Authority: Title 16.1, Article 18, and Title 37.2, Chapters 2, 3, 4, 5, 6 and 7, and Title 2.2, Chapters 26 and 53 Code of Virginia; P.L. 102-119, Federal Code.

A. Out of this appropriation, $5,050,000 the first year and $5,050,000 the second year from the general fund shall be used for Developmental Disability Health Support Networks in regions served, or previously served, by Southside Virginia Training Center, Central Virginia Training Center, Northern Virginia Training Center, and Southwestern Virginia Training Center.

B. Out of this appropriation, $705,000 the first year and $705,000 the second year from the general fund shall be used to provide community-based services to individuals transitioning from state training centers to community settings who are not eligible for Medicaid.

C.1. Out of this appropriation, $27,722,785 the first year and $27,722,785 the second year from the general fund shall be used to address census issues at state facilities by providing community-based services for those individuals determined clinically ready for discharge or for the diversion of admissions to state facilities by purchasing acute inpatient or community-based psychiatric services.

2. Out of this appropriation, $2,500,000 the first year and $2,500,000 the second year from the general fund is provided for the development or acquisition of clinically appropriate housing options to provide comprehensive community-based care for individuals in state hospitals who have complex and resource-intensive needs who have been clinically determined able to move from a hospital to a more integrated setting. In addition to the funds in this Item, $250,000 the first year and $250,000 the second year from the general fund is provided in Item 311 of this Act for a community support team to assist housing providers in addressing the complex needs of residents who have been discharged from state facilities or individuals who are at risk of institutionalization.

3. In addition to the amounts in C.1. above, $770,000 the first year and $770,000 the second year is provided to improve clinical and financial tracking of Discharge Assistance Planning funds and Local Inpatient Purchase of Services funds through the purchase of an information technology solution.

4. In addition to the amounts in C.1. above, $400,000 the first year is provided for the costs of a contract to study and implement rates for services provided with Discharge Assistance Planning funds. No fewer than ninety days prior to implementing any rate structure recommended by the study, the Department of Behavioral Health and Developmental Services shall report the results of the rate study and the projected impact of any changes in rates to the Governor and the Chairmen of the House Appropriations and Senate Finance and Appropriations Committee. This report shall be due no later than June 30, 2023.

D.1. Out of this appropriation, $6,429,216$8,429,216 the first year and $6,429,216$10,788,632 the second year from the general fund shall be provided to the Department of Behavioral Health and Developmental Services to provide alternative transportation for adults and children under a temporary detention order and for a program of alternative custody for individuals under a temporary detention order who are awaiting transport to an inpatient bed. The Department of Behavioral Health and Developmental Services, in consultation with local law enforcement, community services boards, and other stakeholders as appropriate, shall implement a plan to provide alternative custody options for individuals under temporary detention orders to reduce the length of time law enforcement resources are involved and improve patient outcomes. The department may contract with private contractors, enter into agreements with local law enforcement organizations, contract with Community Services Boards, or use other methods as necessary to implement the program. The department shall report to the Governor and Chairmen of the House Appropriations and Senate Finance and Appropriations Committees on the effectiveness and outcomes of the program funding by October 1 of each year.

2. Of the amounts in D.1., $1,000,000 the second year from the general fund shall be available for the Department of Behavioral Health and Developmental Services to contract with local law enforcement agencies who have agreed to utilize off-duty officers to provide transportation services or assume custody of an individual under a temporary detention order who is awaiting admission to a facility or for whom a bed has not yet been identified. The department shall include details on the utilization and effectiveness of this funding in the report required by paragraph D.1.

E. Out of this appropriation, $1,150,000 the first year and $1,150,000 the second year from the general fund shall be provided for costs of transporting individuals from state behavioral health facilities to their homes after being discharged from such facility as a result from an admission under a temporary detention order.

F. Out of this appropriation, $2,000,000 the first year and $3,359,416 the second year from the general fund is provided for a program of alternative custody for individuals under a temporary detention order who are awaiting transport to an inpatient bed. The Department of Behavioral Health and Developmental Services, in consultation with local law enforcement, community services boards, and other stakeholders as appropriate, shall implement a plan to provide alternative custody options for individuals under temporary detention orders to reduce the length of time law enforcement resources are involved and improve patient outcomes.

