BILL REQ. #: H-1702.1
| State of Washington | 60th Legislature | 2007 Regular Session |
READ FIRST TIME 02/13/07.
AN ACT Relating to children's mental health services; amending RCW 71.36.005 and 71.36.010; adding new sections to chapter 71.36 RCW; adding new sections to chapter 74.09 RCW; adding a new section to chapter 71.24 RCW; creating new sections; repealing RCW 71.36.020, 71.36.030, and 71.36.040; and making appropriations.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 71.36.005 and 1991 c 326 s 11 are each amended to read
as follows:
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))
substantially improve the delivery of children's mental health services
in Washington state through the development and implementation of a
children's mental health system that:
(1) Values early identification, intervention, and prevention;
(2) Coordinates existing categorical children's mental health
programs and funding, through efforts that include elimination of
duplicative care plans and case management;
(3) Treats each child in the context of his or her family, and
provides services and supports needed to maintain a child with his or
her family and community;
(4) Integrates families into treatment through choice of treatment,
participation in treatment, and provision of peer support;
(5) Focuses on resiliency and recovery;
(6) Relies to a greater extent on evidence-based and promising
practices;
(7) Is sensitive to the unique cultural circumstances of children
of color((, eliminates duplicative case management,)) and children in
families whose primary language is not English; and
(8) To the greatest extent possible, blends categorical funding to
offer more service and support options to each child.
Sec. 2 RCW 71.36.010 and 1991 c 326 s 12 are each amended to read
as follows:
Unless the context clearly requires otherwise, the definitions in
this section apply throughout this chapter.
(1) "Agency" means a state, tribal, or local governmental entity or
a private not-for-profit organization.
(2) "Child" means a person under ((eighteen)) twenty-one years of
age, except as expressly provided otherwise in federal law.
(3) "County authority" means the board of county commissioners 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), as amended.
(6) "Evidence-based practice" means practices that are based on
valid and reliable scientific evidence demonstrating that the practice
is effective, adapted when necessary to respond to individual treatment
needs and cultural values.
(7) "Family" means a child's biological parents, adoptive parents,
foster parents, guardian, a relative with whom a child has been placed
by the department of social and health services or a tribe, or other
kinship care or nonrelative living arrangements established to care for
a child.
(8) "Promising practice" means a practice that has been shown to be
effective and that presents, based upon preliminary information,
potential for becoming an evidence-based practice.
(9) "Regional support network" means a county authority or group of
county authorities or other nonprofit entity that ((have)) has entered
into contracts with the secretary pursuant to chapter 71.24 RCW.
(((7))) (10) "Secretary" means the secretary of social and health
services.
(11) "Wraparound process" means a process of addressing the needs
of children and youth with complex needs that involves the formation of
a team that empowers the family to make key decisions regarding the
care of the child or youth through partnership with professionals and
the family's natural supports, focuses on strengths and needs based
upon a care plan produced by the team, defines goals that the family
and team seek to achieve, respects the unique culture and values of the
child and youth, and adheres to the ten principles of the wraparound
process and evidence-based wraparound practices developed through the
national wraparound initiative at Portland State University.
NEW SECTION. Sec. 3 A new section is added to chapter 71.36 RCW
to read as follows:
(a) A continuum of services from early identification,
intervention, and prevention through crisis intervention and inpatient
treatment, including peer support and parent mentoring services;
(b) Equity in access to services for similarly situated children,
including children with co-occurring disorders;
(c) Developmentally appropriate, high quality, and culturally
responsive services available statewide;
(d) Treatment of each child in the context of his or her family and
other persons that are a source of support and stability in his or her
life;
(e) A sufficient supply of qualified and culturally diverse
children's mental health providers;
(f) Use of developmentally appropriate evidence-based and promising
practices;
(g) Integrated and flexible services to meet the needs of children
who, due to mental illness or emotional or behavioral disturbance, are
at risk of out-of-home placement or involved with multiple child-serving systems.
(2) The effectiveness of the children's mental health system shall
be determined through the use of outcome-based performance measures.
