Revision: Jan. 25, 2018, 10:27 a.m.
SB 590-FN-A - AS INTRODUCED
2018 SESSION
18-2835
01/05
SENATE BILL 590-FN-A
SPONSORS: Sen. Bradley, Dist 3; Sen. Carson, Dist 14; Sen. Avard, Dist 12; Sen. Gray, Dist 6; Sen. Fuller Clark, Dist 21; Sen. Watters, Dist 4; Sen. Feltes, Dist 15; Rep. Danielson, Hills. 7; Rep. Rosenwald, Hills. 30; Rep. M. MacKay, Hills. 30
COMMITTEE: Health and Human Services
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ANALYSIS
This bill:
I. Clarifies admission to receiving facilities and other services for persons who are involuntarily committed under RSA 135-C.
II. Makes a supplemental appropriation to the state loan repayment program.
III. Clarifies the determination of unfounded but with reasonable concern for possible abuse and neglect under the child protection law.
IV. Makes appropriations for voluntary services and community-based prevention programs under the Child Protection Act.
V. Makes an appropriation to the department of health and human services to hire 3 attorneys for the division for children, youth and families.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
18-2835
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eighteen
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Mental Health Services System; Definitions. Amend RSA 135-C:2 by inserting after paragraph XV the following new paragraph:
XV-a. "Transitional housing program services'' means the residential program operated on the campus of the Governor Hugh J. Gallen State Office Park in Concord or other site designated by the commissioner that provides housing and support services to persons with serious and persistent mental illness.
2 Involuntary Emergency Admissions; Examination. Amend RSA 135-C:28, I to read as follows:
I. The involuntary emergency admission of a person shall be to the state mental health services system under the supervision of the commissioner. The admission may be ordered upon the certificate of a physician or APRN, as defined in RSA 135-C:2, II-a, who is approved by either a designated receiving facility or a community mental health program approved by the commissioner, provided that within 3 days of the completion of the petition the physician or APRN has conducted, or has caused to be conducted, a physical examination if indicated and circumstances permit, and a mental examination. The physician or APRN must find that the person to be admitted meets the criteria of RSA 135-C:27. The certificate shall state the time and, in detail, the nature of the examinations conducted. The certificate shall also state a specific act or actions the physician or APRN has actually observed or which have been reported to him or her by the petitioner or a reliable witness who shall be identified in the certificate, and which in the physician's or APRN's opinion satisfy the criteria set forth in RSA 135-C:27. The physician or APRN shall [identify in the certificate the facility in the state mental health services system to which the person shall be admitted] inform the person of the specific designated receiving facility in the mental health services system that he or she will be transported to upon the facility location being identified. The admission shall be made to the facility which can best provide the degree of security and treatment required by the person and shall be consistent with the placement principles set forth in RSA 135-C:15. As used in RSA 135-C:27-33, "petitioner'' means any individual, including a physician or APRN completing a certificate, who has requested that a physician or APRN conduct or who has conducted an examination for purposes of involuntary emergency admission. Every certificate shall be accompanied by a written petition signed by a petitioner.
3 Involuntary Emergency Admissions; Ten-Day Limitation. Amend RSA 135-C:32 to read as follows:
135-C:32 Ten-Day Limitation; Petition for Involuntary Admission. No person shall be admitted for an involuntary emergency admission under RSA 135-C:27-33 for longer than a 10-day period, not including Saturdays and Sundays, unless a subsequent petition for involuntary emergency admission which contains allegations of specific acts or actions which occurred subsequent to the initial involuntary emergency admission is completed and the admission is ordered by a physician or A.P.R.N., as defined in RSA 135-C:2, II-a, in accordance with RSA 135-C:28, or unless a petition requesting a judicial hearing on the issue of involuntary admission under RSA 135-C:34-54 has been filed with the appropriate probate court within the involuntary admission period. Upon the filing of the petition with the probate court, the period of involuntary emergency admission may be extended until the issuance of the order of the probate court pursuant to RSA 135-C:45. The initial 10-day period, not including Saturdays and Sundays, begins upon the person's admission to a designated receiving facility.
