2127-S AMH HINK H4504.1

SHB 2127  - H AMD1231
     By Representative Hinkle

FAILED 02/28/2012

     Beginning on page 48, line 19, strike all of section 204 and insert the following:

"Sec. 204   2011 2nd sp.s. c 9 s 204 (uncodified) is amended to read as follows:
FOR THE DEPARTMENT OF SOCIAL AND HEALTH SERVICES -- MENTAL HEALTH PROGRAM
     (1) COMMUNITY SERVICES/REGIONAL SUPPORT NETWORKS
General Fund -- State Appropriation (FY 2012) . . . . . . . . . . . . (($317,392,000))
       $316,380,000
General Fund -- State Appropriation (FY 2013) . . . . . . . . . . . . (($322,982,000))
       $320,482,000
General Fund -- Federal Appropriation . . . . . . . . . . . . (($448,732,000))
       $449,801,000
General Fund -- Private/Local Appropriation . . . . . . . . . . . . $17,864,000
Hospital Safety Net Assessment Fund--State
     Appropriation . . . . . . . . . . . . (($6,802,000))
       $5,251,000
          TOTAL APPROPRIATION . . . . . . . . . . . . (($1,113,772,000))
       $1,109,778,000

     The appropriations in this subsection are subject to the following conditions and limitations:
     (a) (($109,342,000)) $107,988,000 of the general fund--state appropriation for fiscal year 2012 and (($109,341,000)) $106,091,000 of the general fund--state appropriation for fiscal year 2013 are provided solely for persons and services not covered by the medicaid program. This is a reduction ((of $4,348,000 each fiscal year)) from the nonmedicaid funding that was allocated for expenditure by regional support networks during fiscal year 2011 prior to supplemental budget reductions. This (($4,348,000)) reduction shall be distributed among regional support networks proportional to each network's share of the total state population. To the extent possible, levels of regional support network spending shall be maintained in the following priority order: (i) Crisis and commitment services; (ii) community inpatient services; and (iii) residential care services, including personal care and emergency housing assistance.
     (b) $6,590,000 of the general fund--state appropriation for fiscal year 2012, $6,590,000 of the general fund--state appropriation for fiscal year 2013, and $7,620,000 of the general fund--federal appropriation are provided solely for the department and regional support networks to continue to contract for implementation of high-intensity programs for assertive community treatment (PACT) teams. In determining the proportion of medicaid and nonmedicaid funding provided to regional support networks with PACT teams, the department shall consider the differences between regional support networks in the percentages of services and other costs associated with the teams that are not reimbursable under medicaid. The department may allow regional support networks which have nonmedicaid reimbursable costs that are higher than the nonmedicaid allocation they receive under this section to supplement these funds with local dollars or funds received under section 204(1)(a) of this act. The department and regional support networks shall maintain consistency with all essential elements of the PACT evidence-based practice model in programs funded under this section.
     (c) $5,850,000 of the general fund--state appropriation for fiscal year 2012, $5,850,000 of the general fund--state appropriation for fiscal year 2013, and $1,300,000 of the general fund--federal appropriation are provided solely for the western Washington regional support networks to provide either community- or hospital campus-based services for persons who require the level of care previously provided by the program for adaptive living skills (PALS) at western state hospital.
     (d) The number of nonforensic beds allocated for use by regional support networks at eastern state hospital shall be 192 per day. The number of nonforensic beds allocated for use by regional support networks at western state hospital shall be 557 per day through June 2012, 527 per day from July 2012 through September 2012, and 497 per day from October 2012 through the end of fiscal year 2013.
     (e) From the general fund--state appropriations in this subsection, the secretary of social and health services shall assure that regional support networks reimburse the aging and disability services administration for the general fund--state cost of medicaid personal care services that enrolled regional support network consumers use because of their psychiatric disability.
     (f) $4,582,000 of the general fund--state appropriation for fiscal year 2012 and $4,582,000 of the general fund--state appropriation for fiscal year 2013 are provided solely for mental health services for mentally ill offenders while confined in a county or city jail and for facilitating access to programs that offer mental health services upon release from confinement.
     (g) The department is authorized to continue to contract directly, rather than through contracts with regional support networks, for children's long-term inpatient facility services.
     (h) $750,000 of the general fund--state appropriation for fiscal year 2012 and $750,000 of the general fund--state appropriation for fiscal year 2013 are provided solely to continue performance-based incentive contracts to provide appropriate community support services for individuals with severe mental illness who were discharged from the state hospitals as part of the expanding community services initiative. These funds will be used to enhance community residential and support services provided by regional support networks through other state and federal funding.
     (i) $1,125,000 of the general fund--state appropriation for fiscal year 2012 and $1,125,000 of the general fund--state appropriation for fiscal year 2013 are provided solely for the Spokane regional support network to implement services to reduce utilization and the census at eastern state hospital. Such services shall include:
     (i) High intensity treatment team for persons who are high utilizers of psychiatric inpatient services, including those with co-occurring disorders and other special needs;
     (ii) Crisis outreach and diversion services to stabilize in the community individuals in crisis who are at risk of requiring inpatient care or jail services;
     (iii) Mental health services provided in nursing facilities to individuals with dementia, and consultation to facility staff treating those individuals; and
     (iv) Services at the sixteen-bed evaluation and treatment facility.
     At least annually, the Spokane regional support network shall assess the effectiveness of these services in reducing utilization at eastern state hospital, identify services that are not optimally effective, and modify those services to improve their effectiveness.
     (j) $1,529,000 of the general fund--state appropriation for fiscal year 2012 and $1,529,000 of the general fund--state appropriation for fiscal year 2013 are provided solely to reimburse Pierce and Spokane counties for the cost of conducting 180-day commitment hearings at the state psychiatric hospitals.
     (k) Regional support networks may use local funds to earn additional federal medicaid match, provided the locally matched rate does not exceed the upper-bound of their federally allowable rate range, and provided that the enhanced funding is used only to provide medicaid state plan or waiver services to medicaid clients. Additionally, regional support networks may use a portion of the state funds allocated in accordance with (a) of this subsection to earn additional medicaid match, but only to the extent that the application of such funds to medicaid services does not diminish the level of crisis and commitment, community inpatient, residential care, and outpatient services presently available to persons not eligible for medicaid.
     (l) Given the recent approval of federal medicaid matching funds for the disability lifeline and the alcohol and drug abuse treatment support act programs, the department shall charge regional support networks for only the state share rather than the total cost of community psychiatric hospitalization for persons enrolled in those programs.
     (m) $750,000 of the general fund--state appropriation for fiscal year 2012, $750,000 of the general fund--state appropriation for fiscal year 2013, and $1,500,000 of the general fund--federal appropriation are provided solely to adjust regional support network capitation rates to account for the per diem rates actually paid for psychiatric care provided at hospitals participating in the certified public expenditure program operated pursuant to section 213 of this act.