The department and the evidence-based practice institute established in
section 7 of this act, in consultation with parents, caregivers, youth,
regional support networks, mental health services providers, health
plans, primary care providers, tribes, and others, shall develop
outcome-based performance measures such as:
(a) Decreased emergency room utilization;
(b) Decreased psychiatric hospitalization;
(c) Lessening of symptoms, as measured by commonly used assessment
tools;
(d) Decreased out-of-home placement, including residential, group,
and foster care, and increased stability of such placements, when
necessary;
(e) Decreased runaways from home or residential placements;
(f) Decreased rates of chemical dependency;
(g) Decreased recidivism;
(h) Improved school attendance and performance;
(i) Reductions in school or child care suspensions or expulsions;
(j) Improved rates of high school graduation and employment; and
(k) Decreased use of mental health services upon reaching adulthood
for mental disorders other than those that require ongoing treatment to
maintain stability.
Performance measure reporting for children's mental health services
should be integrated into existing performance measurement and
reporting systems developed and implemented under chapter 71.24 RCW.
NEW SECTION. Sec. 4
(1) The development of recommended revisions to the access to care
standards for children. The recommended revisions shall reflect the
policies and principles set out in RCW 71.36.005, 71.36.010, and
section 3 of this act, and recognize that early identification,
intervention and prevention services, and brief intervention services
may be provided outside of the regional support network system.
Revised access to care standards shall assess a child's need for mental
health services relying upon behaviors exhibited by a child and
interference with a child's functioning in family, school, or the
community, as well as a child's diagnosis, and should not condition the
receipt of services upon a determination that a child is engaged in
high risk behavior or is in imminent need of hospitalization or out-of-home placement. Assessment and diagnosis for children under five years
of age shall be determined using a nationally accepted assessment tool
designed specifically for children of that age. The recommendations
shall also address whether amendments to RCW 71.24.025 (26) and (27)
and 71.24.035(5) are necessary to implement revised access to care
standards;
(2) Development of a revised children's mental health benefit
package. The department shall ensure that services included in the
children's mental health benefit package reflect the policies and
principles included in RCW 71.36.005 and section 3 of this act, to the
extent allowable under medicaid, Title XIX of the federal social
security act. Strong consideration shall be given to developmentally
appropriate evidence-based and promising practices, family-based
interventions, the use of natural and peer supports, and community
support services. This effort shall include a review of other states'
efforts to fund family-centered children's mental health services
through their medicaid programs;
(3) Consistent with the timeline developed for the system
transformation initiative, recommendations for revisions to the
children's access to care standards and the children's mental health
services benefits package shall be presented to the legislature by
January 1, 2009.
NEW SECTION. Sec. 5 A new section is added to chapter 74.09 RCW
to read as follows:
(a) Outpatient therapy services to be provided by licensed mental
health professionals, as defined in RCW 71.34.020; and
(b) Up to twenty outpatient therapy visits per year, including
family therapy visits integral to a child's treatment.
(2)(a) In conjunction with the revision of program standards under
this section, the department, in consultation with the evidence-based
practice institute established in section 7 of this act, shall develop
and implement policies to improve prescribing practices for treatment
of emotional or behavioral disturbances in children, improve the
quality of children's mental health therapy through increased use of
evidence-based and promising practices and reduced variation in
practice, and improve communication and care coordination between
primary care and mental health providers.
(b) The department shall identify those children with emotional or
behavioral disturbances who may be at high risk due to off-label use of
prescription medication, use of multiple medications, high medication
dosage, or lack of coordination among multiple prescribing providers,
and establish one or more mechanisms to evaluate the appropriateness of
the medication these children are using, including but not limited to
obtaining second opinions from experts in child psychiatry.
(3) The department shall convene a representative group of regional
support networks, community mental health centers, and managed health
care systems contracting with the department under RCW 74.09.522 to:
(a) Establish mechanisms and develop contract language that ensures
increased coordination of and access to medicaid mental health benefits
available to children and their families, including ensuring access to
services that are identified as a result of a developmental screen
administered through early periodic screening, diagnosis, and
treatment;
(b) Define managed health care system and regional support network
contractual performance standards that track access to and utilization
of services; and
(c) Set standards for reducing the number of children that are
prescribed antipsychotic drugs and receive no outpatient mental health
services with their medication.