4 Nonemergency Involuntary Admissions; Conditions of Conditional Discharge. Amend RSA 135-C:50, III to read as follows:
III. During the term of conditional discharge, the person conditionally discharged shall be provided with continuing treatment on an out-patient basis by a community mental health program approved by the commissioner or by transitional housing services.
5 Nonemergency Involuntary Admissions; Revocation of Conditional Discharge. Amend the introductory paragraph of RSA 135-C:51, I to read as follows:
I. If a psychiatrist or APRN, as defined in RSA 135-C:2, II-a, at a community mental health program or transitional housing services providing continuing treatment on an outpatient basis to a person conditionally discharged pursuant to RSA 135-C:50, reasonably believes that:
6 Nonemergency Involuntary Admissions; Revocation of Conditional Discharge. Amend RSA 135-C:51, III to read as follows:
III. If the psychiatrist or APRN, following the examination the psychiatrist or APRN conducted or caused to be conducted of the person, finds that the person either has violated a condition of the discharge or is in such a mental condition as a result of mental illness as to create a potentially serious likelihood of danger to himself or herself or to others, he or she may temporarily revoke the conditional discharge. If the conditional discharge is temporarily revoked, the psychiatrist, or APRN, or designee, shall prepare, offer to and explain to the person a written notice, if it can be done safely without significant possibility of bodily harm, giving the reasons for the revocation and to [identify the receiving facility to which the person is to be delivered] inform the person of the specific designated receiving facility in the mental health services system that he or she will be transported to upon the facility location being identified. If this cannot be done safely, a description of the circumstances indicating such risk shall be placed in the file.
7 Guardians and Conservators; General Powers and Duties of Guardian of the Person. Amend RSA 464-A:25, I(a) to read as follows:
(a) To the extent that it is consistent with the terms of any order by a court of competent jurisdiction relating to detention or commitment of the ward, the guardian shall be entitled to custody of the ward and may establish the ward's place of abode within or without this state. Admission to a state institution or other designated receiving facility shall be in accordance with the following:
(1) A guardian may admit a ward to a state institution or other designated receiving facility with prior approval of the probate court if, following notice and hearing, the court finds beyond a reasonable doubt that the placement is in the ward's best interest and is the least restrictive placement available. Authorization for such admission shall not be time limited unless the court so orders. Authority to admit a ward to a state institution or other designated receiving facility with prior approval under this subparagraph shall not be subject to the limitations contained in RSA 464-A:25, I(a)(2) through (7).
(2) A guardian may admit a ward to a state institution or other designated receiving facility without prior approval of the probate court upon written certification by a physician licensed in the state of New Hampshire, or, in the case of placement in New Hampshire hospital or other designated receiving facility, by a psychiatrist licensed in the state of New Hampshire, or an advanced practice registered nurse, as defined in RSA 135-C:2, II-a, that the placement is in the ward's best interest and is the least restrictive placement available. Within 36 hours, excluding days when the court is closed, of such an admission of a ward to a state institution or other designated receiving facility, the guardian shall submit to the Merrimack county probate court notice of the admission and the reasons therefor, together with a copy of the certificate by the physician, psychiatrist, or advanced practice registered nurse.
(3) The Merrimack county probate court shall review the guardian's notice within 48 hours of the filing of the notice, excluding days when the court is closed, to determine whether the notice on its face appears to establish that the placement is in the ward's best interest and is the least restrictive placement available. If the court concludes that the notice is insufficient, the court shall order the immediate release of the ward from the state institution or other designated receiving facility. If the court concludes that the notice is sufficient, counsel for the ward shall be appointed no later than 48 hours following the court's review of the guardian's notice, excluding days when the court is closed. Notice of the appointment shall be transmitted to the ward, to the guardian, and to counsel. Counsel's notice shall be transmitted in writing and electronically or in another manner which is likely to give actual notice of the appointment to counsel at the earliest practicable time. For purposes of proceedings regarding admissions to state institutions or other designated receiving facilities without prior court approval, the ward shall have the right to legal counsel in the same manner as provided in RSA 464-A:6. The court shall also provide the ward a notice stating that the ward has the right to appointed counsel, the right to oppose the admission by the guardian, and the right to a hearing and to present evidence at that hearing.
