or behavioral in nature, for which an individual may require prompt care, support, or assessment at the individual's location.

"Mental or behavioral health" means any health condition involving changes in thinking, emotion, or behavior, and that the medical community treats as distinct from physical health care.

"Physical health" means a health condition that the medical community treats as distinct from mental or behavioral health care.

"Community services" and "community-based mental or behavioral health services" may include both public and private settings.

"Treatment relationship" means an active association with a mental or behavioral care provider able to respond in an appropriate amount of time to requests for care.

"Responder" is any person engaging with a member of the public to provide the service required by Section 25.

Section 20. Regional committees. The Department of Human Services Division of Mental Health shall establish and oversee a community emergency services and support committee in each of the Emergency Medical Services (EMS) Regions for the purpose of developing and, as appropriate, amending 2 plans to set regional guidance and standards for providing mobile mental and behavioral health care.

(1) One plan shall describe how the EMS Region will provide mobile emergency mental and behavioral health services to individuals who do not present as a threat to the responders, and are not involved in criminal activity at the time of the response. This plan shall conform to the requirements of this Act and, recognizing the variety of systems, services, and needs across the State, provide the specific requirements and guidance appropriate for that region. This plan shall be identified as the region's community emergency services and supports plan.

(2) The second plan shall describe the manner and extent to which responders operating under the region's Community Emergency Services and Supports Plan coordinate with law enforcement when responding to individuals who appear to be in a mental or behavioral health emergency while engaged in conduct alleged to constitute a non-violent misdemeanor. This plan shall be identified as the region's Non-Violent Misdemeanor Coordination Plan.

Section 25. Community Emergency Services and Supports Plan Goals. The Community Emergency Services and Supports Plan shall be designed to meet the following service goals, specifying specific expectations for these goals as appropriate:

(1) Provide mobile response service for mental and behavioral health emergencies. Every jurisdiction of local government that provides mobile emergency medical services for individuals with physical health needs must also provide appropriate mobile emergency services to individuals experiencing a mental or behavioral health emergency. Appropriate emergency response services must:

(A) Ensure that individuals experiencing mental or behavioral health crises are diverted from hospitalization or incarceration whenever possible, and are instead linked with available appropriate community services.

(B) Include the option of on-site care if that type of care is appropriate and does not override the care decisions of the individual receiving care. Providing care in the community, through methods like mobile crisis units, is encouraged. If effective care is provided on site, and if it is consistent with the care decisions of the individual receiving the care, further transportation to other medical providers is not required by this Act.

(C) Recommend appropriate referrals for available community services if the individual receiving on-site care is not already in a treatment relationship with a service provider or is unsatisfied with their current service providers. The referrals shall take into consideration waiting lists and copayments, which may present barriers to access.

(2) Subject to the care decisions of the individual receiving care, provide transportation for any individual experiencing a mental or behavioral health emergency. Transportation shall be to the most integrated and least restrictive setting appropriate in the community, such as to the individual's home or chosen location, community crisis respite centers, clinic settings, behavioral health centers, or the offices of particular medical care providers with existing treatment relationships to the individual seeking care.

(3) Prioritize requests for emergency assistance. Provide guidance for prioritizing calls for assistance and maximum response time in relation to the type of emergency reported.

(4) Provide appropriate response times. From the time of first notification, provide the response within response time appropriate to the care requirements of the individual with an emergency.

(5) Require appropriate responder training. Responders must have adequate training to address the needs of individuals experiencing a mental or behavioral health emergency. Adequate training at least includes:

(i) training in de-escalation techniques;

(ii) knowledge of local community services and supports; and

(iii) training in respectful interaction with people experiencing mental or behavioral health crises, including the concepts of stigma and respectful language.

(6) Adopt guidelines directing referral to restrictive care settings. Responders must have guidelines to follow when considering whether to refer an individual to more restrictive forms of care, like emergency room or hospital settings.

