SSB 6558

Brief Description: Concerning intensive home and community-based mental health services for medicaid-eligible children.

Sponsors: Senate Committee on Ways & Means (originally sponsored by Senators O'Ban and Darneille).

Hearing Date: 2/26/14

Staff: Luke Wickham (786-7146).

Background:

Children who meet the Access to Care Standards (ACS) receive their mental health services through the Regional Support Networks (RSNs) in Washington. The RSNs provide services administered by the Department of Social and Health Services (DSHS) including both outpatient and inpatient treatment. For Medicaid eligible youth, comprehensive mental health services are available through the RSNs, while crisis focused services are available to non-Medicaid eligible youth.

Medicaid eligible youth who do not meet the ACS receive outpatient mental health services through the Managed Care Organizations or the Fee-for-Service program. These are outpatient only services administered by the Health Care Authority (HCA).

Wraparound Pilot Programs.

The Legislature directed that the DSHS contract for implementation of a wraparound model of integrated children's mental health services in up to four regional support networks. The wraparound model sites are required to 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 DSHS, a county juvenile court, a tribal court, a school, or a licensed mental health provider or agency.

T.R. vs. Quigley & Teeter Settlement.

There was final court approval of a settlement agreement on December 19, 2013, related to the T.R. v. Quigley & Teeter class action litigation. The class includes youth that qualify or would qualify for Medicaid, have a mental illness or condition as determined by a licensed practitioner, and have a functional impairment that substantially interferes with functioning in family, school, or the community, and for whom intensive home and community-based services coverable by Medicaid have been recommended. The defendants in the litigation are the Secretary of DSHS and the Director of the HCA.

The specific objective of the settlement is the development and successful implementation of a five-year plan that delivers Wraparound with Intensive Services (WISe) and supports statewide. The agreement is intended to result in all eligible class members receiving timely WISe services that are medically necessary.

The WISe program and services are a less restrictive alternative to Behavioral Rehabilitation Services (BRS) and the Children's Long-term Inpatient Program (CLIP), and WISe will be provided if a youth is determined eligible. The DSHS must provide a WISe screen to all youth prior to approval for BRS or CLIP to determine medical necessity for the WISe program and if the youth's needs can be safely met in a less restrictive environment. Youth enrolled in BRS and CLIP will be periodically screened, at least every six months and at discharge, to determine if they can be transitioned to the WISe program.

The settlement agreement includes three components including goals, commitments, and exit strategies. The goals are provided for planning and development purposes. The commitments are the action items that the DSHS and the HCA will do to implement the agreement. The exit criteria are the measures that will determine whether the DSHS and the HCA are in substantial compliance with the settlement agreement such that the case can be dismissed.

Summary of Bill:

The Wraparound Pilot Program for children with serious emotional or behavioral disturbance is replaced with a requirement that the DSHS implement statewide, a Wraparound with Intensive Services Medicaid program of integrated home and community-based children's mental health services beginning July 1, 2014.

The WISe program must serve youth under age 21 with a mental illness or condition who have a functional impairment which substantially interferes with or substantially limits the ability to function in the family, school, or community setting, and for whom intensive home and community-based services have been recommended by a licensed practitioner to correct the mental illness.

The individuals who may refer youth for the WISE program include:

• self-referrals from the youth or youth's family;

• regional support networks;

• mental health or medical providers;

• tribes or tribal courts;

• the Health Care Authority;

• the DSHS;

• juvenile Courts;

• schools; and

• law enforcement.

The DSHS must track, monitor, and report on client outcomes. During the implementation of the WISE program, the DSHS must provide annual implementation outcome report to the Office of Financial Management and the appropriate legislative committees by December 1. Throughout the implementation process, the DSHS must seek input from stakeholders on:

• the adequacy and availability of core services required for the WISE program within each provider network;

• performance measures, outcomes and quality improvement; and

• recommendations for participants in a local collaborative body to ensure that stakeholders have a clear pathway to receive intensive home and community-based wraparound services.

Appropriation: None.

Fiscal Note: Available.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.