HOUSE BILL REPORT

                 SSB 5670

                       As Passed House

                       April 19, 1991

Title:  An act relating to screening and treatment of children for mental health services.

Brief Description:  Changing provisions relating to children's mental health.

Sponsor(s):  Senate Committee on Health & Long‑Term Care (originally sponsored by Senators Niemi and West).

Brief History:

  Reported by House Committee on:

Human Services, April 4, 1991, DPA;

Passed House, April 19, 1991, 97-0.

HOUSE COMMITTEE ON

HUMAN SERVICES

Majority Report: Do pass as amended.  Signed by 11 members:  Representatives Leonard, Chair; Riley, Vice Chair; Winsley, Ranking Minority Member; Tate, Assistant Ranking Minority Member; Anderson; Beck; Brekke; Hargrove; Hochstatter; R. King; and H. Myers.

Staff:  David Knutson (786-7146).

Background:  A 1989 Washington State Children's Mental Health System Analysis estimates that approximately 6.7 percent of the public school population, or 50,250 children, have a severe emotional disturbance (SED).  The report defines SED children as suffering from "chronic mental disability, psychosis or other behavioral disorders that require sustained treatment interventions for a year or more and which require attention on several levels of functioning." 

The report estimates that 94 percent of SED public school children are not receiving a specific mental health service, despite the presence of severe emotional disturbance.  The report also indicates that only 26 percent of these children are receiving state-funded treatment.  According to the report, 60 percent of SED children are from families within a low socio-economic class.

The 1990 supplemental budget contained a proviso which required the Department of Social and Health Services (DSHS) to develop a statewide action plan for children's mental health.  This action plan was required to contain recommendations for changes to the mental health and other statutes to accommodate children's special needs and circumstances.

The Title XIX Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) is a federally mandated Medicaid program which provides scheduled checkups and follow-up health services to eligible children under age 21.  The federal Omnibus Reconciliation Act of 1989 requires states to provide all medically necessary health services to children whose physical or mental illnesses are discovered by EPSDT screening services.  These health services must be provided regardless of whether these services are currently covered by the state Medicaid plan. 

Children of substance abusers will require additional services from education and human service agencies in the future.

Summary of Bill:  Legislative intent regarding the Community Mental Health Program is expanded to promote the early identification of mentally ill children and ensure that they receive mental health care and treatment which is appropriate to their developmental level.  Children's mental health care should improve home, school and community functioning and maintain children in a safe and nurturing home environment.  Children's mental health treatment decisions should be made in response to the child's clinical needs, using sound professional judgment and recognizing a parent's right to participate in decisions regarding their child's treatment.

The current definition of children eligible for mental health services is modified as follows:  Severely emotionally disturbed children are defined as infants or children determined by the regional support network to be experiencing a mental disorder that is clearly interfering with the child's functioning in their school or family, who have undergone inpatient or involuntary treatment or out-of-home placement related to their mental disorder within the last two years, or are currently served by a specified child-serving system, or are at risk of escalating maladjustment due to chronic family dysfunction involving mentally ill or inadequate caretakers, changes in custodial adult or residential setting, repeated physical abuse or neglect, substance abuse or homelessness.  Mental disorders include those which result in a behavioral or conduct disorder.

Severely emotionally disturbed children are included in existing priority populations.  These children must receive equal priority with chronically mentally ill adults. 

Severely emotionally disturbed children are added to the groups eligible for community support services.  These services include diagnosis and treatment for acutely mentally ill and severely emotionally disturbed children discovered under screening through the federal Title XIX EPSDT Program and the maintenance of a patient tracking system for severely emotionally disturbed children.

Residential services are expanded to include severely emotionally disturbed children.  With the exception of children's long term residential facilities existing prior to January 1, 1991, residential services for children in out-of-home placements related to their mental disorder must not include the costs of food and shelter.  

Resource management services must include mental health screening for children eligible under the federal Title XIX EPSDT Program. 

The Department of Social and Health Services, in consultation with affected parties, must revise the existing community mental health funding formula to include and reflect the number of severely emotionally disturbed children.  The Department of Social and Health Services must submit the revised distribution formula to the Ways and Means and Health and Long-Term Care committees of the Senate and to the Ways and Means and Human Services committees of the House of Representatives by October 1, 1991.

Existing requirements regarding county authorities and the administration and development of regional support networks are expanded to include severely emotionally disturbed children.

The Department of Social and Health Services must amend the Title XIX funding plan for services provided to children through the EPSDT Program to authorize regional support networks as exclusive agents of the state to certify mental health screening providers.  The plan must require prior authorization and utilization review for residential and inpatient services including inpatient acute hospitalizations and admissions to evaluation and treatment facilities.  In consultation with regional support networks and private practitioners, DSHS must develop referral criteria used by EPSDT screening providers to identify children with mental disorders eligible for further evaluation and treatment planning.  The Title XIX funding plan must also be amended to provide reimbursement for specialized family, home, school and community based mental health services or programs designed to promote primary prevention and maximize the development and potential of acutely mentally ill and severely emotionally disturbed children and their families.

The Department of Social and Health Services' authority to operate a pilot program regarding the impact of case management services for persons released from state or community hospitals is repealed.  This program terminated June 30, 1989.

The bill contains a severability clause.  In addition, if any part of this act conflicts with federal requirements that is a necessary condition to the receipt of federal funds by the state, the state appropriation for mental health services provided to children whose mental disorders are discovered under screening through the federal Title XIX EPSDT Program must be provided through the Division of Medical Assistance and no state funds appropriated to the Division of Mental Health may be expended or transferred for this purpose. 

A task force on the children of substance abusers is created.  The  task force will review the issues related to children of substance abuse and report its finding and recommendations by December 1, 1991 to appropriate legislative committees.

Fiscal Note:  Available.

Effective Date:  Ninety days after adjournment of session in which bill is passed.

Testimony For:  Existing statutes relating to mental health programs need to specifically reference mentally ill children.  The Department of Social and Health Services should develop a plan to use the EPSDT Program to address the mental health needs of children.

Testimony Against:  None.

Witnesses:  Senator Niemi; Sharon Stuart-Johnson, Colleen Waterhouse, and Dennis Olson, Department of Social and Health Services; Margaret Casey, Children's Alliance; and Marilyn Lacelle.