NEW SECTION. Sec. 6 A new section is added to chapter 71.36 RCW
to read as follows:
NEW SECTION. Sec. 7 A new section is added to chapter 71.24 RCW
to read as follows:
(2) Within funds provided in the biennial operating budget, the
department shall establish a children's mental health evidence-based
practice institute through a request for proposal process. The request
for proposal shall include provisions necessary to ensure collaboration
among entities currently engaged in evaluating and promoting the use of
evidence-based and promising practices in children's mental health
treatment, including but not limited to the University of Washington
department of psychiatry and behavioral sciences, children's hospital
and regional medical center, the University of Washington school of
nursing, the University of Washington school of social work, and the
Washington state institute for public policy. To ensure that funds
appropriated are used to the greatest extent possible for their
intended purpose, the request for proposal shall limit the contractor's
costs of administration to a maximum of fifteen percent of contracted
funding. The institute shall:
(a) Improve the implementation of evidence-based and promising
practices by providing sustained and effective training and
consultation to licensed children's mental health providers and
child-serving agencies who are implementing evidence-based or promising
practices for treatment of children's emotional or behavioral
disorders, or who are interested in adapting these practices to better
serve ethnically or culturally diverse children. Efforts under this
subsection should include a focus on appropriate oversight of
implementation of evidence-based practices to ensure fidelity to these
practices and thereby achieve positive outcomes;
(b) Continue the successful implementation of the "partnerships for
success" model by consulting with communities so they may select,
implement, and continually evaluate the success of evidence-based
practices that are relevant to the needs of children, youth, and
families in their community;
(c) Partner with youth, family members, family advocacy, and
culturally diverse provider organizations to develop a series of
information sessions, literature, and on-line resources for families to
become informed and engaged in evidence-based and promising practices;
(d) Participate in the identification of outcome-based performance
measures under section 3(2) of this act and partner in a statewide
effort to implement statewide outcomes monitoring and quality
improvement processes; and
(e) Serve as a statewide resource to the department and other
entities on child and adolescent evidence-based and promising practices
for children's mental health treatment, maintaining a working knowledge
through ongoing review of academic and professional literature, and
knowledge of other evidence-based practice implementation efforts in
Washington and other states.
(3) Within funds provided in the biennial operating budget, the
department shall issue a request for proposal to implement a pilot
program to support primary care providers in the assessment and
provision of appropriate diagnosis and treatment of children with
mental and behavioral health disorders and track outcomes of this
program. The program shall be designed to promote more accurate
diagnoses and treatment through timely case consultation between
primary care providers and child psychiatric specialists, and focused
educational learning collaboratives with primary care providers.
NEW SECTION. Sec. 8 A new section is added to chapter 74.09 RCW
to read as follows:
(1) The department shall adopt rules and policies providing that
when youth who were enrolled in a medical assistance program
immediately prior to confinement are released from confinement, their
medical assistance coverage will be fully reinstated on the day of
their release, subject to any expedited review of their continued
eligibility for medical assistance coverage that is required under
federal or state law.
(2) The department, in collaboration with county juvenile court
administrators and regional support networks, shall establish
procedures for coordination between department field offices, juvenile
rehabilitation administration institutions, and county juvenile courts
that result in prompt reinstatement of eligibility and speedy
eligibility determinations for youth who are likely to be eligible for
medical assistance services upon release from confinement. Procedures
developed under this subsection must address:
(a) Mechanisms for receiving medical assistance services'
applications on behalf of confined youth in anticipation of their
release from confinement;
(b) Expeditious review of applications filed by or on behalf of
confined youth and, to the extent practicable, completion of the review
before the youth is released; and
(c) Mechanisms for providing medical assistance services' identity
cards to youth eligible for medical assistance services immediately
upon their release from confinement.
(3) For purposes of this section, "confined" or "confinement" means
detained in a facility operated by or under contract with the
department of social and health services, juvenile rehabilitation
administration, or detained in a juvenile detention facility operated
under chapter 13.04 RCW.
(4) The department shall adopt standardized statewide screening and
application practices and forms designed to facilitate the application
of a confined youth who is likely to be eligible for a medical
assistance program.
NEW SECTION. Sec. 9 Educational service district boards may
respond to a request for proposal for operation of a wraparound model
site under this act and, if selected, may contract for the provision of
services to coordinate care and facilitate the delivery of services and
other supports under a wraparound model.
NEW SECTION. Sec. 10 The following acts or parts of acts are
each repealed:
(1) RCW 71.36.020 (Plan for early periodic screening, diagnosis,
and treatment services) and 2003 c 281 s 4 & 1991 c 326 s 13;
(2) RCW 71.36.030 (Children's mental health services delivery
system -- Local planning efforts) and 1991 c 326 s 14; and
(3) RCW 71.36.040 (Issue identification, data collection, plan
revision -- Coordination with other state agencies) and 2003 c 281 s 2.
