H-1671

AN ACT Relating to mental health services for children; amending RCW 71.24.049 and 71.24.300; adding a new chapter to Title 71 RCW; creating a new section; making an appropriation; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. (1) The legislature finds that because of limited service capacity and the lack of collaboration among child-serving systems and the focus on acute and chronic mental illness in providing mental health services in Washington state, mental health services for children must be expanded and reoriented to better meet each child's unique needs. The legislature further finds that because children with emotional disturbances come into contact with multiple child-serving systems, such as schools, child welfare programs, and mental health providers, a distinct collaborative system must be established to adequately meet their needs. The legislature further finds that recent federal mandates relating to the early periodic screening, diagnosis, and treatment component of the medicaid program provide an opportunity to reform the delivery of children's mental health services in Washington state.

(2) It is the policy of the state of Washington to provide mental health services to children in a manner that recognizes and meets each child's unique needs and involves all of the child-serving systems that each child has contact with. The legislature intends to encourage the development of community-based interagency collaborative efforts to plan for and provide mental health services to children in a manner that coordinates existing categorical children's mental health programs and funding. The legislature further intends that children's mental health services be provided in a manner that meets each child's needs, is sensitive to the unique cultural circumstances of children of color, eliminates duplicative case management, and to the greatest extent possible, blends categorical funding to offer more service options to each child. The legislature further intends that criteria be developed and implemented for the use of early periodic screening, diagnosis, and treatment services that include authorized treatment plans for medicaid-eligible children in need of mental health services and other cost control mechanisms.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Agency" means a state or local governmental entity or a private not-for-profit organization.

(2) "Child" means a person under twenty-one years of age.

(3) "County authority" means the board of county commissioners, county council, or county executive.

(4) "Department" means the department of social and health services.

(5) "Early periodic screening, diagnosis, and treatment" means the component of the federal medicaid program established pursuant to 42 U.S.C. Sec. 1396d(r).

(6) "Regional support network" means a county authority or group of county authorities that have entered into contracts with the secretary pursuant to chapter 71.24 RCW.

(7) "Secretary" means the secretary of social and health services.

PART I

INVENTORY OF CHILDREN'S MENTAL HEALTH SERVICES

NEW SECTION. Sec. 3. (1) The office of financial management shall provide the following information to the appropriate committees of the legislature on or before December 1, 1991, and update such information biennially thereafter:

(a) An inventory of state and federally funded programs providing mental health services to children in Washington state. For purposes of the inventory, "children's mental health services" shall be broadly construed to include services related to children's mental health provided through education, children and family services, juvenile justice, mental health, health care, and developmental disabilities programs, such as: The primary intervention program; treatment foster care; the fair start program; therapeutic child care and day treatment for children in the child protective services system, as provided in RCW 74.14B.040; family reconciliation services counseling, as provided in chapter 13.32A RCW; the community mental health services act, as provided in chapter 71.24 RCW; mental health services for minors, as provided in chapter 71.34 RCW; the medical assistance program, limited casualty program for the medically needy and children's health program, as provided in chapter 74.09 RCW; counseling for delinquent children, as provided in RCW 72.05.170; child welfare services, as provided in chapter 74.13 RCW; and services to emotionally disturbed and mentally ill children, as provided in chapter 74.14A RCW.

(b) For each program or service inventoried pursuant to (a) of this subsection:

(i) Statutory authority;

(ii) Level and source of funding;

(iii) Agency administering the service and description of how services are delivered;

(iv) Programmatic or financial eligibility criteria;

(v) Characteristics of, and number of children served;

(vi) Number of children of color served, by race and nationality, and number and type of minority mental health providers, by race and nationality, in each regional support network area, to the extent such information is available;

(vii) Amount of program or service funding distributed to each county or school district in the state during the biennium ending June 30, 1991, to the extent such information is available; and

(viii) Statutory changes necessary to remove categorical restrictions in the program or service, including federal statutory or regulatory changes.

