H-0497

AN ACT Relating to mental health services for children; amending RCW 74.09.700, 71.24.049, and 71.24.300; reenacting and amending RCW 74.09.520; 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.

(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. 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, maximizes federal funding of children's mental health services, and to the greatest extent possible, blends categorical funding to offer more service options to each child.

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) "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.

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

PART I

MENTAL HEALTH SERVICES TO CHILDREN UNDER

THE MEDICAL ASSISTANCE PROGRAM AND THE LIMITED

CASUALTY PROGRAM FOR THE MEDICALLY NEEDY

Sec. 3. RCW 74.09.520 and 1990 c 33 s 594 and 1990 c 25 s 1 are

each reenacted and amended to read as follows:

(1) The term "medical assistance" may include the following care and services: (a) Inpatient hospital services; (b) outpatient hospital services; (c) other laboratory and x‑ray services; (d) skilled nursing home services; (e) physicians' services, which shall include prescribed medication and instruction on birth control devices; (f) medical care, or any other type of remedial care as may be established by the secretary; (g) early periodic screening, diagnosis, and treatment services for children under age twenty-one, which shall be culturally relevant and accessible to children of color and which shall include case management and mental health services provided as a rehabilitation service, as defined in federal medical assistance regulations, for maximum reduction of a child's mental disability; (h) home health care services; ((~~(h)~~)) (i) private duty nursing services; ((~~(i)~~)) (j) dental services; ((~~(j)~~)) (k) physical therapy and related services; ((~~(k)~~)) (l) prescribed drugs, dentures, and prosthetic devices; and eyeglasses prescribed by a physician skilled in diseases of the eye or by an optometrist, whichever the individual may select; ((~~(l)~~)) (m) personal care services, as provided in this section; ((~~(m)~~)) (n) hospice services; ((~~(n)~~)) (o) other diagnostic, screening, preventive, and rehabilitative services; and ((~~(o)~~)) (p) like services when furnished to a handicapped child by a school district as part of an individualized education program established pursuant to RCW 28A.155.010 through 28A.155.100. For the purposes of this section, the department may not cut off any prescription medications, oxygen supplies, respiratory services, or other life‑ sustaining medical services or supplies.

"Medical assistance," notwithstanding any other provision of law, shall not include routine foot care, or dental services delivered by any health care provider, that are not mandated by Title XIX of the social security act unless there is a specific appropriation for these services. Services included in an individualized education program for a handicapped child under RCW 28A.155.010 through 28A.155.100 shall not qualify as medical assistance prior to the implementation of the funding process developed under RCW 74.09.524.

(2) The department shall amend the state plan for medical assistance under Title XIX of the federal social security act to include personal care services, as defined in 42 C.F.R. 440.170(f), in the categorically needy program.

(3) The department shall adopt, amend, or rescind such administrative rules as are necessary to ensure that Title XIX personal care services are provided to eligible persons in conformance with federal regulations.

(a) These administrative rules shall include financial eligibility indexed according to the requirements of the social security act providing for medicaid eligibility.

(b) The rules shall require clients be assessed as having a medical condition requiring assistance with personal care tasks. Plans of care must be approved by a physician and reviewed by a nurse every ninety days.

(4) The department shall design and implement a means to assess the level of functional disability of persons eligible for personal care services under this section. The personal care services benefit shall be provided to the extent funding is available according to the assessed level of functional disability. Any reductions in services made necessary for funding reasons should be accomplished in a manner that assures that priority for maintaining services is given to persons with the greatest need as determined by the assessment of functional disability.

(5) The department shall report to the appropriate fiscal committees of the legislature on the utilization and associated costs of the personal care option under Title XIX of the federal social security act, as defined in 42 C.F.R. 440.170(f), in the categorically needy program. This report shall be submitted by January 1, 1990, and submitted on a yearly basis thereafter.

(6) Effective July 1, 1989, the department shall offer hospice services in accordance with available funds. The department shall provide a complete accounting of the costs of providing hospice services under this section by December 20, 1990. The report shall include an assessment of cost savings which may result by providing hospice to persons who otherwise would use hospitals, nursing homes, or more expensive care. The hospice benefit under this section shall terminate on June 30, 1991, unless extended by the legislature.

Sec. 4. RCW 74.09.700 and 1989 c 87 s 3 are each amended to read as follows:

(1) To the extent of available funds, medical care may be provided under the limited casualty program to persons not otherwise eligible for medical assistance or medical care services who are medically needy as defined in the social security Title XIX state plan and medical indigents in accordance with medical eligibility requirements established by the department. This includes residents of skilled nursing homes, intermediate care facilities, and intermediate care facilities for the mentally retarded who are aged, blind, or disabled as defined in Title XVI of the federal social security act and whose income exceeds three hundred percent of the federal supplement security income benefit level.