     (2) INSTITUTIONAL SERVICES
General Fund -- State Appropriation (FY 2012) . . . . . . . . . . . . (($115,317,000))
       $115,146,000
General Fund -- State Appropriation (FY 2013) . . . . . . . . . . . . (($114,111,000))
       $108,574,000
General Fund -- Federal Appropriation . . . . . . . . . . . . (($153,324,000))
       $154,002,000
General Fund -- Private/Local Appropriation . . . . . . . . . . . . (($67,325,000))
       $67,416,000
          TOTAL APPROPRIATION . . . . . . . . . . . . (($450,077,000))
       $445,138,000

     The appropriations in this subsection are subject to the following conditions and limitations:
     (a) The state psychiatric hospitals may use funds appropriated in this subsection to purchase goods and supplies through hospital group purchasing organizations when it is cost-effective to do so.
     (b) $231,000 of the general fund--state appropriation for fiscal year 2012 and $231,000 of the general fund--state appropriation for fiscal year 2013 are provided solely for a community partnership between western state hospital and the city of Lakewood to support community policing efforts in the Lakewood community surrounding western state hospital. The amounts provided in this subsection (2)(b) are for the salaries, benefits, supplies, and equipment for one full-time investigator, one full-time police officer, and one full-time community service officer at the city of Lakewood.
     (c) $45,000 of the general fund--state appropriation for fiscal year 2012 and $45,000 of the general fund--state appropriation for fiscal year 2013 are provided solely for payment to the city of Lakewood for police services provided by the city at western state hospital and adjacent areas.
     (d) $20,000,000 of the general fund--state appropriation for fiscal year 2012 and $20,000,000 of the general fund--state appropriation for fiscal year 2013 are provided solely to maintain staffed capacity to serve an average daily census in forensic wards at western state hospital of 270 patients per day.

