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STATE OF OKLAHOMA
1st Session of the 60th Legislature (2025)
HOUSE BILL 1911 By: Alonso-Sandoval
AS INTRODUCED
An Act relating to mental health; providing
definitions; creating the 988 Suicide and Crisis
Lifeline System; providing for administrative
structure; providing for evaluation; providing for
workforce retention; establishing a trust fund;
creating a telecommunication fee; directing
maximization of federal funding; providing for
codification; and providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 12-200 of Title 43A, unless
there is created a duplication in numbering, reads as follows:
As used in this section:
1. "911" means any telephone system whereby telephone
subscribers may utilize a three-digit number (9-1-1) for reporting
an emergency to the appropriate public agency providing law
enforcement, fire, medical or other emergency services, including
ancillary communications systems and personnel necessary to pass the
reported emergency to the appropriate emergency service and which
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the wireless service provider is required to provide pursuant to the
Federal Communications Commission Order 94-102, 961 Federal Register
40348;
2. "988" means the universal telephone number within the United
States designated by the Federal Communications Commission for the
purpose of the National Suicide Prevention Lifeline program
operating through the 988 Suicide and Crisis Lifeline (988
Lifeline), or its successor maintained by the Assistant Secretary
for Mental Health and Substance Use under Section 520E–3 of the
Public Health Service Act, 42 U.S.C. 290bb-36c;
3. "988 administrator" means the administrator of the National
988 Suicide and Crisis Lifeline system maintained by the Assistant
Secretary for Mental Health and Substance Use under Section 520E–3
of the Public Health Service Act. The administrator oversees the
administration of the 988 Lifeline system with expectations of
clinical, technical and operational performance. The Lifeline
administrator is responsible for leadership and coordination of 200-
plus individual state and locally funded crisis contact centers
across the country. Each center is responsible for abiding by a
series of requirements that include, but are not limited to, an
accreditation process, insurance, a formal agreement with the
Lifeline administrator, and a center liaison;
4. "988 contact" means a communication with the 988 Suicide and
Crisis Lifeline system within the United States or its successor via
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modalities offered, including call, chat, text or a transfer from
peer-operated warmlines, other behavioral health crisis hotlines and
emotional support lines;
5. "988 fee" means the surcharge assessed on commercial
landline, mobile service, prepaid wireless voice service, and
interconnected voice over Internet protocol (VoIP) service lines
created under Section 4 of this act authority for communication law,
regulation, and technological innovation;
6. "988 Lifeline Crisis Centers" are a national network of
local crisis centers that provide free and confidential emotional
support to people in suicidal crisis, behavioral health crisis, or
emotional distress twenty-four (24) hours a day, seven (7) days a
week in the United States. It is the national Suicide Prevention
and Mental Health Crisis Hotline system maintained by the Assistant
Secretary for Mental Health and Substance Use under Section 520E-3
of the Public Health Service Act (42 U.S.C. 290bb-36c);
7. "988 Trust Fund" means the 988 Suicide and Crisis Lifeline
program fund created under Section 3 of this act;
8. "Behavioral health crisis services" are intensive services
that are provided to address or prevent behavioral health symptoms,
situations, or events that may negatively impact an individual's
ability to function within his or her current family or caregiver
and living situation, school, workplace, or community. Behavioral
health crisis services are for anyone, anywhere, and at any time and
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can be provided in a variety of settings, including via text or
telephone, face-to-face at an individual's home, or in the
community;
9. "Behavioral health crisis system" is an organized set of
structures, processes, and services in place to meet all types of
urgent and emerging mental health and substance use needs in a
defined population or community, effectively and efficiently.
Essential elements of a behavioral health crisis system include 988
crisis lines that accept all calls and texts, and provide support
and referrals based on the needs of the individual or family member
or caregiver; mobile crisis teams that respond to the location of
need in the community; and crisis stabilization facilities that
serve everyone who enters their doors from all referral sources.
Comprehensive behavioral health crisis systems:
a. address recovery needs, significant use of peers, and
trauma-informed care,
b. provide "suicide safer" care,
c. ensure safety and security for staff and those in
crisis, and
d. involve collaboration with law enforcement and
emergency medical services.
