SB 534-FN - AS INTRODUCED
2016 SESSION
16-2932
05/01
SENATE BILL 534-FN
AN ACT to implement a system of care for children's behavioral health.
SPONSORS: Sen. Forrester, Dist 2; Sen. Avard, Dist 12; Sen. Carson, Dist 14; Sen. Feltes, Dist 15; Sen. Fuller Clark, Dist 21; Sen. Kelly, Dist 10; Sen. Lasky, Dist 13; Sen. Little, Dist 8; Sen. Morse, Dist 22; Sen. Reagan, Dist 17; Sen. Sanborn, Dist 9; Sen. Stiles, Dist 24; Sen. Watters, Dist 4; Rep. Wallner, Merr. 10; Rep. Rosenwald, Hills. 30; Rep. Kotowski, Merr. 24; Rep. Ladd, Graf. 4
COMMITTEE: Health and Human Services
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ANALYSIS
This bill directs the department of health and human services and the department of education to develop a comprehensive system of care for children's behavioral health services. The bill establishes reporting requirements and authorizes the departments to enter into an interagency agreement regarding program implementation.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
16-2932
05/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT to implement a system of care for children's behavioral health.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Findings. The general court finds that:
I. Mental health disorders are the most expensive health conditions in childhood, straining public and private resources. The cost of the most expensive interventions are largely borne by the public sector.
II. Children with serious and complex behavioral health conditions are frequently involved in multiple service systems, creating a risk of expensive duplication of services and reduced effectiveness due to inconsistent approaches to treatment.
III. Serious mental health disorders can result in devastating consequences to children and their families, including dropping out of school, juvenile and criminal justice involvement, low vocational success, inability to live independently, and suicide.
IV. Effective treatment of such disorders at the earliest possible stage reduces total expenditures and makes it more likely that affected children will graduate from high school, become employed, and avoid the need for public benefits.
V. Meaningful family and youth involvement in the planning and delivery of their own services increases effectiveness by building peer supports and leveraging families’ strengths and natural supports.
VI. Schools and early childhood programs using multi-tiered system of supports optimize school and student functioning through services supported by the community and parents, positive behavior supports, and data for decision-making.
VII. The Children’s Behavioral Health Collaborative, a joint effort of the department of education, the department of health and human services, and more than 50 other entities engaged in children’s services, has developed a comprehensive plan for improving the effectiveness, efficiency, and integration of children’s behavioral health services in New Hampshire. The collaborative's efforts have been assisted by funding from the federal government, the New Hampshire Charitable Foundation and the Endowment for Health. The resulting plan calls for transitioning to a system of care for children’s behavioral health consisting of a coordinated array of services designed to improve cost-effectiveness, avoid duplication, and provide care in the least restrictive environment. Cost-effectiveness in the plan is achieved by decreased use of inpatient and residential services, increased cross-system collaboration, decreased duplication, and improved use of Medicaid.
VIII. Other states have implemented approaches utilizing a system of care, and they have experienced improvements in the functioning of youth and their families, improvements in systems, improvements in quality of care, and decreased costs for youth with the most serious behavioral health challenges.
2 New Chapter; System of Care for Children’s Mental Health. Amend RSA by inserting after chapter 135-E the following new chapter:
CHAPTER 135-F
SYSTEM OF CARE FOR CHILDREN’S MENTAL HEALTH
135-F:1 Purposes. The purposes of this chapter are to:
I. Increase service effectiveness and improve outcomes for children with behavioral health challenges and their caretakers.
II. Reduce the cost of providing services by leveraging funding sources other than general funds, reducing the need for costly out-of-home placements, and reducing duplication across agencies.
III. Coordinate care for children involved in multiple systems and children at risk of court involvement and out-of-home placement.
135-F:2 Statement of Policy. It is the policy of New Hampshire to implement a system of care model for providing behavioral health services to children in all of the publicly-funded service systems in the state.
135-F:3 Definition; System of Care.
I. In this chapter, “system of care” means an integrated and comprehensive delivery structure for the provision of publicly funded behavioral health services to New Hampshire children and youth.
II. The system of care is to provide services to all children and youth receiving publicly-funded behavioral health services, including, but not limited to, children and youth in any of the following systems:
(a) Children in need of services under RSA 169-D.
(b) Juvenile delinquency under RSA 169-B.
(c) Child protection under RSA 169-C.
(d) Children with disabilities under RSA 186-C.
(e) Children and youth eligible for services under RSA 135-C.
(f) Children eligible for early intervention pursuant to Part C of the Individuals with Disabilities Education Act and He-M 510.
(g) Children eligible for the child care scholarship program under He-C 6910 due to disability.
III. The system of care shall have the following characteristics:
(a) A comprehensive behavioral health program with a flexible benefit package that includes clinically necessary and appropriate home and community-based treatment services and comprehensive support services in the least restrictive setting.
(b) An absence of significant gaps in services and barriers to access services.