     (3) SPECIAL PROJECTS
General Fund -- State Appropriation (FY 2012) . . . . . . . . . . . . $1,168,000
General Fund -- State Appropriation (FY 2013) . . . . . . . . . . . . (($1,164,000))
       $1,726,000
General Fund -- Federal Appropriation . . . . . . . . . . . . $4,109,000
General Fund--Private/Local Appropriation . . . . . . . . . . . . $700,000
          TOTAL APPROPRIATION . . . . . . . . . . . . (($7,141,000))
       $7,703,000

     The appropriations in this subsection are subject to the following conditions and limitations:
     (a) $1,161,000 of the general fund--state appropriation for fiscal year 2012 and $1,161,000 of the general fund--state appropriation for fiscal year 2013 are provided solely for children's evidence based mental health services. Funding is sufficient to continue serving children at the same levels as fiscal year 2009.
     (b) $700,000 of the general fund--private/local appropriation is provided solely for the University of Washington's evidence based practice institute which supports the identification, evaluation, and implementation of evidence-based or promising practices for serving children and youth with mental health disorders. The department shall enter into an interagency agreement with the office of the attorney general for expenditure of $700,000 of the state's proceeds of the cy pres settlement in State of Washington v. AstraZeneca (Seroquel) for this purpose.
     (c) $55,000 of the general fund--state appropriation for fiscal year 2013 is provided solely for the department to contract with the evidence-based practice institute to consult with the department and the Washington state institute for public policy in efforts to identify and expand the use of evidence-based practices for mental health prevention and treatment services to children in accordance with Engrossed Second Substitute House Bill No. 2536 (children services/delivery). Funding provided in this subsection may not be used to pay for costs of the director of the institute and shall lapse if Engrossed Second Substitute House Bill No. 2536 (children services/delivery) is not enacted by June 30, 2012.
     (d) $509,000 of the general fund--state appropriation for fiscal year 2013 is provided solely for training costs associated with implementation of Engrossed Second Substitute House Bill No. 2536 (children services/delivery). The amounts provided in this subsection must be used for coordinated evidence-based practice training to programs providing mental health, child welfare, and juvenile justice services to children. If Engrossed Second Substitute House Bill No. 2536 (children services/delivery) is not enacted by June 30, 2012, the amount provided in this subsection shall lapse.


     (4) PROGRAM SUPPORT
General Fund -- State Appropriation (FY 2012) . . . . . . . . . . . . (($4,476,000))
       $4,486,000
General Fund -- State Appropriation (FY 2013) . . . . . . . . . . . . (($4,261,000))
       $4,385,000
General Fund -- Federal Appropriation . . . . . . . . . . . . (($7,227,000))
       $7,309,000
General Fund--Private/Local Appropriation . . . . . . . . . . . . $446,000
          TOTAL APPROPRIATION . . . . . . . . . . . . (($16,410,000))
       $16,626,000

     (a) The appropriations in this subsection are subject to the following conditions and limitations: In accordance with RCW 43.20B.110, 43.135.055, and 71.24.035, the department is authorized to increase license and certification fees in fiscal years 2012 and 2013 to support the costs of the regulatory program. The fee schedule increases must be developed so that the maximum amount of additional fees paid by providers statewide in the 2011-2013 fiscal biennium is $446,000. The department's fee schedule shall have differential rates for providers with proof of accreditation from organizations that the department has determined to have substantially equivalent standards to those of the department, including but not limited to the joint commission on accreditation of health care organizations, the commission on accreditation of rehabilitation facilities, and the council on accreditation. To reflect the reduced costs associated with regulation of accredited programs, the department's fees for organizations with such proof of accreditation must reflect the lower costs of licensing for these programs than for other organizations which are not accredited.
     (b) $19,000 of the general fund--state appropriation for fiscal year 2012, $17,000 of the general fund--state appropriation for fiscal year 2013, and $34,000 of the general fund--federal appropriation are provided solely to support a partnership among the department of social and health services, the department of health, and agencies that deliver medical care and behavioral health services in Cowlitz county. The partnership shall identify and recommend strategies for resolving regulatory, licensing, data management, reporting, and funding barriers to more effective integration of primary medical and behavioral health care services in the county.
     (c) $105,000 of the general fund--state appropriation for fiscal year 2013 and $68,000 of the general fund--federal appropriation are provided solely for staffing costs associated with implementation of Engrossed Second Substitute House Bill No. 2536 (children services/delivery). The amounts provided in this subsection must be used for coordinated evidence-based practice implementation amongst the department's programs providing mental health, child welfare, and juvenile justice services to children. If Engrossed Second Substitute House Bill No. 2536 (children services/delivery) is not enacted by June 30, 2012, the amounts provided in this subsection shall lapse."

