Illinois General Assembly - Full Text of HB2784
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Full Text of HB2784  102nd General Assembly




HB2784 EnrolledLRB102 14976 RLC 20331 b

1    AN ACT concerning health.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4    Section 1. Short title.
5    (a) This Act may be cited as the Community Emergency
6Services and Support Act.
7    (b) This Act may be referred to as the Stephon Edward Watts
9    Section 5. Findings. The General Assembly recognizes that
10the Illinois Department of Human Services Division of Mental
11Health is preparing to provide mobile mental and behavioral
12health services to all Illinoisans as part of the federally
13mandated adoption of the 9-8-8 phone number. The General
14Assembly also recognizes that many cities and some states have
15successfully established mobile emergency mental and
16behavioral health services as part of their emergency response
17system to support people who need such support and do not
18present a threat of physical violence to the responders. In
19light of that experience, the General Assembly finds that in
20order to promote and protect the health, safety, and welfare
21of the public, it is necessary and in the public interest to
22provide emergency response, with or without medical
23transportation, to individuals requiring mental health or



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1behavioral health services in a manner that is substantially
2equivalent to the response already provided to individuals who
3require emergency physical health care.
4    Section 10. Applicability; home rule. This Act applies to
5every unit of local government that provides or coordinates
6ambulance or similar emergency medical response or
7transportation services for individuals with emergency medical
8needs. A home rule unit may not respond to or provide services
9for a mental or behavioral health emergency, or create a
10transportation plan or other regulation, relating to the
11provision of mental or behavioral health services in a manner
12inconsistent with this Act. This Act is a limitation under
13subsection (i) of Section 6 of Article VII of the Illinois
14Constitution on the concurrent exercise by home rule units of
15powers and functions exercised by the State.
16    Section 15. Definitions. As used in this Act:
17    "Division of Mental Health" means the Division of Mental
18Health of the Department of Human Services.
19    "Emergency" means an emergent circumstance caused by a
20health condition, regardless of whether it is perceived as
21physical, mental, or behavioral in nature, for which an
22individual may require prompt care, support, or assessment at
23the individual's location.
24    "Mental or behavioral health" means any health condition



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1involving changes in thinking, emotion, or behavior, and that
2the medical community treats as distinct from physical health
4    "Physical health" means a health condition that the
5medical community treats as distinct from mental or behavioral
6health care.
7    "PSAP" means a Public Safety Answering Point
9    "Community services" and "community-based mental or
10behavioral health services" may include both public and
11private settings.
12    "Treatment relationship" means an active association with
13a mental or behavioral care provider able to respond in an
14appropriate amount of time to requests for care.
15    "Responder" is any person engaging with a member of the
16public to provide the mobile mental and behavioral service
17established in conjunction with the Division of Mental Health
18establishing the 9-8-8 emergency number. A responder is not an
19EMS Paramedic or EMT as defined in the Emergency Medical
20Services (EMS) Systems Act unless that responding agency has
21agreed to provide a specialized response in accordance with
22the Division of Mental Health's services offered through its
239-8-8 number and has met all the requirements to offer that
24service through that system.
25    Section 20. Coordination with Division of Mental Health.



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1Each 9-1-1 PSAP and provider of emergency services dispatched
2through a 9-1-1 system must coordinate with the mobile mental
3and behavioral health services established by the Division of
4Mental Health so that the following State goals and State
5prohibitions are met whenever a person interacts with one of
6these entities for the purpose seeking emergency mental and
7behavioral health care or when one of these entities
8recognizes the appropriateness of providing mobile mental or
9behavioral health care to an individual with whom they have
10engaged. The Division of Mental Health is also directed to
11provide guidance regarding whether and how these entities
12should coordinate with mobile mental and behavioral health
13services when responding to individuals who appear to be in a
14mental or behavioral health emergency while engaged in conduct
15alleged to constitute a non-violent misdemeanor.
16    Section 25. State goals.
17    (a) 9-1-1 PSAPs, emergency services dispatched through
189-1-1 PSAPs, and the mobile mental and behavioral health
19service established by the Division of Mental Health must
20coordinate their services so that the State goals listed in
21this Section are achieved. Appropriate mobile response service
22for mental and behavioral health emergencies shall be
23available regardless of whether the initial contact was with
249-8-8, 9-1-1 or directly with an emergency service dispatched
25through 9-1-1. Appropriate mobile response services must:



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1        (1) ensure that individuals experiencing mental or
2    behavioral health crises are diverted from hospitalization
3    or incarceration whenever possible, and are instead linked
4    with available appropriate community services;
5        (2) include the option of on-site care if that type of
6    care is appropriate and does not override the care
7    decisions of the individual receiving care. Providing care
8    in the community, through methods like mobile crisis
9    units, is encouraged. If effective care is provided on
10    site, and if it is consistent with the care decisions of
11    the individual receiving the care, further transportation
12    to other medical providers is not required by this Act;
13        (3) recommend appropriate referrals for available
14    community services if the individual receiving on-site
15    care is not already in a treatment relationship with a
16    service provider or is unsatisfied with their current
17    service providers. The referrals shall take into
18    consideration waiting lists and copayments, which may
19    present barriers to access; and
20        (4) subject to the care decisions of the individual
21    receiving care, provide transportation for any individual
22    experiencing a mental or behavioral health emergency.
23    Transportation shall be to the most integrated and least
24    restrictive setting appropriate in the community, such as
25    to the individual's home or chosen location, community
26    crisis respite centers, clinic settings, behavioral health



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1    centers, or the offices of particular medical care
2    providers with existing treatment relationships to the
3    individual seeking care.
4    (b) Prioritize requests for emergency assistance. 9-1-1
5PSAPs, emergency services dispatched through 9-1-1 PSAPs, and
6the mobile mental and behavioral health service established by
7the Division of Mental Health must provide guidance for
8prioritizing calls for assistance and maximum response time in
9relation to the type of emergency reported.
10    (c) Provide appropriate response times. From the time of
11first notification, 9-1-1 PSAPs, emergency services dispatched
12through 9-1-1 PSAPs, and the mobile mental and behavioral
13health service established by the Division of Mental Health
14must provide the response within response time appropriate to
15the care requirements of the individual with an emergency.
16    (d) Require appropriate responder training. Responders
17must have adequate training to address the needs of
18individuals experiencing a mental or behavioral health
19emergency. Adequate training at least includes:
20        (1) training in de-escalation techniques;
21        (2) knowledge of local community services and
22    supports; and
23        (3) training in respectful interaction with people
24    experiencing mental or behavioral health crises, including
25    the concepts of stigma and respectful language.
26    (e) Require minimum team staffing. The Division of Mental



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1Health, in consultation with the Regional Advisory Committees
2created in Section 40, shall determine the appropriate
3credentials for the mental health providers responding to
4calls, including to what extent the responders must have
5certain credentials and licensing, and to what extent the
6responders can be peer support professionals.
7    (f) Require training from individuals with lived
8experience. Training shall be provided by individuals with
9lived experience to the extent available.
10    (g) Adopt guidelines directing referral to restrictive
11care settings. Responders must have guidelines to follow when
12considering whether to refer an individual to more restrictive
13forms of care, like emergency room or hospital settings.
14    (h) Specify regional best practices. Responders providing
15these services must do so consistently with best practices,
16which include respecting the care choices of the individuals
17receiving assistance. Regional best practices may be broken
18down into sub-regions, as appropriate to reflect local
19resources and conditions. With the agreement of the impacted
20EMS Regions, providers of emergency response to physical
21emergencies may participate in another EMS Region for mental
22and behavioral response, if that participation shall provide a
23better service to individuals experiencing a mental or
24behavioral health emergency.
25    (i) Adopt system for directing care in advance of an
26emergency. The Division of Mental Health shall select and



