Revision: Dec. 15, 2009, midnight
HB 1602-FN – AS INTRODUCED
2010 SESSION
01/04
HOUSE BILL 1602-FN
AN ACT relative to the secure psychiatric unit.
SPONSORS: Rep. Cushing, Rock 15
COMMITTEE: Criminal Justice and Public Safety
This bill changes the name of the secure psychiatric unit to the New Hampshire secure psychiatric hospital and transfers it to the department of health and human services.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
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STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Ten
AN ACT relative to the secure psychiatric unit.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Transfer of Secure Psychiatric Unit; Duties of Commissioner. Amend RSA 126-A:5 by inserting after paragraph XVIII the following new paragraph:
XIX. The commissioner shall be the principal administrator of the New Hampshire secure psychiatric hospital established pursuant to RSA 622:41. He or she shall establish the treatment standards for the hospital after consultation with the commissioner of the department of corrections. The commissioner shall:
(a) Administer the hospital;
(b) Consult with the commissioner of the department of corrections regarding transfers to the hospital;
(c) Transfer persons in his or her custody to the unit if treatment is needed for mental disturbance;
(d) Discharge persons pursuant to RSA 622:48;
(e) Review, at least annually, the mental health programs with the commissioner of the department of corrections to determine what policies, standards, or practices should be revised to improve treatment;
(f) Appoint qualified persons to positions established in RSA 622:43, I;
(g) Administer the hospital in such a manner as to meet accreditation standards and to seek accreditation; and
(h) Perform other tasks necessary to carry out the administration of RSA 622:40-48.
2 Secure Psychiatric Unit; Commissioner Change. Amend RSA 622:40, I to read as follows:
I. “Commissioner” means the commissioner of the department of [corrections under RSA 21-H:2] health and human services.
3 Secure Psychiatric Unit; Name Change. RSA 622:40, IV is repealed and reenacted to read as follows:
IV. “Hospital” means the New Hampshire secure psychiatric hospital.
4 New Section; Memorandum of Understanding. Amend RSA 622 by inserting after section 42 the following new section:
622:42-a Memorandum of Understanding. The commissioner and the commissioner of the department of corrections shall enter into a memorandum of understanding to cooperate in the operation of the hospital. The commissioners shall cooperate in the effectuation of the transfer and in meeting the needs of the persons committed to the hospital.
5 Secure Psychiatric Unit; Rulemaking. Amend RSA 622:44, I to read as follows:
I. The commissioner, in consultation with the commissioner of the department of corrections, shall adopt rules, pursuant to RSA 541-A, which provide for effective treatment for persons found to be dangerous to themselves or others and committed or transferred pursuant to RSA 622:45 to an environment which provides for safety and security for the public, the staff, and those committed.
6 Secure Psychiatric Unit; Commitment. Amend RSA 622:45, II and III to read as follows:
II. Except upon an order of court under subparagraph I(a) or in an emergency, no admission or transfer to the [unit] hospital shall occur without the prior approval of the commissioner and the commissioner of the department of [health and human services] corrections, or their designees. In such instances, if the person to be admitted or transferred objects to the transfer, the person may request a hearing or review of the decision by the commissioner of the department of [health and human services] corrections or designee in accordance with rules adopted pursuant to RSA 541-A. The review or hearing may occur following the admission or transfer where immediate admission or transfer has been determined necessary to protect the person or others. If the commissioner of the department of [health and human services] corrections upholds the objection of a person to be transferred, the transfer shall not be made. If the commissioner of the department of [health and human services] corrections upholds the objection of a person already transferred, the person shall promptly be delivered to a receiving facility named by the commissioner [of the department of health and human services].
III. Except where ordered by a court of competent jurisdiction, if the commissioner objects to a proposed admission or transfer approved by the commissioner of the department of [health and human services] corrections, the commissioners may agree to have the disagreement resolved by a mutually acceptable third party.
7 Secure Psychiatric Unit; Treatment Standards. Amend RSA 622:46, I to read as follows:
I. The commissioner shall establish clinical and treatment standards for the operation of the [unit] hospital in consultation with the commissioner of the department of [health and human services] corrections. The commissioners shall review, at least annually, any interagency agreements, memoranda of understanding, and the mental health program at the [unit] hospital to determine which provisions, standards, or practices should be revised to improve treatment.
8 Secure Psychiatric Unit; Discharge. Amend RSA 622:48, I(b) and (c) to read as follows:
(b) The commissioner or designee may transfer to the state mental health services system, or the state developmental services system only if the person was admitted or transferred to the [unit] hospital pursuant to RSA 171-B, any person admitted or transferred to the [unit] hospital, pursuant to RSA 622:45, I, upon a determination that the person no longer presents a serious likelihood of danger to self or others if such person were to be confined within a receiving facility in the state mental health services system or the state developmental services delivery system. If the commissioner of [health and human services] corrections objects to a proposed transfer, the commissioners may agree to have the disagreement resolved by a mutually acceptable third party, or if none is acceptable, by the attorney general.
(c) The commissioner or designee may transfer to the state mental health services system any person committed to the [unit] hospital under RSA 651:9-a upon a determination by a physician that the person presents a potentially serious likelihood of danger to self or others as a result of mental illness, but the person no longer requires the degree of safety and security provided by the [unit] hospital. No transfer may occur under this subparagraph without the prior approval of the commissioner of the department of [health and human services] corrections and administrative due process pursuant to rules adopted by the commissioner under RSA 541-A. If the commissioner of [health and human services] the department of corrections objects to a proposed transfer, the commissioners may agree to have the disagreement resolved by a mutually acceptable third party. No transfer may occur under this subparagraph without the prior approval of the superior court. Any person transferred under this subparagraph shall, for purposes of treatment, be under the care and custody of the commissioner of the department of health and human services but shall for all other purposes, including, but not limited to, discharge, granting of privileges, parole, and recommittal, remain under the jurisdiction of the commissioner of the department of corrections and the superior court.
