On Thursday, March 12th, the Virginia General Assembly wrapped up its historic 2020 session by passing a two-year budget that makes historic investments in mental health services for children and families.

We are grateful to our legislative champions who are committed to transforming our behavioral health system–piece by piece and year after year. This year, Governor Northam and the Legislature made investments that target access to evidence-based services, children’s psychiatric hospital census pressures, school-based mental health, primary and behavioral health care integration and workforce development.

 The most profound changes to our behavioral health system can be found in the budget. This year, Governor Northam committed historic investments to improve access, quality of services and workforce. The legislature put their stamp on the budget by adding additional investments in behavioral health workforce, Children’s psychiatric inpatient care and school behavioral health. Taken to together, Virginia’s biennium budget includes over $100 million in additional funding to improve our behavioral health system.

Children’s State Psychiatric Hospital Census Pressures

 Increase availability of inpatient psychiatric services for kids: $14.7 Million

• $6.3 M in FY21 and $8.4 M in FY22 for the provision of acute inpatient behavioral health services to children.
• Senate and House changes to final budget The legislature eliminated language in the introduced budget which authorized Dept. of Behavioral Health and Developmental Services authority to establish new state hospital beds for kids if a private hospital was not identified or unwilling to assist the Commonwealth Center for Children and Adolescents bed census overflow.

Partnership with the Children’s Hospital of the King’s Daughters (CHKD)

• Governor Northam’s original budget included $33.4 million (bonds proceeds) to help support the construction of a new private inpatient psychiatric hospital for children in Norfolk. The final budget removes state funding to help support this private hospital.
• Senate & House Changes: In place of funding for FY2021, the final budget includes an amendment directing the Dept. of Behavioral Health and Developmental Services to collaborate with CHKD to develop a memorandum of understanding for dedicating a portion of the future beds of a 60-bed mental health hospital at CHKD for use in providing treatment services to children who would otherwise be treated or sent to the Commonwealth Center for Children and Adolescents.

 Pilot Programs to Reduce State Hospital Census Pressures: $15 Million

• This amendment provides $7.5 million each year to fund various pilot programs in the Commonwealth to help address census pressures on state psychiatric hospitals for children and adults.
• Two-year pilot projects will be awarded to regional projects addressing comprehensive psychiatric emergency services, complex medical and neurodevelopment needs of children and adolescents receiving inpatient behavioral health services.

Clinical Staffing at the Commonwealth Center for Children and Adolescents: $1.53 million

• $1.53 million over the biennium to support the need for additional clinical staff at the Commonwealth Center for Children and Adolescents, Virginia’s only inpatient psychiatric hospital for children. Three full-time staff in admissions, six full-time Direct Service assistants, three full-time Registered Nurses, and one part-time Clinical Psychologists.

 

Behavioral Health and Physical Health Integration

Virginia Mental Health Access Program: $8.4 million  

• We are pleased that the final budget retains Governor Northam’s budget amendment, adding an additional $4.2 million each year to fund 14 positions to expand VMAP statewide.
• VMAP is an integrated care pediatric program that increases access for children to behavioral health services through enhanced pediatric training, psychiatric consultations, tele-health, and care navigation.
• This funding will allow statewide implementation, provide mental health training for primary care providers focusing on screening, diagnosis, management, treatment, referral and resources to address pediatric MH disorders. In addition, three regional teams will be added to the existing two teams providing two care navigators, a licenses clinical social worker, and child psychiatrists for each region. Funding will also allow for increased use of the call center by providers seeking mental health resources for children, development of a database for care navigation, and quality assurance and program evaluation.

 

Behavioral Health System Transformation

STEP-Virginia: $52.6 million

Building off progress and investments in STEP-VA since 2017, the Governor’s proposal includes:

• Outpatient mental health services: $9.4 million in FY21 & $6.9 million FY22
• Mobile crisis services: $6.2million FY22
• Military services: $4.3 million FY21 & $3.8 million FY22
• Family and peer support services: $2.8 million FY21 & $5.3 million FY22

Additionally, $5 million NGF in FY21 and $500,000 NGF in FY22 from the DBHDS Trust Fund to improve the crisis response system. The funding will support the development of and maintain a state-wide crisis hotline and startup fund for emergency dispatch.

• Senate and House Changes: the final budget reduced funding in the introduced budget for 7 positions at central office for administration of STEP-VA. Funding for five positions remains in the budget.