(2) The office of financial management shall develop a plan and criteria for the use of early periodic screening, diagnosis, and treatment services for medicaid-eligible children in need of mental health services. The plan shall include at least the following components:

(a) Criteria for screening and referral for development of a treatment plan;

(b) Criteria for development of treatment plans or prior authorization for receipt of mental health treatment services;

(d) Mechanisms to ensure that federal medicaid matching funds are obtained for services inventoried pursuant to subsection (1) of this section, to the greatest extent practicable; and

(e) Other cost control mechanisms, such as prospective or capitated payments for mental health services.

In developing the plan, the office of financial management shall provide an opportunity for comment by the major child-serving systems and regional support networks. The plan shall be submitted to appropriate committees of the legislature on or before December 1, 1991.

PART II

CHILDREN'S MENTAL HEALTH SERVICES DELIVERY SYSTEMS

NEW SECTION. Sec. 4. (1) On or before January 1, 1992, each regional support network, or county authority in counties that have not established a regional support network, shall initiate a local planning effort to develop a children's mental health services delivery system and act as lead agency, in implementation and administration of such system.

(2) Representatives of the following agencies or organizations and the following individuals shall participate in the local planning effort:

(a) Representatives of the department of social and health services in the following program areas: Children and family services, medical care, mental health, juvenile rehabilitation, and developmental disabilities;

(b) The juvenile courts;

(d) The school districts;

(e) The educational service district serving schools in the county;

(f) Head start or early childhood education and assistance programs;

(g) Parents of children in need of mental health services;

(h) Children's services providers including minority mental health providers; and

(i) Parents of children of color.

(3) The following information shall be developed through the local planning effort and submitted to the secretary as provided in section 6 of this act:

(a) A supplement to the county's January 1, 1991, children's mental health services report prepared pursuant to RCW 71.24.049 to include the following data:

(i) The number of children in need of mental health services in the county or counties covered by the local planning effort, including children in school and children receiving services through the department of social and health services division of children and family services, division of developmental disabilities, and division of juvenile rehabilitation, grouped by severity of their mental illness;

(ii) The number of such children that are underserved or unserved;

(iii) The continuum of nonresidential and residential services needed to meet the mental health needs of children in the county or counties covered by the local planning effort and the extent to which those services are currently provided; and

(iv) The supply of children's mental health specialists in the county or counties covered by the local planning effort.

(b) A children's mental health services delivery plan that includes a description of the following:

(i) Children that will be served, giving consideration to children who are at significant risk of experiencing mental illness, as well as those already experiencing mental illness;

(ii) Services that will be provided, including prevention and identification services;

(iii) How a lead case manager for each child will be identified;

(iv) How funding for existing services will be coordinated to create more flexibility in meeting children's needs. Such funding shall include the services and programs inventoried pursuant to section 3(1) of this act;

(v) How the children's mental health delivery system will incorporate the elements of the early periodic screening, diagnosis, and treatment services plan developed pursuant to section 3 of this act; and

(vi) How the children's mental health delivery system will coordinate with the regional support network information system developed pursuant to RCW 71.24.035(5)(g).

(4) In developing the children's mental health services delivery plan, every effort shall be made to reduce duplication in service delivery and promote complementary services among all entities that provide children's services related to mental health.

(5) The children's mental health services delivery plan shall assure that the needs of children of color are met through at least the following mechanisms:

(a) Designing outreach initiatives, services, and modes of service provision to meet the unique needs of children of color;

(b) Ensuring that services to children of color are culturally relevant and acceptable, as well as linguistically accessible; and

(c) Increasing the role of minority mental health providers in the children's mental health delivery system through contracts and subcontracts with minority providers and affirmative action employment efforts.

NEW SECTION. Sec. 5. All counties wishing to implement their children's mental health services delivery plan as provided in section 4 of this act on August 1, 1992, shall submit their plan to the department on or before April 1, 1992. Counties wishing to implement their children's mental health services delivery plan as provided in section 4 of this act on July 1, 1993, shall submit their plan to the department on or before March 1, 1993.