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1publicly identify a system that allows individuals who
2voluntarily chose to do so to provide confidential advanced
3care directions to individuals providing services under this
4Act. No system for providing advanced care direction may be
5implemented unless the Division of Mental Health approves it
6as confidential, available to individuals at all economic
7levels, and non-stigmatizing. The Division of Mental Health
8may defer this requirement for providing a system for advanced
9care direction if it determines that no existing systems can
10currently meet these requirements.
11    (j) Train dispatching staff. The personnel staffing 9-1-1,
123-1-1, or other emergency response intake systems must be
13provided with adequate training to assess whether coordinating
14with 9-8-8 is appropriate.
15    (k) Establish protocol for emergency responder
16coordination. The Division of Mental Health shall establish a
17protocol for responders, law enforcement, and fire and
18ambulance services to request assistance from each other, and
19train these groups on the protocol.
20    (l) Integrate law enforcement. The Division of Mental
21Health shall provide for law enforcement to request responder
22assistance whenever law enforcement engages an individual
23appropriate for services under this Act. If law enforcement
24would typically request EMS assistance when it encounters an
25individual with a physical health emergency, law enforcement
26shall similarly dispatch mental or behavioral health personnel



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1or medical transportation when it encounters an individual in
2a mental or behavioral health emergency.
3    Section 30. State prohibitions. 9-1-1 PSAPs, emergency
4services dispatched through 9-1-1 PSAPs, and the mobile mental
5and behavioral health service established by the Division of
6Mental Health must coordinate their services so that, based on
7the information provided to them, the following State
8prohibitions are avoided:
9    (a) Law enforcement responsibility for providing mental
10and behavioral health care. In any area where responders are
11available for dispatch, law enforcement shall not be
12dispatched to respond to an individual requiring mental or
13behavioral health care unless that individual is (i) involved
14in a suspected violation of the criminal laws of this State, or
15(ii) presents a threat of physical injury to self or others.
16Responders are not considered available for dispatch under
17this Section if 9-8-8 reports that it cannot dispatch
18appropriate service within the maximum response times
19established by each Regional Advisory Committee under Section
21        (1) Standing on its own or in combination with each
22    other, the fact that an individual is experiencing a
23    mental or behavioral health emergency, or has a mental
24    health, behavioral health, or other diagnosis, is not
25    sufficient to justify an assessment that the individual is



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1    a threat of physical injury to self or others, or requires
2    a law enforcement response to a request for emergency
3    response or medical transportation.
4        (2) If, based on its assessment of the threat to
5    public safety, law enforcement would not accompany medical
6    transportation responding to a physical health emergency,
7    unless requested by responders, law enforcement may not
8    accompany emergency response or medical transportation
9    personnel responding to a mental or behavioral health
10    emergency that presents an equivalent level of threat to
11    self or public safety.
12        (3) Without regard to an assessment of threat to self
13    or threat to public safety, law enforcement may station
14    personnel so that they can rapidly respond to requests for
15    assistance from responders if law enforcement does not
16    interfere with the provision of emergency response or
17    transportation services. To the extent practical, not
18    interfering with services includes remaining sufficiently
19    distant from or out of sight of the individual receiving
20    care so that law enforcement presence is unlikely to
21    escalate the emergency.
22    (b) Responder involvement in involuntary commitment. In
23order to maintain the appropriate care relationship,
24responders shall not in any way assist in the involuntary
25commitment of an individual beyond (i) reporting to their
26dispatching entity or to law enforcement that they believe the



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1situation requires assistance the responders are not permitted
2to provide under this Section; (ii) providing witness
3statements; and (iii) fulfilling reporting requirements the
4responders may have under their professional ethical
5obligations or laws of this state. This prohibition shall not
6interfere with any responder's ability to provide physical or
7mental health care.
8    (c) Use of law enforcement for transportation. In any area
9where responders are available for dispatch, unless requested
10by responders, law enforcement shall not be used to provide
11transportation to access mental or behavioral health care, or
12travel between mental or behavioral health care providers,
13except where no alternative is available.
14    (d) Reduction of educational institution obligations. The
15services coordinated under this Act may not be used to replace
16any service an educational institution is required to provide
17to a student. It shall not substitute for appropriate special
18education and related services that schools are required to
19provide by any law.
20    Section 35. Non-violent misdemeanors. The Division of
21Mental Health's Guidance for 9-1-1 PSAPs and emergency
22services dispatched through 9-1-1 PSAPs for coordinating the
23response to individuals who appear to be in a mental or
24behavioral health emergency while engaging in conduct alleged
25to constitute a non-violent misdemeanor shall promote the