 

Behavioral Health Redesign (now called Enhancement): $13.3 million

New funding invests in evidence-based mental health services covered by Virginia Medicaid, including:

• Multi-Systemic Therapy, Functional Family Therapy, Assertive Community Treatment: $3.1 million GF & $4.1 million NGF FY21
• Comprehensive Crisis Services, Partial hospitalization, Intensive Outpatient: $10.3 million GF & $14.1 million NGF FY22
• Permits DBHDS to promulgate emergency regulations related to the licensing of services impacted by the enhancement of Medicaid behavioral health services included in the introduced budget

Senate and House Changes:

• Training funds: The final budget reduced funding ($2 million) for training of these evidence-based services to the current workforce. Funding for a training coordinator position remains in the budget.
• DMAS Advisory Panel on Behavioral Health Redesign (language only): This amendment requires DMAS to convene an advisory panel of representatives from stakeholder organizations to review and advise on agency efforts to redesign Medicaid-funded behavioral health services, including specifics of implementation and a review of operational processes that affect sustainable business models.

 

Medicaid Managed Care and Waivers

Senate and House additions:   

• Mental Health Services Waiver (language only): The final budget directs DMAS to continue working with DBHDS to complete the actions necessary to qualify Virginia to file an 1115 waiver application for Serious Mental Illness/or SED.
• Community Behavioral Health Managed Care Requirements (language only): The final budget requires DMAS to amend its contracts with managed care organizations to ensure service authorizations for community mental health and rehabilitation services are handed in a timely and transparent manner.

 

Behavioral Health Workforce Development

Increase Mental Health Provider Rates: $4.9 Million

• During the 2019 session, the General Assembly increased mental health provider rates to 100 percent of Medicare. Building off of this progress, we are pleased the final budget retained Governor Northam’s proposal to increase psychiatric services rate by 14.7 percent.
• This action increases rates to the equivalent of 110 percent of the 2019 Medicare rates; Specifically, $2.4 million GF and $4.4 million in federal Medicaid matching funds in FY 2021 and $2.5 million GF and $4.5 million in federal Medicaid matching funds in FY 2022.

Behavioral Health Loan Repayment Program: $1,688,914 Million

• This amendment establishes the Behavioral Health Loan Repayment Program with the goal of increasing the number of Virginia behavioral health practitioners through an educational loan repayment incentive.
• Mental Health practitioners will receive loan repayment for up to 25 percent of their student loan debt for each year of health services provided to the Commonwealth.
• Participating practitioners will have an initial two-year minimum participation obligation and may renew for a third and fourth year.

 

School-based Mental Health Services

Chesterfield Recovery High School: $500,000 over the biennium

• Provides $250,000 each year to the Chesterfield County School Board to assist with establishing a recovery high school, which will serve students who are in the early stages of recovery from substance use disorder or dependency.

Medicaid Reimbursement for School-Based Services (language only)

• Directs the Department of Medical Assistance Services to consider options to allow local education agencies to bill for services provided outside of an Individualized Education Plan and expand the services that are reimbursable.

Early Childhood Mental Health Consultation: Feasibility study | HJ51 (Sickles) This bill directs DOE, DBHDS & DSS to convene a workgroup to study the feasibility of building out a statewide early childhood mental health consultation program for all children care programs serving children 0-5yrs old.

Banning the practice of Conversion Therapy for Children and Youth | HB386 (Hope) & SB245 (Surovell). This bill prohibits any mental health provider from providing conversion therapy with any person under 18 years of age.

Health Insurance and Mental Health Parity  | SB280 (Barker). This bill requires the State Corporation Commission’s Bureau of Insurance to report claims information and network adequacy for mental health and substance use disorders. JLARC will review of the Bureau’s report regarding mental health parity.

Study Residential Psychiatric Placement and Services  | SB734 (Deeds)& HB728 (Hope): The Secretary of Education & HHR directed to study residential psychiatric placement and services for children.

School-Based Behavioral Health 

Excused Absence for Mental and Behavioral Health | HB308 (Hope):  This bill directs the Department of Education to establish guidelines for excused absences that are due to mental and behavioral health needs.

Mental Health Awareness Training | HB74 (Kory, Deeds Samirah & Reid): This bill directs each school board to adopt and implement policies that require each teacher and other relevant personnel to complete a mental health awareness training or similar program at least once. This bill incorporates SB619, HB716 & HB1554.

Social & Emotional Learning | HB753 (Rasoul): This bill directs the Dept. of Education to develop uniform definition of social-emotional learning and guidance standards for all public students in grades kindergarten through 12. A report is required by Nov 1, 2020 on the resources needed to successfully support local school divisions with the implementation of a statewide social-emotional learning program.

School Lock Down Drills

• Parental Notice | HB270 (Van Valkenburg): This bill requires every public school to give parents at least 24 hours’ notice before conducing any lock-down drill.
• Exemptions for Pre-K and Kindergarten students| HB402 (Keam): This bills exempts Pre-k and kindergarten students from mandatory participation in lock-down drill during the first 60 days of school.

School Counselors | SB880 (Locke) Adjusts the minimum staff ratios for school counselors to 1: 325

 

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