G. Out of this appropriation, $6,885,488 the first year and $6,885,488 the second year from the general fund shall be provided to the Department of Behavioral Health and Developmental Services to contract with the Virginia Mental Health Access Program to develop integrated mental health services for children.

H. Out of this appropriation, $300,000 the first year and $300,000 the second year from the general fund and $1,416,398 the first year and $1,416,398 the second year from nongeneral funds shall be used to purchase and distribute additional REVIVE! kits and associated doses of naloxone used to treat emergency cases of opioid overdose or suspected opioid overdose. The nongeneral funds shall be provided from amounts reflected in the Commonwealth Opioid Abatement and Remediation Fund.

I. Out of this appropriation, $8,400,000 in the first year and $8,400,000 the second year from the general fund shall be used to address census issues at state facilities by providing community-based services for children and adolescents determined clinically ready for discharge or for the diversion of admissions of children and adolescents to state facilities by purchasing acute inpatient services, step-down services, or community-based services as an alternative to inpatient care.

J. The Department of Behavioral Health and Developmental Services shall post its annual federal State Targeted Response Report and State Opioid Response (SOR) Report on its website no later than December 31 of each year. The report will describe the amount of any grants received from the Substance Abuse and Mental Health Services Administration as part of any State Opioid Response grant funding, and shall provide information on how the funds are distributed among programs, the number of individuals served if available, and any available outcome-based data specific to treatment engagement and impact on access.

K. Out of this appropriation, $89,396 the first year and $89,396 the second year from the general fund shall be provided to the Department of Behavioral Health and Developmental Services to contract with the Jewish Foundation for Group Homes to expand the Transitioning Youth program for individuals with developmental disability who are aging out and exiting the school system in Loudoun County.

L1. Out of this appropriation, $1,700,000 the first year and $1,700,000 the second year is provided to make grants to members of the Virginia Association of Recovery Residences for recovery support services. The association must ensure that members accredited by the Council on Accreditation of Peer Recovery Support Services (CAPRSS) receive a share of these funds. The Department of Behavioral Health and Developmental Services shall report to the Governor and the Chairmen of the House Appropriations and Senate Finance and Appropriations Committees by August 1, 2023, and each year thereafter, on the distribution and use of the funds authorized in this paragraph.

2. The Department of Behavioral Health and Developmental Services shall monitor credentialed recovery homes for regulatory compliance and consult with the Virginia Association of Recovery Residences to keep the agency's public website's list of credentialed recovery homes up to date.

M.1. Out of this appropriation, $3,547,000 the first year and $3,547,000 the second year from the general fund shall be used to support the diversion and discharge of individuals with a diagnosis of dementia. Priority shall be given to those individuals who would otherwise be served by state facilities.

2. Of the amounts in M.1., $2,820,000 in each year shall be used to establish contracts to support the diversion and discharge into private settings of individuals with a diagnosis of dementia.

3. Of the amounts in M.1., $727,000 in each year shall be used for a pilot mobile crisis program targeted for individuals with a diagnosis of dementia.

N. Out of this appropriation, $8,774,784 the first year and $8,774,784 the second year from the general fund is provided from a transfer from Item 313 for Community Services Boards and a Behavioral Health Authority to divert admissions from state hospitals by purchasing acute inpatient or community-based psychiatric services at private facilities. This funding shall continue to be allocated to Community Services Boards and a Behavioral Health Authority for such purpose in an efficient and effective manner so as not to disrupt local service contracts and to allow for expeditious reallocation of unspent funding between Community Services Boards and a Behavioral Health Authority.