(4) Counsel for a ward admitted to a state institution or other designated receiving facility who has been appointed pursuant to subparagraph (3) shall deliver a written report to the court within 5 days of his or her appointment which shall declare whether the ward requests a hearing on the propriety of the admission. Unless the ward waives a hearing, counsel's report shall include a request for a hearing on behalf of the ward. A copy of counsel's report shall be sent to the ward and to the guardian. If the court does not receive a written report from counsel within 5 days of counsel's appointment, the court shall order appropriate relief, including but not limited to substitution of counsel, an order to show cause, or scheduling of a hearing on the propriety of the admission without awaiting a report from counsel.
(5) Upon receipt of a request for a hearing, the court shall schedule a hearing on the admission to a state institution or other designated receiving facility without prior approval of the probate court, at which the guardian shall have the burden of proving, beyond a reasonable doubt, that the placement is in the ward's best interest and is the least restrictive placement available. The hearing shall be held within 10 days, excluding days when the court is closed, from the date that the request is received.
(6) A guardian may not admit a ward to a state institution or other designated receiving facility for more than 60 days for any single admission or more than 90 days in any 12-month period upon certification of a physician or psychiatrist, or an advanced practice registered nurse, as defined in RSA 135-C:2, II-a, without filing a petition requesting approval of the probate court.
(7) At any time, the ward or counsel for the ward may request a hearing on the admission to a state institution or other designated receiving facility without prior approval of the probate court, at which the guardian shall have the burden of proving, beyond a reasonable doubt, that the placement is in the ward's best interest and is the least restrictive placement available. The hearing shall be held within 15 days, excluding days when the court is closed, from the date that the hearing is requested.
8 Child Protection Act; Duties of the Department of Health and Human Services. Amend RSA 169-C:34, II-a and II-b to read as follows:
II-a. The department may issue a confidential letter of concern to a person or persons responsible for the safety and welfare of the child that although there is insufficient evidence to substantiate a finding of abuse or neglect or of unfounded but with reasonable concern, the department encourages the person or persons responsible for the safety and welfare of the child to seek family support services and provide contact information to obtain such services. Prior to issuing a confidential letter of concern, the department shall either refer the minor and the minor's family to ameliorative services or offer voluntary services pursuant to paragraph V. Thirty days, but not longer than 60 days, after issuing a letter of concern, the department shall contact the family or household to facilitate accessing the ameliorative services offered or referred to them.
II-b. The department may make a confidential determination of unfounded but with reasonable concern. Upon making such a determination, the department shall provide appropriate community-based ameliorative services to the child or family for a period of up to 180 days.
9 Child Protection Act; Duties of the Department of Health and Human Services. Amend RSA 169-C:34, V and V-a to read as follows:
V. Notwithstanding any other provision of law to the contrary, the department may[, pursuant to a voluntary service plan that is developed and provided for a minor and the minor's family by the department,] offer voluntary services to families without making a determination of the person or persons [apparently] responsible for the abuse or neglect. The department shall adopt rules, pursuant to RSA 541-A, relative to the provision of voluntary services under this paragraph. The costs of voluntary services provided by the department under this paragraph shall not be subject to reimbursement under RSA 169-C:27.
V-a. Notwithstanding any other provision of law to the contrary, the department may[, pursuant to a voluntary service plan that is developed and provided for the child by the department,] offer voluntary services to any child who prior to his or her eighteenth birthday was found to be neglected or abused, who was in legal custody of the department as of his or her eighteenth birthday, and who is less than 21 years of age. The costs of voluntary services provided by the department under this paragraph shall not be subject to reimbursement under RSA 169-C:27.
10 Child Protection Act; Liability of Expenses and Hearing on Liability. Amend RSA 169-C:27, I(a) to read as follows:
(a) Whenever an order creating liability for expenses is issued by the court under this chapter [or whenever a voluntary service plan is developed and provided for a minor and the minor's family by the department], any expenses incurred for services, placements, and programs the providers of which are certified pursuant to RSA 170-G:4, XVIII, shall be payable by the department of health and human services.