10. "Behavioral health equity" is the right to access high-
quality, affordable behavioral health care services and support,
regardless of race, ethnicity, sexual orientation, gender identity,
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geography, socioeconomic status, or other characteristics. This
includes addressing the needs of historically underserved
populations such as:
a. individuals from diverse racial and ethnic
backgrounds, including Black, Latino, Indigenous,
Native American, Asian American, and Pacific Islander
communities,
b. persons of varying faiths and beliefs, including
members of religious minorities,
c. individuals with disabilities,
d. members of the LGBTQ community, including lesbian and
gay individuals,
e. residents of rural or remote areas, and
f. those experiencing systemic inequities or barriers due
to persistent poverty, discrimination, or inequality;
11. "Behavioral health urgent care" is an ambulatory setting
that offers safe, voluntary, and time-limited services and supports
to individuals experiencing behavioral health crisis. This setting
is an alternative to the use of hospital emergency departments or
more intensive crisis services;
12. "Community Mental Health Centers, and Certified Community
Behavioral Health Clinics" are facilities as defined under Section
1913(c) of the Public Health Services Act or Section 223(d) of the
Protecting Access to Medicare Act of 2014 (PAMA), and Community
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Behavioral Health Organizations as licensed and certified by
relevant state agencies;
13. "Community outreach teams (COTs)" engage in outreach to
communities and community members to support a variety of needs of
individuals including behavioral health, physical care, housing,
benefits, education, and employment. COTs do not provide on-demand
crisis services. Instead, through outreach and engagement, COTs aim
to promote wellness, resilience, recovery, self-advocacy,
development of supports, and maintenance of community living skills.
COTs can work effectively alongside mobile crisis teams to prevent
crisis and provide wraparound supports to those in need. Some rural
and under-resourced communities have created teams with dual roles
of mobile crisis services and COTs. COTs can be especially helpful
for follow-up care;
14. "Co-response" is a collaborative approach to behavioral
health crisis developed in response to the need for local adaptation
in which first responders, sometimes including law enforcement
officers, are partnered with behavioral health professionals as an
effective way to respond to behavioral health crises and other
situations involving unmet behavioral health needs;
15. "Crisis stabilization services" reflect a range of models
and care to support individuals through emergent and urgent
behavioral health needs. Crisis stabilization services involve
facility-, home-, and community-based services that provide access
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to care and stabilization for adults and youth in crisis. Crisis
stabilization services are delivered across a continuum of care that
includes no barrier, low barrier, and referral-based services;
16. "Emotional support lines" focus on providing connection and
wellness promotion. They are not hotlines; however, they are still
expected to have the capacity to determine if referral to a crisis
hotline or more intensive intervention is warranted. They are
sometimes referred to as helplines. Emotional support lines are
recognized for providing services such as active, empathetic
listening, safety planning, rapport building, and crisis support and
prevention planning. Prominent examples include Substance Abuse and
Mental Health Services Administration National Helpline, the Alcohol
and Drug Helpline, and the Alzheimer's Association 24/7 Helpline;
17. "Federal Communications Commission" regulates interstate
and international communications by radio, television, wire,
satellite, and cable in all fifty (50) states, the District of
Columbia and U.S. territories. An independent U.S. government
agency overseen by Congress, the Commission is the federal agency
responsible for implementing and enforcing America's communications
law and regulations;
18. "Health insurance" means any individual or group hospital
or medical-expense-incurred policy or health care benefits plan or
contract providing insurance against loss through illness or injury
of the insured. The term does not include any policy governing
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short-term accidents only, a fixed indemnity policy, a limited
benefit policy, a specified accident policy, a specified disease
policy, a Medicare supplement policy, a long-term care policy,
medical payment or personal injury coverage in a motor vehicle
policy, coverage issued as a supplement to liability insurance, a
disability policy or workers' compensation;
19. "Law enforcement" describes a type of first-responder
agency and employee responsible for enforcing laws, maintaining
public order, and managing public safety;
20. "Lived experience" is personal knowledge about mental
health, substance use, or co-occurring mental health and substance
use disorders, treatment, and recovery gained through direct
involvement as an individual with past or current mental health or
substance use challenges;
21. "Mobile crisis team" means a multidisciplinary behavioral
health team that includes at least one behavioral health care
professional who is capable of conducting an assessment of the
individual, in accordance with the professional's permitted scope of
practice under state law, and other professionals or
paraprofessionals with appropriate expertise in behavioral health or
mental health crisis response, including nurses, social workers,
peer support specialists, and others, whose members are trained in
trauma-informed care, de-escalation strategies, and harm reduction;
that is able to respond in a timely manner and, where appropriate,
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provide screening and assessment; stabilization and de-escalation;
and coordination with, and referrals to, health, social, and other
services and supports as needed; that maintains relationships with
relevant community partners, including medical and behavioral;
22. "Other behavioral health crisis hotlines" include phone,
text, and chat services that are not part of the 988 Lifeline
