BILL REQ. #:  H-0458.2 

Read first time 01/20/09.   Referred to Committee on Early Learning & Children's Services.

     AN ACT Relating to equitable access to appropriate and effective children's mental health services; amending RCW 71.24.025, 71.24.055, and 74.09.521; reenacting and amending RCW 71.24.035; and making appropriations.

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

Sec. 1   RCW 71.24.025 and 2008 c 261 s 2 are each amended to read as follows:
     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Acutely mentally ill" means a condition which is limited to a short-term severe crisis episode of:
     (a) A mental disorder as defined in RCW 71.05.020 or, in the case of a child, as defined in RCW 71.34.020;
     (b) Being gravely disabled as defined in RCW 71.05.020 or, in the case of a child, a gravely disabled minor as defined in RCW 71.34.020; or
     (c) Presenting a likelihood of serious harm as defined in RCW 71.05.020 or, in the case of a child, as defined in RCW 71.34.020.
     (2) "Available resources" means funds appropriated for the purpose of providing community mental health programs, federal funds, except those provided according to Title XIX of the Social Security Act, and state funds appropriated under this chapter or chapter 71.05 RCW by the legislature during any biennium for the purpose of providing residential services, resource management services, community support services, and other mental health services. This does not include funds appropriated for the purpose of operating and administering the state psychiatric hospitals.
     (3) "Child" means a person under the age of eighteen years.
     (4) "Chronically mentally ill adult" or "adult who is chronically mentally ill" means an adult who has a mental disorder and meets at least one of the following criteria:
     (a) Has undergone two or more episodes of hospital care for a mental disorder within the preceding two years; or
     (b) Has experienced a continuous psychiatric hospitalization or residential treatment exceeding six months' duration within the preceding year; or
     (c) Has been unable to engage in any substantial gainful activity by reason of any mental disorder which has lasted for a continuous period of not less than twelve months. "Substantial gainful activity" shall be defined by the department by rule consistent with Public Law 92-603, as amended.
     (5) "Clubhouse" means a community-based program that provides rehabilitation services and is certified by the department of social and health services.
     (6) "Community mental health program" means all mental health services, activities, or programs using available resources.
     (7) "Community mental health service delivery system" means public or private agencies that provide services specifically to persons with mental disorders as defined under RCW 71.05.020 and receive funding from public sources.
     (8) "Community support services" means services authorized, planned, and coordinated through resource management services including, at a minimum, assessment, diagnosis, emergency crisis intervention available twenty-four hours, seven days a week, prescreening determinations for persons who are mentally ill being considered for placement in nursing homes as required by federal law, screening for patients being considered for admission to residential services, diagnosis and treatment for children who are acutely mentally ill or severely emotionally disturbed discovered under screening through the federal Title XIX early and periodic screening, diagnosis, and treatment program, investigation, legal, and other nonresidential services under chapter 71.05 RCW, case management services, psychiatric treatment including medication supervision, counseling, psychotherapy, assuring transfer of relevant patient information between service providers, recovery services, and other services determined by regional support networks.
     (9) "Consensus-based" means a program or practice that has general support among treatment providers and experts, based on experience or professional literature, and may have anecdotal or case study support, or that is agreed but not possible to perform studies with random assignment and controlled groups.
     (10) "County authority" means the board of county commissioners, county council, or county executive having authority to establish a community mental health program, or two or more of the county authorities specified in this subsection which have entered into an agreement to provide a community mental health program.
     (11) "Department" means the department of social and health services.
     (12) "Designated mental health professional" means a mental health professional designated by the county or other authority authorized in rule to perform the duties specified in this chapter.
     (13) "Emerging best practice" or "promising practice" means a practice that presents, based on preliminary information, potential for becoming a research-based or consensus-based practice.
     (14) "Evidence-based" means a program or practice that has had multiple site random controlled trials across heterogeneous populations demonstrating that the program or practice is effective for the population.
     (15) "Licensed service provider" means an entity licensed according to this chapter or chapter 71.05 RCW or an entity deemed to meet state minimum standards as a result of accreditation by a recognized behavioral health accrediting body recognized and having a current agreement with the department, that meets state minimum standards or persons licensed under chapter 18.57, 18.71, 18.83, or 18.79 RCW, as it applies to registered nurses and advanced registered nurse practitioners.