O.1. Out of this appropriation, $7,500,000 the first year and $7,500,000 the second year from the general fund is provided for the Department of Behavioral Health and Developmental Services (DBHDS) to pursue alternative inpatient options to state behavioral health hospital care or to increase capacity in the community for patients on the Extraordinary Barriers List through projects that will reduce census pressures on state hospitals. Proposals shall be evaluated on: (i) the expected impact on state hospital bed use, including the impact on the extraordinary barrier list; (ii) the speed by which the project can become operational; (iii) the start-up and ongoing costs of the project; (iv) the sustainability of the project without the use of ongoing general funds; (v) the alignment between the project target population and the population currently being admitted to state hospitals; and (vi) the applicant's history of success in meeting the needs of the target population. No project shall be allocated more than $2,500,000 each year. Projects may include public-private partnerships, to include contracts with private entities. The department shall give preference to projects that serve individuals who would otherwise be admitted to a state hospital operated by DBHDS, that can be rapidly implemented, and provide the best long-term outcomes for patients. Consideration may be given to regional projects addressing comprehensive psychiatric emergency services, complex medical and neuro-developmental needs of children and adolescents receiving inpatient behavioral health services, and addressing complex medical needs of adults receiving inpatient behavioral health services.

2. Of the amounts in O.1., $1,500,000 the second year may be utilized to pursue a pilot program to support the discharge of private hospital patients at risk of transfer to state mental health hospitals. The department shall prioritize assistance to patients who can be diverted from state hospital admission through discharge training, planning consultation, and/or one-time financial assistance. Financial assistance from this program shall only be provided as a method of last resort to assist in re-entry to the community.

P. Out of this appropriation, $1,650,000 the second year from the general fund is provided for pilot programs for individuals with dementia and older persons, as defined in § 51.5-116, who may otherwise be admitted to a state facility. In addition to the funds provided in this Item, $1,650,000 the first year is provided for these purposes in Item 486 out of the revenues received from the federal distributions of the American Rescue Plan Act of 2021.

Q. Out of this appropriation, $2,500,000 the first year from the general fund shall be provided for one-time start-up costs for the Northwestern Crisis Response Center to provide crisis services for 23 hours per day, seven days per week to individuals with a mental illness.

R. Out of this appropriation, $2,500,000 the first year from the general fund shall be provided for one-time start-up costs to establish a crisis receiving center in Southwest Virginia.

S. Out of this appropriation, $2,500,000 the first year from the general fund shall be provided for one-time start-up costs to establish a crisis receiving center in Prince William County.

T. Out of this appropriation, $50,000 the first year from the general fund shall be provided to contract with Restoration and Hope House to provide for housing and programs for nonviolent offenders looking to transition back into the community.

U. The Department of Behavioral Health and Developmental Services is authorized to enter into a contract for use of up to eight beds of a 20-bed acute, inpatient psychiatric unit at Chesapeake Regional Healthcare for state purposes to increase diversion from state mental health hospitals. The department shall begin developing the contract after Chesapeake Regional Healthcare starts construction of the 20-bed acute, inpatient psychiatric unit. As part of the contracting process, the department shall develop an estimate of the potential cost savings of diversion from state hospital beds that could occur with use of the eight beds and provide an estimated annual state contribution to support Chesapeake Regional Healthcare. The department shall execute the contract contingent on an appropriation by the General Assembly. The department shall report to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees by December 1 of each year on the status of the contract and any state contribution that has been estimated.

V. The Department of Behavioral Health and Developmental Services is authorized to accept unsolicited proposals from private providers to establish a pilot project for the purpose of acquiring clinically appropriate housing options for individuals on the Extraordinary Barriers List or to prevent unnecessary hospitalizations for appropriate individuals to address census issues at state facilities.

W.1. Out of this appropriation, $57,500,000 the second year from the general fund shall be provided to expand and modernize the comprehensive crisis services system, including, but not limited to, investment in additional crisis receiving centers, crisis stabilization units, and enhancements to existing sites.

2. In addition to the amounts in W.1 above, $845,204 the second year from the general fund is provided for the increased administrative costs of the expanded crisis system.

X. Out of this appropriation, $8,000,000 the second year from the general fund is provided for supervised residential care. The department shall give priority to projects that prioritize individuals on the state's extraordinary barriers list. Projects may include public-private partnerships, to include contracts with private entities. Notwithstanding any other provision of law, contracts entered into pursuant to this paragraph shall be exempt from competition as otherwise required by the Virginia Public Procurement Act, §§ 2.2-4300 through 2.2-4377, Code of Virginia.

Y. Out of this appropriation, $20,000,000 the second year from the general fund is provided for the one-time costs of establishing additional mobile crisis services in underserved areas.