network but that also provide support to people experiencing
emotional distress or to third-party callers who are concerned about
another person. These hotlines typically fall into one or more of
the following categories:
a. topically focused to a specific type of need or
stressor,
b. focused on providing services to a specific
population, including but not limited to, a geographic
catchment area, and
c. targets the needs of individuals experiencing the
types of emotional distress that are similar in scope
to the 988 Lifeline but are not connected to the 988
Lifeline;
23. "Peer-operated warmlines" provide ongoing phone, text, or
chat support by an individual with lived experience. Calls are
answered by trained peers who have lived experience with the type of
mental health support the line is intended to provide. Peer-
operated warmlines are typically local to the caller's jurisdiction
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or state, though there also are national peer warmlines geared
toward specific groups such as teens, older adults, and LGBTQI+
individuals;
24. "Peer crisis respites" are voluntary short-term programs
offering rest and peer support in a home environment for individuals
experiencing or recovering from a crisis;
25. "Respite services" are short-term relief services for
primary caregivers;
26. "State" as defined herein includes the U.S. territories
under 16 USC, Section 6602(9);
27. "State-certified peer support specialists" are individuals
who are employed based on his or her personal lived experience of a
crisis or suicide attempt and who have successfully completed a
state-recognized peer support training program;
28. "Substance Abuse and Mental Health Services Administration
("SAMHSA")" is the agency within the U.S. Department of Health and
Human Services that leads public health efforts to advance the
behavioral health of the nation;
29. "Trauma-informed care" is a program, organization, or
system that:
a. realizes the widespread impact of trauma and
understands potential paths for recovery,
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b. recognizes the signs and symptoms of trauma in
clients, families, staff, and others involved with the
system,
c. responds by fully integrating knowledge about trauma
into policies, procedures, and practices, and
d. seeks to actively resist re-traumatization; and
30. "Veterans Crisis Line (VCL)" means Veterans Crisis Line
maintained by the Secretary of Veterans Affairs under Section
1720F(h) of Title 38, United States Code.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 12-201 of Title 43A, unless
there is created a duplication in numbering, reads as follows:
The State of Oklahoma shall designate the Department of Mental
Health and Substance Abuse Services to have primary oversight over
the suicide prevention and crisis service activities and essential
coordination with designated 988 Lifeline Crisis Centers to provide
crisis intervention services and crisis care coordination to
individuals accessing the 988 Suicide and Crisis Lifeline program
from any jurisdiction within Oklahoma twenty-four (24) hours a day,
seven (7) days a week.
The oversight and coordination of a 988 Suicide and crisis
Lifeline System will be dependent upon design, implementation, and
sustainability which will be achieved through the following
essential infrastructure components:
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A. The designated 988 Lifeline Crisis Centers shall have an
active agreement with the 988 administrator for participation with
the Lifeline network;
B. The designated 988 Lifeline Centers shall have the authority
to deploy crisis and outgoing services, including mobile crisis
teams, and coordinate access to crisis receiving and stabilization
services or other local resources as appropriate and consistent with
any guidelines and best practices that may be established by the
state or 988 Lifeline administrator;
C. Facilitation of the ongoing care needs of persons contacting
the 988 Lifeline, the state or related public health authority by
assuring active collaborations and coordination of service linkages
between the designated centers, mental health and substance use
disorder treatment providers, local community mental health centers
including certified community behavioral health clinics and
community behavioral health centers, mobile crisis teams, and
community-based as well as hospital emergency departments and
inpatient psychiatric settings, establishing formal agreements and
appropriate information sharing procedures where appropriate;
D. The Department of Mental Health and Substance Abuse Services
having primary oversight of suicide prevention and crisis service
activities and essential coordination with designated 988 Lifeline
Crisis Centers, and working in concert with the 988 Lifeline, VCL,
and other SAMHSA-approved networks, local 24-hour local crisis
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hotlines, the National Mental Health Hotline, and peer warmlines.
Other behavioral health crisis hotlines play an important part in
the crisis response system for the purposes of ensuring consistency
of public messaging about 988 services;
E. The designated 988 Lifeline Crisis Centers shall meet 988
Lifeline Program requirements and best practices guidelines for
operational, performance and clinical standards;
F. The following information and reporting are required by the
Department of Mental Health and Substance Abuse Services or 988
Lifeline Centers to the organizations indicated:
1. Designated 988 Lifeline Crisis Centers shall provide to the
State of Oklahoma including the Department of Mental Health and
Substance Abuse Services having primary oversight of suicide
prevention, data and reports on crisis service activities and
essential coordination;
2. Data related to their participation in evaluations related
to quality improvement activities; and
3. Other data and reports as required; and
G. The following information and reporting are required by the
Department of Mental Health and Substance Abuse Services or 988
Lifeline Centers to the organizations indicated:
The Department of Mental Health and Substance Abuse Services
will report revenue generated by the 988 telecommunications fees,
fund deposits, expenditures and other related information as
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required to the Legislature and to the Federal Communications
Commission (FCC).