     (16) "Long-term inpatient care" means inpatient services for persons committed for, or voluntarily receiving intensive treatment for, periods of ninety days or greater under chapter 71.05 RCW. "Long-term inpatient care" as used in this chapter does not include: (a) Services for individuals committed under chapter 71.05 RCW who are receiving services pursuant to a conditional release or a court-ordered less restrictive alternative to detention; or (b) services for individuals voluntarily receiving less restrictive alternative treatment on the grounds of the state hospital.
     (17) "Mental health services" means all services provided by regional support networks and other services provided by the state for persons who are mentally ill.
     (18) "Mentally ill persons," "persons who are mentally ill," and "the mentally ill" mean persons and conditions defined in subsections (1), (4), (27), and (28) of this section.
     (19) "Recovery" means the process in which people are able to live, work, learn, and participate fully in their communities.
     (20) "Regional support network" means a county authority or group of county authorities or other entity recognized by the secretary in contract in a defined region.
     (21) "Registration records" include all the records of the department, regional support networks, treatment facilities, and other persons providing services to the department, county departments, or facilities which identify persons who are receiving or who at any time have received services for mental illness.
     (22) "Research-based" means a program or practice that has some research demonstrating effectiveness, but that does not yet meet the standard of evidence-based practices.
     (23) "Residential services" means a complete range of residences and supports authorized by resource management services and which may involve a facility, a distinct part thereof, or services which support community living, for persons who are acutely mentally ill, adults who are chronically mentally ill, children who are severely emotionally disturbed, or adults who are seriously disturbed and determined by the regional support network to be at risk of becoming acutely or chronically mentally ill. The services shall include at least evaluation and treatment services as defined in chapter 71.05 RCW, acute crisis respite care, long-term adaptive and rehabilitative care, and supervised and supported living services, and shall also include any residential services developed to service persons who are mentally ill in nursing homes, boarding homes, and adult family homes, and may include outpatient services provided as an element in a package of services in a supported housing model. Residential services for children in out-of-home placements related to their mental disorder shall not include the costs of food and shelter, except for children's long-term residential facilities existing prior to January 1, 1991.
     (24) "Resilience" means the personal and community qualities that enable individuals to rebound from adversity, trauma, tragedy, threats, or other stresses, and to live productive lives.
     (25) "Resource management services" mean the planning, coordination, and authorization of residential services and community support services administered pursuant to an individual service plan for: (a) Adults and children who are acutely mentally ill; (b) adults who are chronically mentally ill; (c) children who are severely emotionally disturbed; or (d) adults who are seriously disturbed and determined solely by a regional support network to be at risk of becoming acutely or chronically mentally ill. Such planning, coordination, and authorization shall include mental health screening for children eligible under the federal Title XIX early and periodic screening, diagnosis, and treatment program. Resource management services include seven day a week, twenty-four hour a day availability of information regarding enrollment of adults and children who are mentally ill in services and their individual service plan to designated mental health professionals, evaluation and treatment facilities, and others as determined by the regional support network.
     (26) "Secretary" means the secretary of social and health services.
     (27) "Seriously disturbed person" means a person who:
     (a) Is gravely disabled or presents a likelihood of serious harm to himself or herself or others, or to the property of others, as a result of a mental disorder as defined in chapter 71.05 RCW;
     (b) Has been on conditional release status, or under a less restrictive alternative order, at some time during the preceding two years from an evaluation and treatment facility or a state mental health hospital;
     (c) Has a mental disorder which causes major impairment in several areas of daily living;
     (d) Exhibits suicidal preoccupation or attempts; or
     (e) Is a child diagnosed by a mental health professional, as defined in chapter 71.34 RCW, as experiencing a mental disorder which is clearly interfering with the child's functioning in family or school or with peers or is clearly interfering with the child's personality development and learning.