NEW SECTION. Sec. 11
(a) Funding provided in this subsection may be expended for: Costs
associated with a request for proposal and contracting process;
administrative costs associated with successful bidders' operation of
the wraparound model; the evaluation under (e) of this subsection; and
funding for services needed by children enrolled in wraparound model
sites that are not otherwise covered under existing state programs.
The services provided through the wraparound model sites shall include,
but not be limited to, services covered under the medicaid program.
The department shall maximize the use of medicaid and other existing
state-funded programs as a funding source. However, a broader service
package may be developed with state funds appropriated in this
subsection to meet needs identified in a child's care plan. Amounts
appropriated in this subsection shall supplement, and not supplant,
state, local, or other funding for services funded in this subsection.
(b) The wraparound model sites shall serve children with serious
emotional or behavioral disturbances who are at high risk of
residential or correctional placement or psychiatric hospitalization,
and who have been referred for services from the department, a county
juvenile court, a tribal court, a school, or a licensed mental health
provider or agency.
(c) Through a request for proposal process, the department shall
contract, with educational service districts, regional support
networks, or entities licensed to provide mental health services to
children with serious emotional or behavioral disturbances, to operate
the wraparound model sites. The contractor shall provide care
coordination and facilitate the delivery of services and other supports
to families using a strength-based, highly individualized wraparound
process that adheres to the ten principles of the wraparound process
and evidence-based wraparound practices developed through the national
wraparound initiative at Portland State University. The request for
proposal shall require that the contractor provide evidence of
commitments from at least the following entities to participate in
wraparound care plan development and service provision when
appropriate: Regional support networks, community mental health
agencies, schools, the department of social and health services
children's administration, juvenile courts, the department of social
and health services juvenile rehabilitation administration, and managed
health care systems contracting with the department under RCW
74.09.522.
(d) Contracts for operation of the wraparound model sites shall be
executed on or before April 1, 2008, with enrollment and service
delivery beginning on or before July 1, 2008.
(e) The department shall contract with an independent entity for
evaluation of the wraparound model sites, measuring outcomes for
children served. Outcomes measured shall include, but are not limited
to: Stable family environment, school attendance, school performance,
recidivism, emergency room utilization, and hospitalization.
(2) Ten million dollars from the general fund--state for fiscal
year 2008 and ten million dollars from the general fund--state for
fiscal year 2009 is provided to the department of social and health
services solely for mental health services for low-income children who
do not meet regional support network access to care standards,
regardless of their medical assistance eligibility status. These funds
are intended to serve as a temporary source of funding during the 2007-2009 biennium, pending the adoption of revised regional support network
children's access to care standards and a revised children's mental
health services package. Funds may be expended through contracts with
licensed community mental health centers, licensed mental health
professionals as defined in RCW 71.34.020, community or migrant health
clinics, managed health care systems contracting with the department
under RCW 74.09.522, or other providers. Funds appropriated under this
subsection may be used for necessary mental health services for
children that include, but are not limited to:
(a) Children being served by the children's administration;
(b) Children on parole following release from a facility operated
by or under contract with the juvenile rehabilitation administration;
(c) Children on probation under a court order issued by a county
juvenile court or tribal court; and
(d) Medicaid eligible children who have exhausted their medicaid
managed care or fee-for-service benefit.
These amounts shall supplement, and not supplant, state, local, or
other funding for services funded in this subsection.
(3) Seven hundred thousand dollars from the general fund--state for
fiscal year 2008 and seven hundred thousand dollars from the general
fund--state for fiscal year 2009 is provided to the department of
social and health services for the purpose of implementing section 7(2)
of this act.
(4) One million forty thousand dollars from the general fund--state
for fiscal year 2008 and six hundred thousand dollars from the general
fund--state for fiscal year 2009 is provided to the department of
social and health services for the purpose of implementing section 7(3)
of this act.
(5) Five hundred thousand dollars from the general fund--state for
fiscal year 2008 and five hundred thousand dollars from the general
fund--state for fiscal year 2009 is provided to the economic services
program for the purpose of implementing section 8 of this act.
NEW SECTION. Sec. 12 Captions used in this act are not part of
the law.