9 Replace Term. Replace “Secure Psychiatric Unit” with “New Hampshire Secure Psychiatric Hospital” in the following RSA sections: RSA 98-A:6-b; 126-A:34, I(a); 135:17, I; 135:17-a, II; 135-E:11, II; 171-A:8, V(a); 171-A:8-a, II; 171-B:12, III; 171-B:14; 171-B:15, I; 171-B:16; 188-F:26, XVI; 622:31-a, III(g); subdivision heading preceding RSA 622:40; 622:41; 632-A:2, I(n)(1); 632-A:3, IV(a); 632-A:4, III(a); 651:8-b, I; 651:9-a; 651:10; 651:11; 651:11-a, I, and 651:11-a, IV(c).
10 Replace Term. Replace “unit” with “hospital” in the following RSA sections: RSA 622:41; 622:43, I; 622:44, II; 622:45; 622:46, I; 622:47; 622:48; 622:49; 622:50; and 622:51.
11 Repeal. The following are repealed:
I. RSA 21-H:8, XI-a, relative to the commissioner of corrections as the principal administrator of the secure psychiatric unit.
II. RSA 21-H:13, II-a, relative to rulemaking for the administration of the secure psychiatric unit.
III. RSA 21-H:14-a, III(d), relative to the secure psychiatric unit.
12 Notification Required; Request for New Facility.
I. The commissioner of the department of health and human services shall notify the appropriate federal agency that the secure psychiatric unit has become a hospital and therefore should qualify for Medicaid disproportionate share payments.
II. The commissioner shall also prepare plans and submit a request for the 2012 – 2013 capital budget relative to building a new facility for secure psychiatric purposes.
13 Effective Date. This act shall take effect upon its passage.
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HB 1602-FN - FISCAL NOTE
AN ACT relative to the secure psychiatric unit.
FISCAL IMPACT:
The Department of Health and Human Services states this bill would increase state expenditures by $4,540,658 in FY 2011, $4,586,062 in FY 2012, $4,631,923 in FY 2013, and $4,678,242 in FY 2014. This bill would have no fiscal impact on state, county, and local revenue, or county and local expenditures.
METHODOLOGY:
This Department of Health and Human Services (DHHS) states this bill changes the name of the secure psychiatric unit (SPU) to the New Hampshire secure psychiatric hospital and transfers it from the Department of Corrections (DOC) to the DHHS. The Department assumes DOC will transfer all DOC positions assigned to the SPU; all general funds budgeted for the SPU operations; all capital funds currently budgeted for phase II construction pursuant to the Holliday decree; all funds and staff positions assigned/budgeted for the Sexually Violent Predator Treatment program; all beds (rooms) assigned to the SPU (currently 49 beds which includes 3 isolation rooms); and all office equipment, furniture, and supplies assigned to the SPU. DHHS states to meet the intent of the bill, they must add additional clinical and ancillary support staff to meet accreditation standards of the Joint Commission Accreditation of Healthcare Organizations/The Joint Commission (TJC). The Department cannot determine what capital improvements must be made to the SPU to meet the safety requirements of TJC, however it is likely improvements would need to be made. A DHHS report to the Secure Psychiatric Unit Study Commission in September of 2005 recommended staffing levels for a 24 bed accredited forensic unit at 80.5 full-time equivalent (FTE) employees. SPU current staffing for the 49 beds has 33.5 FTE (which includes 3.25 FTE contract staff). The Department estimated staffing levels from the calculations used for the 24 bed unit in the previously stated Legislative study combined with existing staff assigned to the SPU. The staffing pattern and number of staff would change once a new stand-alone facility was constructed and in use. The Department assumes the New Hampshire Secure Psychiatric Hospital would not be eligible for federal disproportionate share payments (DSH) because of the proximity to the New Hampshire State Prison for Men. The Department assumes the transfer of the SPU to DHHS will occur July 1, 2010 and that a new facility will not be constructed until after FY 2014. The
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Department states the new stand-alone facility will meet TJC standards and be eligible for DSH reimbursements of 30% (Federal FY 2010 rate).
Although this bill does not establish positions or contain an appropriation, DHHS states they will need to hire an additional 67 staff as a result of this bill. In addition, the Department would enter into a contract with Dartmouth Medical School to provide psychiatrist services. The Department estimates the fiscal impact in FY 2011 as follows -
FY 2011
Salary & Benefit Costs
2 psychologists $168,113
1 senior psychiatric social worker $73,241
3 psychiatric social workers $233,977
1 nurse coordinator $92,576
2 nurse specialists $169,901
11 registered nurse III’s $857,917
39 mental health worker III”s $1,697,458
1 ward clerk $38,958
1 rehab occupational therapist $59,874
1 rehab recreational therapist $59,874
2 rehab training & development therapists $98,029
1 food service social worker II $32,914
2 health facilities cleaners $72,118
Subtotal Salary and Benefit Costs $3,654,950
Overtime (and associated Benefits) $168,128
Holiday Pay (and associated Benefits) $98,683
Total Salary, Overtime, Holiday Pay and Benefit Costs $3,921,761
Contract with Dartmouth for Psychiatrist Services $618,897
TOTAL FISCAL IMPACT $4,540,658
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The Department assumes costs would increase by approximately 1% annually thereafter, resulting in an increase in state expenditures of approximately $4,586,062 in FY 2012, $4,631,923 in FY 2013, and $4,678,242 in FY 2014.