     (28) "Severely emotionally disturbed child" or "child who is severely emotionally disturbed" means a child who has been determined by the regional support network to be experiencing a mental disorder as defined in chapter 71.34 RCW, including those mental disorders that result in a behavioral or conduct disorder, that is clearly and substantially interfering with the child's functioning in family, or school or community, or with peers ((and who meets at least one of the following criteria:
     (a) Has undergone inpatient treatment or placement outside of the home related to a mental disorder within the last two years;
     (b) Has undergone involuntary treatment under chapter 71.34 RCW within the last two years;
     (c) Is currently served by at least one of the following child-serving systems: Juvenile justice, child-protection/welfare, special education, or developmental disabilities;
     (d) Is at risk of escalating maladjustment due to:
     (i) Chronic family dysfunction involving a caretaker who is mentally ill or inadequate;
     (ii) Changes in custodial adult;
     (iii) Going to, residing in, or returning from any placement outside of the home, for example, psychiatric hospital, short-term inpatient, residential treatment, group or foster home, or a correctional facility;
     (iv) Subject to repeated physical abuse or neglect;
     (v) Drug or alcohol abuse; or
     (vi) Homelessness)).
     (29) "State minimum standards" means minimum requirements established by rules adopted by the secretary and necessary to implement this chapter for: (a) Delivery of mental health services; (b) licensed service providers for the provision of mental health services; (c) residential services; and (d) community support services and resource management services.
     (30) "Treatment records" include registration and all other records concerning persons who are receiving or who at any time have received services for mental illness, which are maintained by the department, by regional support networks and their staffs, and by treatment facilities. Treatment records do not include notes or records maintained for personal use by a person providing treatment services for the department, regional support networks, or a treatment facility if the notes or records are not available to others.
     (31) "Tribal authority," for the purposes of this section and RCW 71.24.300 only, means: The federally recognized Indian tribes and the major Indian organizations recognized by the secretary insofar as these organizations do not have a financial relationship with any regional support network that would present a conflict of interest.

Sec. 2   RCW 71.24.035 and 2008 c 267 s 5 and 2008 c 261 s 3 are each reenacted and amended to read as follows:
     (1) The department is designated as the state mental health authority.
     (2) The secretary shall provide for public, client, and licensed service provider participation in developing the state mental health program, developing contracts with regional support networks, and any waiver request to the federal government under medicaid.
     (3) The secretary shall provide for participation in developing the state mental health program for children and other underserved populations, by including representatives on any committee established to provide oversight to the state mental health program.
     (4) The secretary shall be designated as the regional support network if the regional support network fails to meet state minimum standards or refuses to exercise responsibilities under RCW 71.24.045, until such time as a new regional support network is designated under RCW 71.24.320.
     (5) The secretary shall:
     (a) Develop a biennial state mental health program that incorporates regional biennial needs assessments and regional mental health service plans and state services for adults and children with mental illness. The secretary shall also develop a six-year state mental health plan;
     (b) Assure that any regional or county community mental health program provides access to treatment for the region's residents, including parents who are respondents in dependency cases, in the following order of priority: (i) Persons with acute mental illness; (ii) adults with chronic mental illness and children who are severely emotionally disturbed; and (iii) persons who are seriously disturbed. Such programs shall provide:
     (A) Outpatient services;
     (B) Emergency care services for twenty-four hours per day;
     (C) Day treatment for persons with mental illness which includes training in basic living and social skills, supported work, vocational rehabilitation, and day activities. Such services may include therapeutic treatment. In the case of a child, day treatment includes age-appropriate basic living and social skills, educational and prevocational services, day activities, and therapeutic treatment;
     (D) Screening for patients being considered for admission to state mental health facilities to determine the appropriateness of admission;
     (E) Employment services, which may include supported employment, transitional work, placement in competitive employment, and other work-related services, that result in persons with mental illness becoming engaged in meaningful and gainful full or part-time work. Other sources of funding such as the division of vocational rehabilitation may be utilized by the secretary to maximize federal funding and provide for integration of services;
     (F) Consultation and education services; and
     (G) Community support services;
     (c) Develop and adopt rules establishing state minimum standards for the delivery of mental health services pursuant to RCW 71.24.037 including, but not limited to:
     (i) Licensed service providers. These rules shall permit a county-operated mental health program to be licensed as a service provider subject to compliance with applicable statutes and rules. The secretary shall provide for deeming of compliance with state minimum standards for those entities accredited by recognized behavioral health accrediting bodies recognized and having a current agreement with the department;
     (ii) Regional support networks; and
     (iii) Inpatient services, evaluation and treatment services and facilities under chapter 71.05 RCW, resource management services, and community support services;
     (d) Assure that the special needs of persons who are minorities, elderly, disabled, children, low-income, and parents who are respondents in dependency cases are met within the priorities established in this section.