H. The state shall use its authority to promulgate rules and
regulations to allow appropriate information sharing and
communication between and across crisis and emergency response
systems for the purpose of real-time crisis care coordination
including, but not limited to, deployment of crisis and outgoing
services and linked, flexible services specific to crisis response;
I. The state or related public health authority shall assure
active collaborations and coordination of service linkages between
the designated centers and crisis receiving and stabilization
services for individuals accessing the 988 Lifeline through
appropriate information sharing regarding availability of services;
J. The Department of Mental Health and Substance Abuse Services
shall work to build collaboration between and among the designated
centers and key community stakeholders including residents,
community groups, peer organizations, faith organizations, business
owners, neighborhood leaders, and Commission members;
K. The designated 988 Lifeline Crisis Centers shall provide
follow-up services to individuals accessing the 988 Lifeline
consistent with guidance and policies established by the 988
Lifeline administrator;
L. The designated 988 Lifeline Crisis Centers shall meet the
requirements set forth by the state or 988 Lifeline administrator
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for serving at-risk and specialized populations as identified by the
state or SAMHSA including, but not be limited to:
1. Children, youth and young people;
2. Racially, ethnically, and linguistically diverse
populations;
3. Rural individuals;
4. Veterans;
5. American Indians;
6. Alaskan Natives; and
7. Other high-risk populations as well as those with co-
occurring substance use; provide culturally and linguistically
competent care; and include training requirements and policies for
transferring a 988 Lifeline contact to an appropriate specialized
center or subnetworks within the 988 Lifeline network;
M. The state or related public health authority and designated
988 Lifeline Crisis Centers shall utilize technology to enhance
communication and coordination in the delivery of behavioral health
crisis services, and for data collection, analysis and sharing; and
N. The state or related public health authority and designated
988 Lifeline Crisis Centers shall take action to identify and
implement behavioral health crisis workforce strategies for
recruitment, retention, and support of a variety of behavioral
health professionals and a certified peer recovery workforce.
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SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 12-202 of Title 43A, unless
there is created a duplication in numbering, reads as follows:
The State of Oklahoma shall establish a statewide 988 Trust Fund
for the following purposes:
1. To create and maintain a statewide 988 Lifeline system
pursuant to the National Suicide Hotline Designation Act of 2020,
the Federal Communication Commission's rules adopted July 16, 2020,
and October 17, 2024, and the National Guidelines For A Behavioral
Health Coordinated System Of Crisis Care;
2. To support or enhance 988 services, including state-
designated 988 Lifeline Crisis Centers, and mobile crisis and
outreach services in specified circumstances;
3. The fund shall consist of:
a. the statewide 988 telecommunications fee assessed on
users under Section 4 of this act,
b. appropriations made by the Legislature,
c. available federal funding that has been allocated by
the state for the purposes of 988 Lifeline
implementation,
d. grants and gifts intended for deposit in the fund,
e. interest, premiums, gains, or other earnings on the
fund, and
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f. monies from any other source deposited in or
transferred to the fund;
4. The fund shall be created and administered by the State
Treasurer or the Department of Mental Health and Substance Abuse
Services and money in the fund shall be expended to offset costs
that are or can be reasonably attributed to:
a. implementing, maintaining, and improving the 988
Suicide and Crisis Lifeline including staffing and
technological infrastructure enhancements necessary to
achieve operational and clinical standards and best
practices set forth by the state, the Department of
Mental Health and Substance Abuse Services, or 988
Lifeline administrator,
b. provision of acute behavioral health, crisis outreach,
and receiving and stabilization services by directly
responding to the 988 Suicide and Crisis Lifeline, or
c. personnel for the 988 Suicide and Crisis Lifeline
centers;
5. Money in the fund:
a. does not revert at the end of any state fiscal year
and shall remain available for the purposes of the
fund in subsequent state fiscal years,
b. is not subject to transfer to any other fund or to
transfer, assignment, or reassignment for any other
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use or purpose outside of those specified in this
section,
c. is continuously appropriated for the purposes of the
fund,
d. to the extent that the 988 Suicide and Crisis Lifeline
Centers are fully funded, the expansion and ongoing
funding of mobile crisis teams and outreach teams,
e. to the extent that the 988 Suicide and Crisis Lifeline
Centers and the mobile crisis teams are fully funded,
remaining revenues in the Trust Fund shall be used for
a variety of crisis receiving and stabilization
services, including services provided by:
(1) crisis stabilization settings,
(2) residential settings,
(3) additional behavioral health stabilization
services and supports, and
(4) peer crisis respite, and
f. mobile crisis teams shall operate in compliance with
rules adopted by the Department of Mental Health and
Substance Abuse Services.