(2) Determination of the amount, scope, and duration of medical coverage under the limited casualty program shall be the responsibility of the department, subject to the following:

(a) Only inpatient hospital services; outpatient hospital and rural health clinic services; physicians' and clinic services; prescribed drugs, dentures, prosthetic devices, and eyeglasses; skilled nursing home services, intermediate care facility services, and intermediate care facility services for the mentally retarded; home health services; other laboratory and x‑ray services; rehabilitative services; medically necessary transportation; and other services for which funds are specifically provided in the omnibus appropriations act shall be covered;

(b) Early periodic screening, diagnosis, and treatment services shall be provided to children under age twenty-one who are medically needy as defined in the social security Title XIX state plan. Such services shall be culturally relevant and accessible to children of color and shall include case management and mental health services provided as a rehabilitation service, as defined in federal medical assistance regulations, for maximum reduction of a child's mental disability;

(c) Persons who are medically indigent and are not eligible for a federal aid program shall satisfy a deductible of not less than one hundred dollars nor more than five hundred dollars in any twelve‑month period;

((~~(c)~~)) (d) Medical care services provided to the medically indigent and received no more than seven days prior to the date of application shall be retroactively certified and approved for payment on behalf of a person who was otherwise eligible at the time the medical services were furnished: PROVIDED, That eligible persons who fail to apply within the seven‑day time period for medical reasons or other good cause may be retroactively certified and approved for payment.

(3) The department shall establish standards of assistance and resource and income exemptions. All nonexempt income and resources of limited casualty program recipients shall be applied against the cost of their medical care services.

PART II

INVENTORY OF CHILDREN'S MENTAL HEALTH SERVICES

NEW SECTION. Sec. 5. 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:

(1) 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.

(2) For each program or service inventoried pursuant to subsection (1) of this section:

(a) Statutory authority;

(b) Level and source of funding;

(d) Programmatic or financial eligibility criteria;

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

(f) 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

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

(3) Options to maximize federal matching funds for mental health services provided to low-income children. As a corollary to this effort, identify methods to reduce the administrative burden associated with reimbursement for providers, through mechanisms such as electronic billing.

PART III

CHILDREN'S MENTAL HEALTH SERVICES DELIVERY SYSTEMS

NEW SECTION. Sec. 6. (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.

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

(g) Children's services providers; and

(h) 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 8 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) The lead agency that has been designated to have primary responsibility for implementation of the plan and administration of the pooled fund established in section 9 of this act;

(ii) 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;

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

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

(v) 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 5(1) of this act;

(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: Designing services to meet the unique needs of children of color, ensuring that majority providers have the goal of providing culturally relevant services, and encouraging the participation of minority mental health providers in the children's mental health delivery system.

NEW SECTION. Sec. 7. All counties wishing to implement their children's mental health services delivery plan as provided in section 6 of the act on January 1, 1992, shall submit their plan to the department on or before September 1, 1991. Counties wishing to implement their children's mental health services delivery plan as provided in section 6 of this act on August 1, 1992, shall submit their plan to the department on or before March 1, 1992. Counties wishing to implement their children's mental health services delivery plan as provided in section 6 of this act on August 1, 1993, shall submit their plan to the department on or before March 1, 1993.

NEW SECTION. Sec. 8. The secretary shall have the following powers and duties related to the development and implementation of children's mental health delivery systems:

(1) To review each children's mental health services delivery plan submitted for review pursuant to section 7 of this act. The review shall determine the extent to which the plan reflects the intent and standards provided in sections 1 and 6 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 under sections 6 and 7 of this act.

NEW SECTION. Sec. 9. (1) Each agency participating in a children's mental health delivery system shall contribute five percent of their state general fund budget attributable to those programs and services inventoried pursuant to section 5(1) of this act to a pooled account of flexible funds to meet the needs of children that cannot be met through categorical programs. An agency contribution shall be in cash or a fixed level of treatment or counseling services equivalent in value to their contribution 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 contribution requirement in order to maximize the availability of federal matching funds for children's mental health services. For counties implementing their system on January 1, 1992, five percent shall be computed based upon the state general fund appropriation to that agency for the period of July 1, 1991, through June 30, 1993. 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 children's mental health services delivery plan submitted to the secretary as provided in this chapter shall designate the agency responsible for administration of the pooled account.

Sec. 10. 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. 11. 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. 12. The sum of two million dollars, or as much thereof as may be necessary, is appropriated for the biennium 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. 13. Part headings as used in this act do not constitute any part of the law.

NEW SECTION. Sec. 14. Sections 1, 2, and 5 through 9 of this act shall constitute a new chapter in Title 71 RCW.

NEW SECTION. Sec. 15. 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. 16. 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.