(7) Specify regional best practices. Responders providing these services must do so consistently with best practices, which include respecting the care choices of the individuals receiving assistance.

(8) Adopt system for directing care in advance of an emergency. Select and publicly identify a system that allows individuals who voluntarily chose to do so to provide confidential advanced care directions to individuals providing services under this Act. No system for providing advanced care direction may be implemented unless the Division of Mental Health approves it as confidential, available to individuals at all economic levels, and non-stigmatizing. The Division of Mental Health may defer this requirement for providing a system for advanced care direction if it determines that no existing systems can currently meet these requirements.

(9) Coordinate service providers. The Regional Plan may coordinate with or include other similar programs, like those operating under the Children's Mental Health Act of 2003, if all the requirements of all programs are met.

(10) Train dispatching staff. The personnel staffing 9-1-1, 311, or other emergency response intake systems must be provided with adequate training to assess whether dispatching emergency mental health responders under this Act is appropriate.

(11) Establish system for emergency responder coordination. Establish a protocol for responders, law enforcement, and fire and ambulance services to request assistance from each other, and train these groups on the protocol.

(12) Integrate law enforcement. Provide for law enforcement to request Responder assistance whenever law enforcement engages an individual appropriate for services under this Act. If law enforcement would typically request EMS assistance when it encounters an individual with a physical health emergency, law enforcement shall similarly dispatch mental or behavioral health personnel or medical transportation when it encounters an individual in a mental or behavioral health emergency.

Section 30. Law enforcement responsibility for providing mental and behavioral health care.

(a) In any area where responders are available for dispatch, law enforcement shall not be dispatched to respond to an individual requiring mental or behavioral health care unless that individual is:

(1) involved in a suspected violation of the criminal laws of this State; or

(2) presents a threat of physical injury to self or others.

(b) Standing on its own or in combination with each other, the fact that an individual is experiencing a mental or behavioral health emergency, or has a mental health, behavioral health, or other diagnosis, is not sufficient to Community Emergency Services and Supports Plan Practices to avoid. The Community Emergency Services and Supports Plan shall be designed to avoid the following practices and outcomes:

(A) justify an assessment that the individual is a threat of physical injury to self or others; or

(B) requires a law enforcement response to a request for emergency response or medical transportation.

(c) If, based on its assessment of the threat to public safety, law enforcement would not accompany medical transportation responding to a physical health emergency, law enforcement may not accompany emergency response or medical transportation personnel responding to a mental or behavioral health emergency that presents an equivalent level of threat to self or public safety.

(d) Without regard to an assessment of threat to self or threat to public safety, law enforcement may station personnel so that they can rapidly respond to requests for assistance from responders if law enforcement does not interfere with the provision of emergency response or transportation services. To the extent practical, not interfering with services includes remaining sufficiently distant from or out of sight of the individual receiving care so that law enforcement presence is unlikely to escalate the emergency.

(e) Responder involvement in involuntary commitment. In order to maintain the appropriate care relationship, responders shall not in any way assist in the involuntary commitment of an individual beyond:

(1) reporting to their dispatching entity or to law enforcement that they believe the situation requires assistance the responders are not permitted to provide under this Section;

(2) providing witness statements; and

(3) fulfilling reporting requirements the responders may have under their professional ethical obligations or laws of this state. This prohibition shall not interfere with any responder's ability to provide physical or mental health care.

(f) Use of law enforcement for transportation. In any area where responders are available for dispatch, law enforcement shall not be used to provide transportation to access mental or behavioral health care, or travel between mental or behavioral health care providers, except where no alternative is available.

(g) Reduction of educational institution obligations: The service provided by the Community Emergency Services and Supports Plan may not be used to replace any service an educational institution is required to provide to a student. It shall not substitute for appropriate special education and related services that schools are required to provide by any law.