11 Appropriation. The sum of $1,000,000 dollars for the fiscal year ending June 30, 2019, is hereby appropriated to the department of health and human services for the purposes of funding voluntary services provided to children, youth and families under RSA 169-C. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.
12 New Paragraph; Services for Children, Youth and Families; Incentive Funds. Amend RSA 170-G:4 by inserting after paragraph XIX the following new paragraph:
XX. Encourage cities, towns and counties to develop and maintain prevention programs, court diversion programs and alternatives to out of home placement for children, youth and families through the transfer of funds to cities, town and counties which have or are developing such programs. The transfer of funds shall be in such amounts as are appropriated by the general court for this purpose. The method of distribution shall be based on rules adopted by the commissioner pursuant to RSA 541-A. For the purposes of this paragraph, prevention programs shall include programs or activities for the prevention of child abuse and neglect as well as programs or activities for the prevention of children in need of services (CHINS) and delinquent behaviors.
13 Appropriation. The sum of $2,000,000 dollars for the fiscal year ending June 30, 2019, is hereby appropriated to the department of health and human services for the purpose of funding community-based prevention programs and services pursuant to RSA 170-G:4, XX. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated
14 Supplemental Appropriation; State Loan Repayment Program. In addition to any other sums appropriated to accounting unit 05, 95, 90, 901010, 7965, line 073, grants-non-federal, there is hereby appropriated the sum of $1,100,000 for the fiscal year ending June 30, 2018 and the sum of $1,100,000 for the fiscal year ending June 30, 2019 for the state loan repayment program. The department may exceed this amount if new federal funds become available to the program. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.
15 New Section; Protection for Maternity and Infancy. Amend RSA 132 by inserting after section 10-d the following new section:
132:10-e Home Visiting Program. The New Hampshire home visiting program shall be available to Medicaid eligible families without restriction.
16 Appropriation; Department of Health and Human Services. The sum of $1 for the biennium ending June 30, 2019 is hereby appropriated to the department of health and human services for the purpose of hiring 3 attorneys for the division for children, youth and families. This sum is in addition to any other funds appropriated to the department. The governor is authorized to draw a warrant for said sum out of any funds not otherwise appropriated.
I. Sections 8-13 of this act shall take effect July 1, 2018.
II. The remainder of this act shall take effect upon its passage.
18-2835
1/22/18
SB 590-FN-A- FISCAL NOTE
AS INTRODUCED
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2018 | FY 2019 | FY 2020 | FY 2021 |
Appropriation | $1,100,000 | $4,100,001 | $0 | $0 |
Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Federal funds | |||
METHODOLOGY:
Among other things, this bill requires that the Department of Health and Human Services ("Department"), prior to issuing a confidential letter of concern in child protection cases: refer the minor and the minor's family to ameliorative services or else offer voluntary services; contact the family within 60 days thereafter to facilitate the family's access to services; and, upon making a determination of unfounded but with reasonable concern, provide appropriate community-based ameliorative services to the child or family for up to 180 days. The Department states that these provisions will require the addition of 12 new Social Worker I positions (labor grade 16), one for each district office, at the following cost:
| FY19 | FY20 | FY21 | FY22 |
Per Position Salary, Benefits, and Expenses | $65,000 | $67,000 | $70,000 | $73,000 |
Total Cost @ 12 Positions | $780,000 | $804,000 | $840,000 | $876,000 |
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Funding Breakdown: |
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38% Federal Funds | $249,600 | $257,280 | $268,800 | $280,320 |
62% General Funds | $483,600 | $498,480 | $520,800 | $543,120 |
The bill does not contain an appropriation for these additional positions.
The cost of the services themselves will be funded by the following general fund appropriations contained in the bill:
The bill makes the two additional general fund appropriations:
Finally, section 15 of the bill establishes that the New Hampshire home visiting program shall be available to Medicaid-eligible families without restriction. The Department states that it is unaware of those who are eligible for the home visiting program and not receiving Medicaid coverage for it, but notes that Medicaid coverage for the program is $15 per 15 minutes.
AGENCIES CONTACTED:
Department of Health and Human Services