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2        (a) Prioritization of Health Care. To the greatest
3    extent practicable, community-based mental or behavioral
4    health services should be provided before addressing law
5    enforcement objectives.
6        (b) Diversion from Further Criminal Justice
7    Involvement. To the greatest extent practicable,
8    individuals should be referred to health care services
9    with the potential to reduce the likelihood of further law
10    enforcement engagement.
11    Section 40. Statewide Advisory Committee.
12    (a) The Division of Mental Health shall establish a
13Statewide Advisory Committee to review and make
14recommendations for aspects of coordinating 9-1-1 and the
159-8-8 mobile mental health response system most appropriately
16addressed on a State level.
17    (b) Issues to be addressed by the Statewide Advisory
18Committee include, but are not limited to, addressing changes
19necessary in 9-1-1 call taking protocols and scripts used in
209-1-1 PSAPs where those protocols and scripts are based on or
21otherwise dependent on national providers for their operation.
22    (c) The Statewide Advisory Committee shall recommend a
23system for gathering data related to the coordination of the
249-1-1 and 9-8-8 systems for purposes of allowing the parties
25to make ongoing improvements in that system. As practical, the



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1system shall attempt to determine issues including, but not
2limited to:
3        (1) the volume of calls coordinated between 9-1-1 and
4    9-8-8;
5        (2) the volume of referrals from other first
6    responders to 9-8-8;
7        (3) the volume and type of calls deemed appropriate
8    for referral to 9-8-8 but could not be served by 9-8-8
9    because of capacity restrictions or other reasons;
10        (4) the appropriate information to improve
11    coordination between 9-1-1 and 9-8-8; and
12        (5) the appropriate information to improve the 9-8-8
13    system, if the information is most appropriately gathered
14    at the 9-1-1 PSAPs.
15    (d) The Statewide Advisory Committee shall consist of:
16        (1) the Statewide 9-1-1 Administrator, ex officio;
17        (2) one representative designated by the Illinois
18    Chapter of National Emergency Number Association (NENA);
19        (3) one representative designated by the Illinois
20    Chapter of Association of Public Safety Communications
21    Officials (APCO);
22        (4) one representative of the Division of Mental
23    Health;
24        (5) one representative of the Illinois Department of
25    Public Health;
26        (6) one representative of a statewide organization of



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1    EMS responders;
2        (7) one representative of a statewide organization of
3    fire chiefs;
4        (8) two representatives of statewide organizations of
5    law enforcement;
6        (9) two representatives of mental health, behavioral
7    health, or substance abuse providers; and
8        (10) four representatives of advocacy organizations
9    either led by or consisting primarily of individuals with
10    intellectual or developmental disabilities, individuals
11    with behavioral disabilities, or individuals with lived
12    experience.
13    (e) The members of the Statewide Advisory Committee, other
14than the Statewide 9-1-1 Administrator, shall be appointed by
15the Secretary of Human Services.
16    Section 45. Regional Advisory Committees.
17    (a) The Division of Mental Health shall establish Regional
18Advisory Committees in each EMS Region to advise on regional
19issues related to emergency response systems for mental and
20behavioral health. The Secretary of Human Services shall
21appoint the members of the Regional Advisory Committees. Each
22Regional Advisory Committee shall consist of:
23        (1) representatives of the 9-1-1 PSAPs in the region;
24        (2) representatives of the EMS Medical Directors
25    Committee, as constituted under the Emergency Medical