     (i) To ensure that the special needs of children are met within the priorities established in this section, the secretary shall include a provision in its standard regional support network biennial contract that establishes minimum thresholds for children served by each regional support network, as a percentage of both the persons served by the regional support network and regional support network outpatient service hours provided. The minimum thresholds shall be as follows:
     (A) For the biennium beginning July 1, 2009, at least thirty percent of the persons served by each regional support network must be children, and at least twenty-five percent of outpatient service hours provided must be provided to children. This minimum threshold must be met by each regional support network on or before July 1, 2010.
     (B) For the biennium beginning July 1, 2011, at least thirty-six percent of the persons served by each regional support network must be children, and at least thirty-six percent of outpatient service hours provided must be provided to children. This minimum threshold must be met by each regional support network on or before July 1, 2012.
     (ii) The contract also must set minimum standards for regional support network collaboration with the department of social and health services children's administration, division of juvenile rehabilitation, and division of alcohol and substance abuse, and with local school districts and juvenile courts to ensure coordinated and effective purchase and delivery of evidence-based services to children who are in need of services from multiple child-serving systems;
     (e) Establish a standard contract or contracts, consistent with state minimum standards, RCW 71.24.320 and 71.24.330, which shall be used in contracting with regional support networks. The standard contract shall include a maximum fund balance, which shall be consistent with that required by federal regulations or waiver stipulations;
     (f) Establish, to the extent possible, a standardized auditing procedure which minimizes paperwork requirements of regional support networks and licensed service providers. The audit procedure shall focus on the outcomes of service and not the processes for accomplishing them;
     (g) Develop and maintain an information system to be used by the state and regional support networks that includes a tracking method which allows the department and regional support networks to identify mental health clients' participation in any mental health service or public program on an immediate basis. The information system shall not include individual patient's case history files. Confidentiality of client information and records shall be maintained as provided in this chapter and in RCW 71.05.390, 71.05.420, and 71.05.440;
     (h) License service providers who meet state minimum standards;
     (i) Certify regional support networks that meet state minimum standards;
     (j) Periodically monitor the compliance of certified regional support networks and their network of licensed service providers for compliance with the contract between the department, the regional support network, and federal and state rules at reasonable times and in a reasonable manner;
     (k) Fix fees to be paid by evaluation and treatment centers to the secretary for the required inspections;
     (l) Monitor and audit regional support networks and licensed service providers as needed to assure compliance with contractual agreements authorized by this chapter;
     (m) Adopt such rules as are necessary to implement the department's responsibilities under this chapter;
     (n) Assure the availability of an appropriate amount, as determined by the legislature in the operating budget by amounts appropriated for this specific purpose, of community-based, geographically distributed residential services;
     (o) Certify crisis stabilization units that meet state minimum standards; and
     (p) Certify clubhouses that meet state minimum standards.
     (6) The secretary shall use available resources only for regional support networks, except to the extent authorized, and in accordance with any priorities or conditions specified, in the biennial appropriations act.
     (7) Each certified regional support network and licensed service provider shall file with the secretary, on request, such data, statistics, schedules, and information as the secretary reasonably requires. A certified regional support network or licensed service provider which, without good cause, fails to furnish any data, statistics, schedules, or information as requested, or files fraudulent reports thereof, may have its certification or license revoked or suspended.
     (8) The secretary may suspend, revoke, limit, or restrict a certification or license, or refuse to grant a certification or license for failure to conform to: (a) The law; (b) applicable rules and regulations; (c) applicable standards; or (d) state minimum standards.