NEW SECTION. Sec. 6. The secretary shall have the following powers and duties related to the development and implementation of children's mental health delivery systems:

(1) To contract with regional support networks, or county authorities in counties that have not established a regional support network, for implementation of a children's mental health services delivery system. No contract shall be approved that does not include progress towards meeting the intent and purposes of this chapter by providing evidence of:

(a) Written interagency agreements between the regional support network, or county authority in a county that has not established a regional support network, and each agency participating in the children's mental health services delivery plan developed in accordance with section 4 of this act, which agreement specifies the role of the participating agency and is binding on that agency; and

(b) Assurances that the children's mental health delivery system will incorporate the elements of the early periodic screening, diagnosis, and treatment services plan developed pursuant to section 3 of this act.

(2) To provide, either directly or by contract, technical assistance to regional support networks and county authorities to develop children's mental health services delivery plans; and

(3) To be designated as the county authority if a regional support network, or county authority in a county that has not established a regional support network, fails to submit a children's mental health services delivery plan pursuant to sections 4 and 5 of this act.

NEW SECTION. Sec. 7. (1) Five percent of the state general fund budget of each agency participating in a children's mental health delivery system attributable to those programs and services inventoried pursuant to section 3(1) of this act shall be allocated by the office of financial management to a pooled account of flexible funds to meet the needs of children that cannot be met through categorical programs. An agency five percent allotment shall be in cash or a fixed level of treatment or counseling services equivalent in value to their allotment obligation. Children's mental health services provided through the medical assistance program or the limited casualty program for the medically needy shall be exempt from the allotment requirement in order to maximize the availability of federal matching funds for children's mental health services. For counties implementing their system on August 1, 1992, five percent shall be computed based upon the state general fund appropriation to that agency for the period of July 1, 1992, through June 30, 1993. For counties implementing their system on August 1, 1993, five percent shall be computed based upon the state general fund appropriation to that agency for the period of July 1, 1993, through June 30, 1995.

(2) The pooled account shall be used only after a determination has been made that the particular service needed by an individual child cannot be provided through existing categorical programs or other community services. Funds contributed to the pooled account shall be exempt from existing statutory or regulatory restrictions on their use.

(3) The regional support network, or county authority in a county that has not established a regional support network, is responsible for administration of the pooled account.

Sec. 8. RCW 71.24.049 and 1986 c 274 s 6 are each amended to read as follows:

(1) By January 1, 1987, and each odd-numbered year thereafter, the county authority shall identify: (1) The number of children in each priority group, as defined by this chapter, who are receiving mental health services funded in part or in whole under this chapter, (2) the amount of funds under this chapter used for children's mental health services, (3) an estimate of the number of unserved children in each priority group, and (4) the estimated cost of serving these additional children and their families.

(2) Each county authority in counties that have not established a regional support network, shall determine the percentage of persons in need of mental heath services that children represent in the county. Each county authority in counties that have not established a regional support network shall provide assurances in its children's mental health services delivery plan that a percentage of its funding received through this chapter, equivalent to the percentage of persons in need of mental health services who are children in the county shall be allocated to children's mental health services.

Sec. 9. RCW 71.24.300 and 1989 c 205 s 5 are each amended to read as follows:

A county authority or a group of county authorities whose combined population is no less than forty thousand may enter into a joint operating agreement to form a regional support network. The roles and responsibilities of county authorities shall be determined by the terms of that agreement and the provisions of law. The state mental health authority may not determine the roles and responsibilities of county authorities as to each other under regional support networks by rule, except to assure that all duties required of regional support networks are assigned and that a single authority has final responsibility for all available resources and performance under the regional support network's contract with the secretary.

(1) Regional support networks shall within three months of recognition submit an overall six-year operating and capital plan, timeline, and budget and submit progress reports and an updated two-year plan biennially thereafter, to assume within available resources all of the following duties by July 1, 1995, instead of those presently assigned to counties under RCW 71.24.045(1):

(a) Administer and provide for the availability of all resource management services, residential services, and community support services.

(b) Administer and provide for the availability of all investigation, transportation, court-related, and other services provided by the state or counties pursuant to chapter 71.05 RCW.

(c) By July 1, 1993, provide within the boundaries of each regional support network evaluation and treatment services for at least eighty-five percent of persons detained or committed for periods up to seventeen days according to chapter 71.05 RCW. Regional support networks with populations of less than one hundred fifty thousand may contract to purchase evaluation and treatment services from other networks. For regional support networks that are created after June 30, 1991, the requirements of (c) of this subsection must be met by July 1, 1995.

