BILL REQ. #: H-0249.4
| State of Washington | 60th Legislature | 2007 Regular Session |
Read first time 01/10/2007. Referred to Committee on Early Learning & Children's Services.
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 a new section to chapter 71.24 RCW; adding a new section to chapter 74.09 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 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
(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, or a relative with whom a child has been
placed by the department of social and health services or a tribe.
(8) "Promising practice" means a practice 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, 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, pediatricians and other physicians, 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.
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. 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. They shall provide an
opportunity for children under the age of six to be served without the
need to diagnose a specific mental disorder. 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;
(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, 2008.
NEW SECTION. Sec. 5 A new section is added to chapter 71.36 RCW
to read as follows:
(1) Outpatient therapy services to be provided by mental health
professionals, as defined in RCW 71.34.020; and
(2) Up to twenty outpatient therapy visits per year, including
family therapy visits integral to a child's treatment.
In conjunction with the revision of program standards under this
section, the department and the evidence-based practice institute
established in section 7 of this act shall develop, and the department
shall 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.
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, a
children's evidence-based practice institute shall be established at
the University of Washington division of public behavioral health and
justice policy. The institute shall be developed and operated in
partnership with the University of Washington school of nursing and the
University of Washington school of social work. The institute shall:
(a) Improve the implementation of evidence-based and promising
practices by providing sustained and effective training and
consultation to specialty and primary care providers statewide on
treatments for specific children's mental health problems. Primary
care providers should receive timely consultation from psychiatric
specialists to promote their ability to safely and effectively
prescribe medication and to coordinate their treatment with therapy and
other supportive services a child is receiving;
(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, 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.
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, county juvenile courts, and
institutes for mental diseases 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:
(a) "Confined" or "confinement" means detained in a facility
operated by or under contract with the department of social and health
services, juvenile rehabilitation administration; detained in a
juvenile detention facility operated under chapter 13.04 RCW; or
admitted to an institute for mental disease, as defined in 42 C.F.R.
Part 435, section 1009 on the effective date of this section.
(b) "Likely to be eligible" means that a youth was enrolled in a
medical assistance program anytime during the year prior to his or her
confinement and his or her enrollment was terminated during his or her
confinement.
(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 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. 10
(a) The wraparound model sites shall serve children with serious
emotional or behavioral disturbances who are at immediate risk of
residential or correctional placement or psychiatric hospitalization,
and who have been referred for services from the children's
administration, a county juvenile court, a tribal court, or the
juvenile rehabilitation administration.
(b) The department shall contract with regional support networks or
other entities that are 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 services and a network of contracted agency and individual
providers to 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.
(c) To fund services provided through the wraparound model sites,
the department shall combine and transfer such funds appropriated in
the biennial operating budget to the children's administration for out-of-home placements, the juvenile rehabilitation administration for
institutional placements, and the health and rehabilitation services
administration for its medical assistance programs and mental health
programs. The amount of funding assigned to the wraparound model sites
from each program may not exceed the average per capita cost of an out-of-home, correctional, or institutional placement assumed in the
biennial budget for the respective programs. In implementing the
wraparound model sites, the department may withhold from calculations
of "available resources," as set forth in RCW 71.24.025, sums needed to
finance mental health services for children receiving mental health
services through the wraparound model sites.
(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) Twelve million dollars from the general fund--state for fiscal
year 2008 and twelve 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 mental health professionals as defined in RCW 71.34.020,
community mental health centers, community or migrant health clinics,
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
healthy options 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 University of
Washington for the purpose of implementing section 7 of this act.
(4) 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. 11 Captions used in this act are not part of
the law.