     (9) The superior court may restrain any regional support network or service provider from operating without certification or a license or any other violation of this section. The court may also review, pursuant to procedures contained in chapter 34.05 RCW, any denial, suspension, limitation, restriction, or revocation of certification or license, and grant other relief required to enforce the provisions of this chapter.
     (10) Upon petition by the secretary, and after hearing held upon reasonable notice to the facility, the superior court may issue a warrant to an officer or employee of the secretary authorizing him or her to enter at reasonable times, and examine the records, books, and accounts of any regional support network or service provider refusing to consent to inspection or examination by the authority.
     (11) Notwithstanding the existence or pursuit of any other remedy, the secretary may file an action for an injunction or other process against any person or governmental unit to restrain or prevent the establishment, conduct, or operation of a regional support network or service provider without certification or a license under this chapter.
     (12) The standards for certification of evaluation and treatment facilities shall include standards relating to maintenance of good physical and mental health and other services to be afforded persons pursuant to this chapter and chapters 71.05 and 71.34 RCW, and shall otherwise assure the effectuation of the purposes of these chapters.
     (13) The standards for certification of crisis stabilization units shall include standards that:
     (a) Permit location of the units at a jail facility if the unit is physically separate from the general population of the jail;
     (b) Require administration of the unit by mental health professionals who direct the stabilization and rehabilitation efforts; and
     (c) Provide an environment affording security appropriate with the alleged criminal behavior and necessary to protect the public safety.
     (14) The standards for certification of a clubhouse shall at a minimum include:
     (a) The facilities may be peer-operated and must be recovery-focused;
     (b) Members and employees must work together;
     (c) Members must have the opportunity to participate in all the work of the clubhouse, including administration, research, intake and orientation, outreach, hiring, training and evaluation of staff, public relations, advocacy, and evaluation of clubhouse effectiveness;
     (d) Members and staff and ultimately the clubhouse director must be responsible for the operation of the clubhouse, central to this responsibility is the engagement of members and staff in all aspects of clubhouse operations;
     (e) Clubhouse programs must be comprised of structured activities including but not limited to social skills training, vocational rehabilitation, employment training and job placement, and community resource development;
     (f) Clubhouse programs must provide in-house educational programs that significantly utilize the teaching and tutoring skills of members and assist members by helping them to take advantage of adult education opportunities in the community;
     (g) Clubhouse programs must focus on strengths, talents, and abilities of its members;
     (h) The work-ordered day may not include medication clinics, day treatment, or other therapy programs within the clubhouse.
     (15) The department shall distribute appropriated state and federal funds in accordance with any priorities, terms, or conditions specified in the appropriations act.
     (16) The secretary shall assume all duties assigned to the nonparticipating regional support networks under chapters 71.05, 71.34, and 71.24 RCW. Such responsibilities shall include those which would have been assigned to the nonparticipating counties in regions where there are not participating regional support networks.
     The regional support networks, or the secretary's assumption of all responsibilities under chapters 71.05, 71.34, and 71.24 RCW, shall be included in all state and federal plans affecting the state mental health program including at least those required by this chapter, the medicaid program, and P.L. 99-660. Nothing in these plans shall be inconsistent with the intent and requirements of this chapter.
     (17) The secretary shall:
     (a) Disburse funds for the regional support networks within sixty days of approval of the biennial contract. The department must either approve or reject the biennial contract within sixty days of receipt.
     (b) Enter into biennial contracts with regional support networks. The contracts shall be consistent with available resources. No contract shall be approved that does not include progress toward meeting the goals of this chapter by taking responsibility for: (i) Short-term commitments; (ii) residential care; and (iii) emergency response systems.
     (c) Notify regional support networks of their allocation of available resources at least sixty days prior to the start of a new biennial contract period.
     (d) Deny all or part of the funding allocations to regional support networks based solely upon formal findings of noncompliance with the terms of the regional support network's contract with the department. Regional support networks disputing the decision of the secretary to withhold funding allocations are limited to the remedies provided in the department's contracts with the regional support networks.
     (18) The department, in cooperation with the state congressional delegation, shall actively seek waivers of federal requirements and such modifications of federal regulations as are necessary to allow federal medicaid reimbursement for services provided by free-standing evaluation and treatment facilities certified under chapter 71.05 RCW. The department shall periodically report its efforts to the appropriate committees of the senate and the house of representatives.

