HB 108
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
Third Reader - Revised
House Bill 108 (Delegate Charkoudian)
Health and Government Operations Finance
Behavioral Health Crisis Response Services – Modifications
This bill alters the Behavioral Health Crisis Response Grant Program by (1) modifying the
priorities for awarding grants to local behavioral health authorities (LBHAs) and
(2) extending the requirement that the Governor provide an appropriation for the program
through fiscal 2025. The bill also requires a crisis communication center to coordinate with
3-1-1, 2-1-1, or other local mental health hotlines and alters how specified data must be
publicly reported and disaggregated.
Fiscal Summary
State Effect: General fund expenditures increase by $5.0 million from FY 2023 through
2025 for the mandated appropriation. Revenues are not affected. This bill establishes a
mandated appropriation for FY 2023 through 2025.
(in dollars) FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Revenues $0 $0 $0 $0 $0
GF Expenditure 0 5,000,000 5,000,000 5,000,000 0
Net Effect $0 ($5,000,000) ($5,000,000) ($5,000,000) $0
Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate increase; (-) = indeterminate decrease
Local Effect: Grant revenues and expenditures for LBHAs that receive grants under the
bill increase in FY 2023 through 2025.
Small Business Effect: Potential meaningful.
Analysis
Bill Summary: “Mobile crisis team” (MCT) means a team established by the LBHA that
(1) operates 24 hours a day and 7 days a week to provide assessments, crisis intervention,
stabilization, follow-up, and referral to urgent care and to arrange appointments for
individuals to obtain behavioral health services; (2) incorporates nationally recognized
standards and best practices; and (3) prioritizes providing connection to services and
coordinating patient follow-up and serving all members of the immediate community with
cultural competency and appropriate language access.
Behavioral Health Crisis Response Grant Program Awards
In addition to existing criteria, when awarding grants, the Maryland Department of Health
(MDH) must prioritize proposals that (1) serve all members of the immediate community
with cultural competency and appropriate language access; (2) commit to gathering
feedback from the community on an ongoing basis and improving service delivery
continually based on this feedback; (3) demonstrate strong partnerships with community
services that include family member and consumer advocacy organizations and regional
stakeholders; and (4) evidence a plan of linking individuals in crisis to peer support and
family support services after stabilization.
Mandated Appropriation
The Governor must include in the State operating budget a $5.0 million appropriation for
the grant program in fiscal 2023 through 2025. Beginning in fiscal 2023, at least one-third
of the mandated appropriation must be used to award competitive grants for MCTs.
Crisis Communication Centers
Crisis communication centers in each jurisdiction or region must provide coordination with
3-1-1, 2-1-1, or other local mental health hotlines.
Data Collection and Reports
In addition to reporting to MDH, an LBHA must make available to the public outcome
measurement data and any public feedback received from the community through a
combination of surveys, public comments, town hall meetings, and other methods for each
service or program that receives funding from the grant program.
Additionally, MDH’s established statewide system of outcome measurement must produce
data that is collected, analyzed, and publicly reported back at least annually as well as
disaggregated by race, gender, age and zip code, in addition to existing requirements.
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Data derived from the evaluation of outcomes of Behavioral Health Crisis Response
System (BHCRS) services must be (1) collected, analyzed, and publicly reported at least
annually; (2) disaggregated by race, gender, age, and zip code; and (3) used to formulate
policy recommendations with the goal of decreasing criminal detention and improving
crisis diversion programs and linkage to effective community health services.
Current Law:
Maryland Behavioral Health Crisis Response System
BHCRS must (1) operate a statewide network utilizing existing resources and coordinating
interjurisdictional services to develop efficient and effective crisis response systems to
serve all individuals in the State, 24 hours a day and 7 days a week; (2) provide skilled
clinical intervention to help prevent suicides, homicides, unnecessary hospitalizations, and
arrests or detention, and to reduce dangerous or threatening situations involving individuals
in need of behavioral health services; and (3) respond quickly and effectively to community
crisis situations.
Behavioral Health Crisis Response Grant Program
Chapter 209 of 2018 established a Behavioral Health Crisis Response Grant Program in
MDH to provide funds to local jurisdictions to establish and expand community behavioral
health crisis response systems. The Governor must include the following appropriations in
the State operating budget for the program: (1) $3.0 million for fiscal 2020;
(2) $4.0 million for fiscal 2021; and (3) $5.0 million for fiscal 2022.
Crisis Communication Center
In each jurisdiction, a crisis communication center provides a single point of entry to the
system and coordination with the local core service agency (CSA) or LBHA, police,
emergency medical service personnel, and behavioral health providers. Crisis
communication centers may provide programs that include:
a clinical crisis telephone line for suicide prevention and crisis intervention;
a hotline for behavioral health information, referral, and assistance;
clinical crisis walk-in services;
critical incident stress management teams;
crisis residential beds to serve as an alternative to hospitalization;
a community crisis bed and hospital bed registry;
transportation coordination;
MCTs;
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23-hour holding beds;
emergency psychiatric services;
urgent care capacity;
expanded capacity for assertive community treatment;
crisis intervention teams; and
individualized family intervention teams.
Data Collection and Report
The Behavioral Health Administration within MDH determines the implementation of
BHCRS in collaboration with the local CSA or LBHA serving each jurisdiction.
Additionally, BHCRS must conduct an annual survey of consumers and family members
who have received services from the system. Annual data collection is also required on the
number of behavioral health calls received by police, attempted and completed suicides,
unnecessary hospitalizations, hospital diversions, arrests and detentions of individuals with
behavioral health diagnoses, and diversion of arrests and detentions of individuals with
behavioral health diagnoses.
State Expenditures: The bill extends the requirement that the Governor provide an
appropriation to the grant program for three more years. Thus, general fund expenditures
for MDH increase by $5.0 million in fiscal 2023 through 2025. MDH may need additional
staff through fiscal 2025 due to the enhanced grant award criteria and the ongoing funding
for the program. To the extent that is the case, contractual staff can be funded with monies
from the existing mandated appropriation in fiscal 2022 and the additional funding
provided under the bill through fiscal 2025.
Local Fiscal Effect: Revenues and expenditures increase for LBHAs that receive grants
under the bill in fiscal 2023 through 2025. The extent of any increase depends on specific
proposals approved in each jurisdiction and corresponding grant awards.
Small Business Effect: Small businesses that provide crisis treatment services (such as
community behavioral health providers) may benefit, in fiscal 2023 through 2025, from
continued grant funding to LBHAs.
Additional Information
Prior Introductions: None.
Designated Cross File: SB 286 (Senator Augustine) - Finance and Budget and Taxation.
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Information Source(s): Maryland Association of County Health Officers; Maryland
Association of Counties; Maryland Municipal League; Department of Budget and
Management; Maryland Department of Health; Department of Public Safety and
Correctional Services; Department of Legislative Services
Fiscal Note History: First Reader - January 31, 2021
rh/jc Third Reader - April 8, 2021
Revised - Amendment(s) - April 8, 2021
Analysis by: Amber R. Gundlach Direct Inquiries to:
(410) 946-5510
(301) 970-5510
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Statutes affected: Text - First - Behavioral Health Crisis Response Services – Modifications: 10-1401 Health General, 10-1402 Health General, 10-1403 Health General
Text - Third - Behavioral Health Crisis Response Services – Modifications: 10-1401 Health General, 10-1402 Health General, 10-1403 Health General