     On page 208, after line 25, insert the following:

"NEW SECTION.  Sec. 724   A new section is added to 2011 1st sp.s. c 50 (uncodified) to read as follows:
FOR THE OFFICE OF FINANCIAL MANAGEMENT--GOODS AND SERVICES
General Fund--State Appropriation (FY 2012) . . . . . . . . . . . . ($1,644,000)
General Fund--State Appropriation (FY 2013) . . . . . . . . . . . . ($6,580,000)
          TOTAL APPROPRIATION . . . . . . . . . . . . ($8,224,000)

     The appropriations in this section are solely for the purposes designated in this section and are subject to the following conditions and limitations:
     (1) Appropriations are adjusted to reflect savings associated with a 10 percent reduction in expenditures related to goods and services.
     (2) The office of financial management shall update agency appropriation schedules to reflect the changes to funding levels in this section as identified by agency and in the amounts specified in LEAP Document HW2-2012 dated February 17, 2012.
     (3) For agencies with appropriations from accounts other than the general fund--state, the office of financial management shall work with agencies to achieve potential savings in other accounts.

NEW SECTION.  Sec. 725   A new section is added to 2011 1st sp.s. c 50 (uncodified) to read as follows:
FOR THE OFFICE OF FINANCIAL MANAGEMENT--PERSONAL SERVICE CONTRACTS
General Fund--State Appropriation (FY 2012) . . . . . . . . . . . . ($1,076,000)
General Fund--State Appropriation (FY 2013) . . . . . . . . . . . . ($4,311,000)
          TOTAL APPROPRIATION . . . . . . . . . . . . ($5,387,000)

     The appropriations in this section are solely for the purposes designated in this section and are subject to the following conditions and limitations:
     (1) Appropriations are adjusted to reflect savings associated with a 20 percent reduction in expenditures related to personal service contracts.
     (2) The office of financial management shall update agency appropriation schedules to reflect the changes to funding levels in this section as identified by agency and in the amounts specified in LEAP Document PSC-2012 dated February 17, 2012.
     (3) For agencies with appropriations from accounts other than the general fund--state, the office of financial management shall work with agencies to achieve potential savings in other accounts."

     Correct the title.

EFFECT:  There is a net increase in general fund--state of $12.8 million and total funds of $20.0 million. A number of changes are made to mental health funding including 1) Regional Support Network (RSN) Medicaid capitation rate funding is reduced by 1 percent through consolidation of RSNs in accordance with House Bill 2139 (regional support networks) rather than being reduced by approximately 3.5 percent with no savings assumed from consolidation; 2) a portion of RSN non-Medicaid funding is restored so that the reduction is 3.0 percent rather than 5.2 percent; 3) funding for Spokane RSN to develop community alternatives for state hospital patients is restored rather than being eliminated; 4) funding is provided for 4 FTEs to increase resources available for forensic evaluations in jails; 5) funding for headquarters is restored to current levels rather than being reduced by 5 FTEs; 6) funding for services to individuals with mental illnesses in or transitioning from jails is restored rather than being reduced by 50 percent; and 7) a requirement for the department to report outcome data on individuals in jail who are referred for regional support network services is eliminated.

Office of Financial Management--Special Appropriations: OFM must reduce agency allotments to reflect savings associated with a 10% reduction in agency purchases of goods and services and a 20% reduction in agency expenditures for personal services contracts.

FISCAL IMPACT:

DSHS--Mental Health Division: Increases General Fund--State by $12,804,000. Increases General Fund--Federal by $7,079,000. Increases General Fund--Private/Local by $91,000.

OFM--Special Appropriations: Reduces General Fund--State by $13,611,000.

NET GFS FISCAL IMPACT: Decreases General Fund--State by $807,000.

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