Sec. 3   RCW 71.24.055 and 2007 c 359 s 4 are each amended to read as follows:
     ((As part of the system transformation initiative,)) The department of social and health services, in consultation with the children's mental health evidence-based practice institute established under RCW 71.24.061, shall undertake the following activities related specifically to children's mental health services:
     (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 71.36.025, 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 based upon the child's diagnosis and its negative impact upon his or her persistent impaired functioning in family, school, or the community, and should not solely 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;)) Revisions to the regional support network access to care standards for children.
     (a) The revisions shall reflect the definition of severely emotionally disturbed child in RCW 71.24.025, and the policies and principles set forth in RCW 71.36.005, 71.36.010, and 71.36.035;
     (b) For children under five years of age, a nationally accepted assessment tool must be used for assessment and diagnosis. The tool must be specifically designed for children of that age, such as the diagnostic classification of mental health and development disorders of infancy and early childhood, revised;
     (c) The access to care standards for children under five years of age must:
     (i) Accommodate the features of the assessment tool adopted under subsection (1)(b) of this section that are specific to infants, toddlers, and young children, recognizing that behaviors that are assessed and demonstrated in such young children may differ significantly from those assessed and demonstrated in school-age children; and
     (ii) Acknowledge the critical importance of the parent-child dyad, both with respect to the impact of a parent's emotional difficulties, such as postpartum or maternal depression or substance abuse, upon a young child and the need to jointly treat both the parent and the young child in order to effectively treat the child;
     (d) The revised access to care standards must be fully implemented by July 1, 2011, based upon an orderly phase-in schedule developed in consultation with regional support networks, mental health service providers, consumers, and other interested stakeholders. The first phase of revisions must address modifications related to children under five years of age, and be implemented on or before July 1, 2010. The department shall submit the phase-in schedule to the governor and the legislature by September 15, 2009; and
     (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 71.36.025, 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 research-based 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)).

Sec. 4   RCW 74.09.521 and 2007 c 359 s 11 are each amended to read as follows:
     (((1))) To the extent that funds are specifically appropriated for this purpose the department shall revise its medicaid healthy options managed care and fee-for-service program standards under medicaid, Title XIX of the federal social security act to improve access to mental health services for children who do not meet the regional support network access to care standards. Effective July 1, 2008, the program standards shall be revised to allow outpatient therapy services to be provided by licensed mental health professionals, as defined in RCW 71.34.020, and up to twenty outpatient therapy hours per calendar year, including family therapy visits integral to a child's treatment.
     (((2) This section expires July 1, 2010.)) The department and the children's mental health evidence-based practice institute established in RCW 71.24.061 shall collaborate to encourage and incentivize the use of prescribing practices and evidence-based and research-based practices developed under RCW 74.09.480 by mental health professionals serving children under this section.

NEW SECTION.  Sec. 5   (1) The sum of __ dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 2011, from the general fund--state appropriation to the department of social and health services. This appropriation is provided solely to continue the activities initiated during the 2007-2009 biennium to implement House Bill No. 1088 (2007). These activities include the wraparound services pilot program, expedited medicaid enrollment for youth leaving juvenile rehabilitation institutions and county juvenile detention facilities, psychiatric consultation services for primary care providers, the University of Washington children's mental health evidence-based practice institute, activities to improve prescribing practices for children's mental health medications under the medicaid program, and expanded medicaid children's mental health outpatient benefits.
     (2) The sum of __ dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 2011, from the general fund--federal appropriation to the department of social and health services. This appropriation is provided solely to continue the activities initiated during the 2007-2009 biennium to implement House Bill No. 1088 (2007). These activities include the wraparound services pilot program, expedited medicaid enrollment for youth leaving juvenile rehabilitation institutions and county juvenile detention facilities, psychiatric consultation services for primary care providers, the University of Washington children's mental health evidence-based practice institute, activities to improve prescribing practices for children's mental health medications under the medicaid program, and expanded medicaid children's mental health outpatient benefits.