(c) Community-based care planning and service delivery, including services and supports for children from birth through early childhood.
(d) Service planning and implementation based on the needs and preferences of the child or youth and his or her family which places an emphasis on early identification, prevention, and treatment and uses an individualized wraparound approach for children with complex needs.
(e) Services that are family-driven, youth-guided, community-based, and culturally and linguistically competent.
(f) An efficient balance of local participation and state-wide administration.
(g) Integration of funding streams.
(h) A performance measurement system for monitoring quality and access.
(i) Accountability for quality, access, and cost.
(j) Comprehensive children and youth behavioral health training for agency and system staff and interested parents and guardians.
(k) Effective identification of youth in need of transition services to adult systems.
135-F:4 Duties of Commissioner of the Department of Health and Human Services. The commissioner of the department of health and human services shall:
I. To the extent possible within existing statutory and budgetary constraints, modify the policies and practices of the department of health and human services to establish a system of care; and
II. Develop a plan for full establishment and maintenance of a system of care. Such plan shall be reviewed and amended annually. It shall include sufficient detail to allow compliance with the reporting requirements of RSA 135-F:6, and shall address at least the following elements:
(a) System capacity, including workforce sufficiency.
(b) Federal funding participation, including but not limited to Medicaid waivers and plan amendments.
(c) Changes to statutes, administrative rules, and structure of appropriations, and department policy, practice, and structure.
(d) Projections of cost savings from increased service effectiveness and reductions in costly forms of care and use of such savings to close existing gaps in children’s behavioral health services.
(e) Recommended modifications to law, practice, and policy to prepare for and accommodate the participation of privately funded service providers in the system of care.
(f) Coordination with the plans and activities of the commissioner of the department of education to implement the system of care.
135-F:5 Duties of Commissioner of the Department of Education. The commissioner of the department of education shall:
I. To the extent possible within existing statutory and budgetary constraints, modify the policies and practices of the department of education to support establishment of a system of care; and
II. Develop a plan for full support and participation of the department of education in the establishment and maintenance of a system of care by the department of health and human services. Such plan shall be reviewed and amended annually. It shall include sufficient detail to allow compliance with the reporting requirements of RSA 135-F:6, and shall address at least the following elements:
(a) Development of a multi-tiered system of supports in New Hampshire schools.
(b) System capacity, including workforce sufficiency.
(c) Federal funding participation, including but not limited to Medicaid waivers and plan amendments.
(d) Changes to statutes, administrative rules, and structure of appropriations, and department policy, practice, and structure.
(e) Projections of cost savings from increased service effectiveness and reductions in costly forms of care and use of such savings to close existing gaps in children’s behavioral health services.
(f) Coordination with the plans and activities of the commissioner of the department of health and human services to implement the system of care.
135-F:6 Reporting Requirements. The commissioners of the department of health and human services and the department of education shall issue a joint system of care report on or before December 1 of each year, beginning on December 1, 2016. The report shall be provided to the governor and executive council, the speaker of the house of representatives, the president of the senate, the house and senate finance committees, and the house and senate policy committees with jurisdiction over health and human services and education issues.
I. Beginning in 2016, the report shall address the following:
(a) The total cost of children's behavioral health services.
(b) The extent to which the state’s behavioral health service systems are consistent with a system of care.
(c) A description of any actual or planned changes in department policy or practice or developments external to the departments that will affect implementation of a system of care.
(d) Any other available information relevant to progress toward full implementation of a system of care.
II. Beginning in 2017, the report shall also address the following:
(a) A summary of the interagency agreement between the departments required by RSA 135-F:7.
(b) Identification of those actions which will be required to maximize federal and private insurance funding participation in the system of care, along with target dates for completion.
(c) Identification of changes to statutes, administrative rules, policies, practices, and managed care and provider contracts which will be necessary to fully implement the system of care.
(d) Identification of significant gaps in the array of children’s behavioral health services, along with a description of plans to close those gaps.
III. Beginning in 2018, the report shall also address the following:
(a) Projections of future demand for services in the system of care.
(b) Identification of shortfalls in workforce sufficiency affecting full implementation of the system of care and plans for addressing those shortfalls.
(c) Identification of specific plan amendments and other changes to the Medicaid system required for full implementation of the system of care and plans for making those changes.
(d) Numbers of children and youth awaiting services in various categories.
IV. Beginning in 2019, the report shall also address the following:
(a) Detailed statistical information regarding children and families serviced, along with demographic characteristics, service need and provision, involvement in service systems, service funding sources, and placement or other site of service provision.
(b) Outcomes, including but not limited to status upon exit from the system of care, measured treatment results, recidivism, and other returns to the service system.
(c) Financial information, including but not limited to measures of cost-effectiveness, comparisons with other states with regard to levels of funding from federal, state, local, and private sources, and cost savings resulting from service coordination and effectiveness.
(d) An assessment of any influences external to the department of health and human services and the department of education, including configuration of the private children's behavioral health care system, which may be affecting establishment of the system of care.
