| Passed by the House April 19, 2007 Yeas 94 ________________________________________ Speaker of the House of Representatives Passed by the Senate April 19, 2007 Yeas 39 ________________________________________ President of the Senate | I, Richard Nafziger, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is SECOND SUBSTITUTE HOUSE BILL 1088 as passed by the House of Representatives and the Senate on the dates hereon set forth. ________________________________________ Chief Clerk | |
| Approved ________________________________________ Governor of the State of Washington | Secretary of State State of Washington |
| State of Washington | 60th Legislature | 2007 Regular Session |
READ FIRST TIME 03/05/07.
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 and 71.36.030; and providing expiration dates.
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 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;
(8) Integrates educational support services that address students'
diverse learning styles; and
(9) 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 years of age, except as
expressly provided otherwise in state or federal law.
(3) "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.
(4) "County authority" means the board of county commissioners or
county executive.
(((4))) (5) "Department" means the department of social and health
services.
(((5))) (6) "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))) (7) "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.
(8) "Family" means a child's biological parents, adoptive parents,
foster parents, guardian, legal custodian authorized pursuant to Title
26 RCW, a relative with whom a child has been placed by the department
of social and health services, or a tribe.
(9) "Promising practice" or "emerging best practice" means a
practice that presents, based upon preliminary information, potential
for becoming a research-based or consensus-based practice.
(10) "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))) (11) "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.
(12) "Secretary" means the secretary of social and health services.
(13) "Wraparound process" means a family driven planning process
designed to address the needs of children and youth by the formation of
a team that empowers families to make key decisions regarding the care
of the child or youth in partnership with professionals and the
family's natural community supports. The team produces a community-based and culturally competent intervention plan which identifies the
strengths and needs of the child or youth and family and defines goals
that the team collaborates on achieving with respect for the unique
cultural values of the family. The "wraparound process" shall
emphasize principles of persistence and outcome-based measurements of
success.
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
competent 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 competent
children's mental health providers;
(f) Use of developmentally appropriate evidence-based and
research-based 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 involvement with the juvenile justice system;
(h) Improved school attendance and performance;
(i) Reductions in school or child care suspensions or expulsions;
(j) Reductions in use of prescribed medication where cognitive
behavioral therapies are indicated;
(k) Improved rates of high school graduation and employment; and
(l) 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 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;
(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 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.
NEW SECTION. Sec. 5 A new section is added to chapter 74.09 RCW
to read as follows:
(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.
(c) The department shall review the psychotropic medications of all
children under five 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.
(d) The department shall track prescriptive practices with respect
to psychotropic medications with the goal of reducing the use of
medication.
(e) The department shall encourage the use of cognitive behavioral
therapies and other treatments which are empirically supported or
evidence-based, in addition to or in the place of prescription
medication where appropriate.
(2) 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.
(3) The department shall submit a report on progress and any
findings under this section to the legislature by January 1, 2009.
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) To the extent that funds are specifically appropriated for this
purpose or that nonstate funds are available, a children's mental
health evidence-based practice institute shall be established at the
University of Washington division of public behavioral health and
justice policy. The institute shall closely collaborate with entities
currently engaged in evaluating and promoting the use of evidence-based, research-based, promising, or consensus-based 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 University of
Washington's indirect costs of administration shall not exceed ten
percent of appropriated funding. The institute shall:
(a) Improve the implementation of evidence-based and research-based
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
researched-based 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 competent 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 research-based
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, research-based,
promising, or consensus-based 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) To the extent that funds are specifically appropriated for this
purpose, the department in collaboration with the evidence-based
practice institute shall 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
partner with regional support networks to 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
(1) Funding provided 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 subsection (5) of this section; 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, state funds provided may
be used to develop a broader service package to meet needs identified
in a child's care plan. Amounts provided shall supplement, and not
supplant, state, local, or other funding for services that a child
being served through a wraparound site would otherwise be eligible to
receive.
(2) 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.
(3) Through a request for proposal process, the department shall
contract, with regional support networks, alone or in partnership with
either educational service districts 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. The request for proposal shall
require that:
(a) The regional support network agree to use its medicaid revenues
to fund services included in the existing regional support network's
benefit package that a medicaid-eligible child participating in the
wraparound model site is determined to need;
(b) The contractor provide evidence of commitments from at least
the following entities to participate in wraparound care plan
development and service provision when appropriate: 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; and
(c) The contractor will operate the wraparound model site in a
manner that maintains fidelity to the wraparound process as defined in
RCW 71.36.010.
(4) 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.
(5) The evidence-based practice institute established in section 7
of this act shall evaluate the wraparound model sites, measuring
outcomes for children served. Outcomes measured shall include, but are
not limited to: Decreased out-of-home placement, including
residential, group, and foster care, and increased stability of such
placements, school attendance, school performance, recidivism,
emergency room utilization, involvement with the juvenile justice
system, decreased use of psychotropic medication, and decreased
hospitalization.
(6) The evidence-based practice institute shall provide a report
and recommendations to the appropriate committees of the legislature by
December 1, 2010.
NEW SECTION. Sec. 11 A new section is added to chapter 74.09 RCW
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.
NEW SECTION. Sec. 12 (1) The evidence-based practice institute
established in section 7 of this act, in consultation with the
Washington state institute for public policy, shall review and
summarize current law with respect to inpatient and outpatient mental
health treatment for minors.
(2) The review shall include current practices to determine the
percentage of cases in which parents are engaged by treatment providers
and the extent to which they are actively involved in the treatment of
their minor children.
(3) The evidence-based practice institute shall provide a report
and recommendations to the appropriate legislative committees by
December 1, 2008.
(4) This section expires December 1, 2008.
NEW SECTION. Sec. 13 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; and
(2) RCW 71.36.030 (Children's mental health services delivery
system -- Local planning efforts) and 1991 c 326 s 14.
NEW SECTION. Sec. 14 Captions used in this act are not part of
the law.
NEW SECTION. Sec. 15 If specific funding for the purposes of
sections 4, 5, 7, 8, 10, and 11 of this act, referencing the section by
section number and by bill or chapter number, is not provided by June
30, 2007, each section not referenced is null and void.