(d) By July 1, 1993, administer a portion of funds appropriated by the legislature to house mentally ill persons in state institutions from counties within the boundaries of any regional support network, with the exception of mentally ill offenders, and provide for the care of all persons needing evaluation and treatment services for periods up to seventeen days according to chapter 71.05 RCW in appropriate residential services, which may include state institutions. The regional support networks shall reimburse the state for use of state institutions at a rate equal to that assumed by the legislature when appropriating funds for such care at state institutions during the biennium when reimbursement occurs. The duty of a state hospital to accept persons for evaluation and treatment under chapter 71.05 RCW is limited by the responsibilities assigned to regional support networks under this section. For regional support networks that are created after June 30, 1991, the requirements of (d) of this subsection must be met by July 1, 1995.

(e) Administer and provide for the availability of all other mental health services, which shall include patient counseling, day treatment, consultation, education services, and mental health services to children as provided in this chapter.

(f) Establish standards and procedures for reviewing individual service plans and determining when that person may be discharged from resource management services.

(2) Regional support networks shall assume all duties assigned to county authorities by this chapter and chapter 71.05 RCW.

(3) A regional support network may request that any state-owned land, building, facility, or other capital asset which was ever purchased, deeded, given, or placed in trust for the care of the mentally ill and which is within the boundaries of a regional support network be made available to support the operations of the regional support network. State agencies managing such capital assets shall give first priority to requests for their use pursuant to this chapter.

(4) Each regional support network shall appoint a mental health advisory board which shall review and provide comments on plans and policies developed under this chapter. The composition of the board shall be broadly representative of the demographic character of the region and the mentally ill persons served therein. Length of terms of board members shall be determined by the regional support network.

(5) Regional support networks shall assume all duties specified in their plans and joint operating agreements through biennial contractual agreements with the secretary.

(6) Counties or groups of counties participating in a regional support network are not subject to RCW 71.24.045(7). The office of financial management shall consider information gathered in studies required in this chapter and information about the experience of other states to propose a mental health services administrative cost lid to the 1991 legislature which shall include administrative costs of licensed service providers, the state psychiatric hospitals and the department.

(7) The first regional support network contract may include a pilot project to: Establish standards and procedures for (a) making referrals for comprehensive medical examinations and treatment programs for those whose mental illness is caused or exacerbated by organic disease, and (b) training staff in recognizing the relationship between mental illness and organic disease.

(8) Each regional support network shall determine the percentage of persons in need of mental health services that children represent in the county or counties served by the regional support network. Each regional support network shall provide assurances in its children's mental health services delivery plan that a percentage of its funding received through this chapter equivalent to the percentage of persons in need of mental health services who are children in the county or counties served by the regional support network shall be allocated to children's mental health services.

NEW SECTION. Sec. 10. (1) Local governments in areas served by regional support networks shall provide local matching funds, in the form of cash, materials, supplies, or physical facilities, for the children's mental health services delivery system, in an amount equal to twenty percent of their regional support network's funding allocated to children's mental health services pursuant to RCW 71.24.300(8).

(2) In counties that have not established regional support networks, each county authority shall provide matching funds, in the form of cash, materials, supplies, or physical facilities, for the children's mental health services delivery system in an amount equal to twenty percent of that county's funding allocated to children's mental health services pursuant to RCW 71.24.049(2).

NEW SECTION. Sec. 11. The sum of two million dollars, or as much thereof as may be necessary, is appropriated for the period beginning July 1, 1992, and ending June 30, 1993, from the general fund to the department of social and health services, solely for case management and mental health services through the early periodic screening, diagnosis, and treatment component of the medical assistance program and limited casualty program for the medically needy.

NEW SECTION. Sec. 12. Part headings as used in this act do not constitute any part of the law.

NEW SECTION. Sec. 13. Sections 1 through 7 and 10 of this act shall constitute a new chapter in Title 71 RCW.

NEW SECTION. Sec. 14. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION. Sec. 15. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.