Section 35. Non-violent Misdemeanor Coordination Plan Goal. The region's Non-violent Misdemeanor Coordination Plan shall be designed to meet the following service goals in a regionally appropriate manner, specifying specific expectations for these goals as appropriate:

(1) prioritize health care;

(2 to the greatest extent practicable, the Non-Violent Misdemeanor Coordination Plan shall first seek to provide community-based mental or behavioral health services before addressing law enforcement objectives; and

(3) divert from further criminal justice involvement.

The plan shall provide for assessment and referral to health care services with the potential to reduce the likelihood of further law enforcement engagement.

Section 40. Composition of regional committees. Each regional committee shall consist of: (i) representatives of the EMS Medical Directors Committee, as constituted under the Emergency Medical Services (EMS) Systems Act, or other similar committee serving the medical needs of the jurisdiction; (ii) representatives of law enforcement officials with jurisdiction in the Emergency Medical Services (EMS) Regions; representatives of the unions representing EMS or emergency mental and behavioral health responders, or both; and iii advocates from the mental health, behavioral health, intellectual disability, and developmental disability communities. The majority of advocates on the Emergency Response Equity Committee must either be individuals with a lived experience of a condition commonly regarded as a mental health or behavioral health disability, developmental disability, or intellectual disability, or be from organizations primarily composed of those individuals. The members of the committee shall also reflect the racial demographics of the jurisdiction served. Subject to the oversight of the Illinois Department of Human Services Division of Mental Health, the EMS Medical Directors Committee is responsible for convening the meetings of the committee. Interested units of local government may also have representatives on the committee subject to approval by the Division of Mental Health, and if this participation is structured in such a way that it does not reduce the influence of the advocates on the committee. § 100Each Region shall begin providing the service required by its plans within 6 months of the Plan's completion.

Section 45. Scope. This Act applies to persons of all ages, both children and adults. This Act does not limit an individual's right to control his or her own medical care. No provision of this Act shall be interpreted in such a way as to limit an individual's right to choose his or her preferred course of care or to reject care. No provision of this Act shall be interpreted to promote or provide justification for the use of restraints when providing mental or behavioral health care.

Section 50. Plans; completion. Both plans required by this Act shall be completed within 6 months after the effective date of this Act, and shall thereafter be reviewed by the region's community emergency services and support committee every other year. At the request of any member of the region's community emergency services and support committee or by the Division of Mental Health, the committee shall reconvene outside the 2 year review period.

Section 105. The Emergency Telephone System Act is amended by changing Section 4 as follows:

(50 ILCS 750/4) (from Ch. 134, par. 34)

(Section scheduled to be repealed on December 31, 2021)

Sec. 4.

(a) Every system shall include police, firefighting, and emergency medical and ambulance services, and may include other emergency services. The system may incorporate private ambulance service. In those areas in which a public safety agency of the State provides such emergency services, the system shall include such public safety agencies. Every system shall dispatch emergency response services for individuals requiring mental or behavioral health care in compliance with the requirements of the Community Emergency Services and Support Act.

(b) Every 9-1-1 Authority shall maintain records of the numbers of calls received, the type of service the caller requested, and the type of service dispatched in response to each call. For emergency medical and ambulance services, the records shall indicate whether physical, mental, or behavioral health response or transportation were requested, and what type of response or transportation was dispatched. When a mental or behavioral health response is requested at a primary, secondary, or post-secondary educational institution, the 9-1-1 Authority shall record which type of educational institution was involved. Broken down geographically by police district, every 9-1-1 Authority shall create aggregated, non-individualized monthly reports detailing the system's activities, including the frequency of dispatch of each type of service and the information required to be collected by this subpart. These reports shall be available to both the Community Emergency Services and Supports Committees created under the Community Emergency Services and Supports Act, and to the Administrator of the 9-1-1 Authority, for the purpose of conducting an annual analysis of service gaps, and to the public upon request.

(Source: P.A. 99-6, eff. 1-1-16; 100-20, eff. 7-1-17.)

Section 999. Effective date. This Act takes effect upon becoming law.