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1    Services (EMS) Systems Act, or other similar committee
2    serving the medical needs of the jurisdiction;
3        (3) representatives of law enforcement officials with
4    jurisdiction in the Emergency Medical Services (EMS)
5    Regions;
6        (4) representatives of both the EMS providers and the
7    unions representing EMS or emergency mental and behavioral
8    health responders, or both; and
9        (5) advocates from the mental health, behavioral
10    health, intellectual disability, and developmental
11    disability communities.
12    (b) The majority of advocates on the Emergency Response
13Equity Committee must either be individuals with a lived
14experience of a condition commonly regarded as a mental health
15or behavioral health disability, developmental disability, or
16intellectual disability, or be from organizations primarily
17composed of such individuals. The members of the Committee
18shall also reflect the racial demographics of the jurisdiction
20    (c) Subject to the oversight of the Department of Human
21Services Division of Mental Health, the EMS Medical Directors
22Committee is responsible for convening the meetings of the
23committee. Impacted units of local government may also have
24representatives on the committee subject to approval by the
25Division of Mental Health, if this participation is structured
26in such a way that it does not give undue weight to any of the



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1groups represented.
2    Section 50. Regional Advisory Committee responsibilities.
3Each Regional Advisory Committee is responsible for designing
4the local protocol to allow its region's 9-1-1 call center and
5emergency responders to coordinate their activities with 9-8-8
6as required by this Act and monitoring current operation to
7advise on ongoing adjustments to the local protocol. Included
8in this responsibility, each Regional Advisory Committee must:
9        (1) negotiate the appropriate amendment of each 9-1-1
10    PSAP emergency dispatch protocols, in consultation with
11    each 9-1-1 PSAP in the EMS Region and consistent with
12    national certification requirements;
13        (2) set maximum response times for 9-8-8 to provide
14    service when an in-person response is required, based on
15    type of mental or behavioral health emergency, which, if
16    exceeded, constitute grounds for sending other emergency
17    responders through the 9-1-1 system;
18        (3) report, geographically by police district if
19    practical, the data collected through the direction
20    provided by the Statewide Advisory Committee in
21    aggregated, non-individualized monthly reports. These
22    reports shall be available to the Regional Advisory
23    Committee members, the Department of Human Service
24    Division of Mental Health, the Administrator of the 9-1-1
25    Authority, and to the public upon request; and



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1        (4) convene, after the initial regional policies are
2    established, at least every 2 years to consider amendment
3    of the regional policies, if any, and also convene
4    whenever a member of the Committee requests that the
5    Committee consider an amendment.
6    Section 55. Immunity. The exemptions from civil liability
7in Section 15.1 of the Emergency Telephone Systems Act apply
8to any act or omission in the development, design,
9installation, operation, maintenance, performance, or
10provision of service directed by this Act.
11    Section 60. Scope. This Act applies to persons of all
12ages, both children and adults. This Act does not limit an
13individual's right to control his or her own medical care. No
14provision of this Act shall be interpreted in such a way as to
15limit an individual's right to choose his or her preferred
16course of care or to reject care. No provision of this Act
17shall be interpreted to promote or provide justification for
18the use of restraints when providing mental or behavioral
19health care.
20    Section 65. PSAP and emergency service dispatched through
21a 9-1-1 PSAP; coordination of activities with mobile and
22behavioral health services. Each 9-1-1 PSAP and emergency
23service dispatched through a 9-1-1 PSAP must begin



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1coordinating its activities with the mobile mental and
2behavioral health services established by the Division of
3Mental Health once all 3 of the following conditions are met,
4but not later than January 1, 2023:
5        (1) the Statewide Committee has negotiated useful
6    protocol and 9-1-1 operator script adjustments with the
7    contracted services providing these tools to 9-1-1 PSAPs
8    operating in Illinois;
9        (2) the appropriate Regional Advisory Committee has
10    completed design of the specific 9-1-1 PSAP's process for
11    coordinating activities with the mobile mental and
12    behavioral health service; and
13        (3) the mobile mental and behavioral health service is
14    available in their jurisdiction.