135-F:7 Joint Responsibilities of the Commissioner of the Department of Education and the Commissioner of the Department of Health and Human Services.
I. The commissioner of the department of education and the commissioner of the department of health and human services shall enter into an interagency agreement which supports full implementation of a system of care. The agreement shall be completed no later than December 1, 2017, and shall be amended as necessary and renewed no less frequently than every 2 years. The agreement shall provide for:
(a) Coordination of a delivery system of behavioral health services across the life span of children, youth, and adults with behavioral health needs.
(b) Maximum federal reimbursement and revenue.
(c) Coordination of care and funding among agencies.
(d) Assistance to local education and behavioral health providers, including but not limited to:
(1) Development of model agreements to be utilized by school districts, other education providers, area agencies, community mental health centers, and other entities participating in the system of care.
(2) Provision of technical assistance to support development of coordinated services by school districts, other education providers, area agencies, community mental health centers, and other entities participating in the system of care.
II. The commissioners may apply for any federal waivers, plan amendments, or other changes or expansion of federal funding mechanisms necessary to implement the provisions of the agreement.
3 Effective Date. This act shall take effect upon its passage.
16-2932
1/28/16
SB 534-FN- FISCAL NOTE
AN ACT to implement a system of care for children's behavioral health.
FISCAL IMPACT:
The Departments of Education and Health and Human Services state this bill, as introduced, will increase state general fund expenditures by $535,870 in FY 2017, $497,393 in FY 2018, $522,790 in FY 2019, and $549,239 in FY 2020. There will be no impact on county and local expenditures, or on state, county, and local revenue.
METHODOLOGY:
The Department of Education states this bill requires it to partner with the Department of Health and Human Services to develop a comprehensive system of care for children's behavioral health services, consisting of a coordinated array of services designed to improve cost-effectiveness, avoid duplication, and provide care in the least restrictive environment. The bill also establishes reporting requirements relative to the performance of services provided. The Department states it does not currently have a plan in place to provide state comprehensive services to school-age children as required by the bill, and four new positions - one Program Administrator III, two Education Consultants, and one Program Assistant I - will be necessary to implement the bill. The Department projects the cost of these positions as follows:
Administrator III (LG 31) | FY 2017 | FY 2018 | FY 2019 | FY 2020 |
Salary | $62,732 | $67,041 | $70,181 | $73,359 |
Benefits | $29,507 | $31,635 | $33,622 | $35,719 |
Other Expenses | $5,350 | $350 | $350 | $350 |
Position Total: | $97,589 | $99,026 | $104,153 | $109,428 |
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Education Consultant I (LG 26) | FY 2017 | FY 2018 | FY 2019 | FY 2020 |
Salary | $50,583 | $53,898 | $56,238 | $58,676 |
Benefits | $27,059 | $28,986 | $30,813 | $32,760 |
Other Expenses | $5,350 | $350 | $350 | $350 |
Position Total: | $82,992 | $83,234 | $87,401 | $91,786 |
x Two Positions: | $165,984 | $166,468 | $174,802 | $183,572 |
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Program Assistant I (LG 12) | FY 2017 | FY 2018 | FY 2019 | FY 2020 |
Salary | $28,743 | $30,401 | $31,649 | $32,858 |
Benefits | $22,659 | $24,252 | $25,858 | $27,558 |
Other Expenses | $5,350 | $350 | $350 | $350 |
Position Total: | $56,752 | $55,003 | $57,857 | $60,766 |
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Total Position Costs: | $320,325 | $320,497 | $336,812 | $353,766 |
The Department of Health and Human Services states development of the required plan and compliance with the bill's reporting requirements will require extensive data collection, evaluation, and analysis. The Department anticipates these requirements will require the addition of one Administrator III position and one Planning Analyst/Data Systems position, and projects the costs of these positions as follows:
Administrator III (LG 31) | FY 2017 | FY 2018 | FY 2019 | FY 2020 |
Salary | $62,732 | $67,041 | $70,181 | $73,359 |
Benefits | $29,507 | $31,635 | $33,622 | $35,719 |
Other Expenses | $5,350 | $350 | $350 | $350 |
Position Total: | $97,589 | $99,026 | $104,153 | $109,428 |
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Planning Analyst (LG 24) | FY 2017 | FY 2018 | FY 2019 | FY 2020 |
Salary | $46,391 | $49,433 | $51,597 | $53,898 |
Benefits | $26,215 | $28,087 | $29,878 | $31,797 |
Other Expenses | $5,350 | $350 | $350 | $350 |
Position Total: | $77,956 | $77,870 | $81,825 | $86,045 |
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Total Position Costs: | $175,545 | $176,896 | $185,978 | $195,473 |
In addition to the above position costs, the Department states that it will need to contract for systems analysis and readiness evaluation as required by the legislation, at an estimated cost of $40,000 in FY 2017 only.
This bill does not provide authorization or appropriations for new positions.