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 12-203 of Title 43A, unless
there is created a duplication in numbering, reads as follows:
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The State of Oklahoma, in compliance with the National Suicide
Hotline Designation Act of 2020, shall establish a monthly statewide
988 telecommunications fee to support and sustain the 988 Suicide
and Crisis Lifeline centers. The fee shall be imposed on each
resident that is a subscriber of a commercial landline telephone,
mobile telephone or IP-enabled voice services, and a point-of-sale
988 fee on each purchaser of a prepaid telephone service, at a rate
that provides for the robust creation, operation, and maintenance of
a statewide 988 Suicide and Crisis Lifeline program and the
continuum of crisis services provided pursuant to the National
Guidelines for a Behavioral Health Coordinated System Of Crisis
Care.
A. The revenue generated by a 988 fee should be sequestered in
a trust as specified in Section 3 of this act to be obligated or
expended only in support of 988 services, or enhancements of such
services.
B. Consistent with 47 U.S.C. Section 251a, the revenue
generated by a 988 fee shall only be used to offset costs that are
or will be reasonably attributed to:
1. Ensuring the efficient and effective routing and answering
or handling of calls, chats and texts made to the 988 Suicide and
Crisis Lifeline and to the designated 988 Lifeline centers including
staffing and technological infrastructure enhancements necessary to
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achieve operational, performance and clinical standards and best
practices set forth by the state or 988 Lifeline administrator;
2. Personnel and the provision of acute mental health services
by directly responding to the 988 Suicide and Crisis Lifeline; and
3. For mobile crisis teams or crisis receiving and
stabilization services as specified in Section 3 of this act.
C. The revenue generated by 988 telecommunications fees may
only be used for expenses that are not:
1. Reimbursed through Medicaid, Medicare, federal or state-
regulated health insurance plans, disability insurers, and
including, but not limited to, municipal or county programs or
funding, not otherwise covered by another entity;
2. A covered service by the individual's health coverage; and
3. Covered because the service recipient's name and health
coverage information cannot be obtained or billed.
D. The 988 fee revenue shall be used to supplement, not
supplant, any federal, state, or local funding for suicide
prevention or behavioral health crisis services.
E. The 988-telecommunication fee amount shall be adjusted
annually based on the Consumer Price Index (CPI) which represents
the rate of inflation and is determined by the Bureau of Labor
Statistics (BLS) to provide for continuous operation, volume
increases, and maintenance.
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SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 12-204 of Title 43A, unless
there is created a duplication in numbering, reads as follows:
The State of Oklahoma shall implement strategies to ensure that
the behavioral health crisis service system is adequately funded,
including mechanisms for reimbursement of behavioral health crisis
response, but not limited to:
A. Ensuring that to the extent available any necessary federal
approvals are obtained and federal financial participation is
available and is not otherwise jeopardized, seeking to maximize all
available federal funding sources for the purposes of behavioral
health crisis services and administrative activities related to 988
implementation, including:
1. Federal Medicaid reimbursement for services;
2. Federal Medicaid reimbursement for administrative expenses,
including the development and maintenance of information technology;
and supporting implementation of the behavioral health crisis
continuum through Medicaid and the Children's Health Insurance
Program (CHIP) through Section 5124 of the Consolidated
Appropriations Act of 2023 (CAA, 2023); and
3. Federal grants.
B. Mandating the Oklahoma Insurance Department and Medicaid
behavioral managed health care to exercise their enforcement
authority by verifying reimbursement to 988 centers for medically
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necessary behavioral health crisis services by health care service
plans and disability insurers, and consistent with the requirements
of the federal Mental Health Parity and Addiction Equity Act of
2008, 29 U.S.C. Sec. 1185a, the September 9, 2024, final rules
implementing the nonquantitative treatment limitation ("NQTL")
comparative analyses requirements under the Mental Health Parity and
Addiction Equity Act of 2008 ("MHPAEA"), in accordance with the
amendments made to the law in 2021, and pursuant to the No Surprises
Act, including 26 U.S. Code Section 9816, 29 U.S. Code Section
1185e, and 42 U.S. Code Section 300gg-111, and it's implementing
regulations.
SECTION 6. This act shall become effective November 1, 2025.
60-1-11179 TJ 01/14/25