Bill Text - SB590 (2018)

(Second New Title) relative to the state loan repayment program, the developmental disabilities wait list, involuntary admissions procedures, and the mental health system.


Revision: April 3, 2018, 11:16 a.m.

SB 590-FN-A - AS AMENDED BY THE SENATE

 

03/14/2018   0991s

03/14/2018   1061s

2018 SESSION

18-2835

01/05

 

SENATE BILL 590-FN-A

 

AN ACT making a supplemental appropriation to the state loan repayment program and relative to emergency involuntary admissions, the child protection act, and the developmental disabilities wait list and making appropriations therefor.

 

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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AMENDED 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, and enables the department of health and human services to offer voluntary services to the family.

 

IV.  Makes appropriations for voluntary services and community-based prevention programs under the child protection act.

 

V.  Provides that the New Hampshire home visiting program shall be available to Medicaid eligible families.

 

VI.  Makes an appropriation to the department of health and human services to hire additional attorneys.

 

VII.  Makes an appropriation to the department of health and human services for the purpose of funding the developmental disabilities wait list.

 

VIII.  Requires the commissioner of the department of health and human services to issue requests for proposals for a behavioral health crisis treatment center and, contingent upon available funding, an additional mobile crisis team and apartments.

 

IX.  Clarifies the department of health and human services' authority to consent to medical treatment for a minor in foster care.

 

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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.

03/14/2018   0991s

03/14/2018   1061s 18-2835

01/05

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Eighteen

 

AN ACT making a supplemental appropriation to the state loan repayment program and relative to emergency involuntary admissions, the child protection act, and the developmental disabilities wait list and making appropriations therefor.

 

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 a residential program that provides housing and support services to persons with serious and persistent mental illness through a contract with the department of health and human services.  

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  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.

4  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:

5  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.

6  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.

7  Child Protection Act; Duties of the Department of Health and Human Services.  Amend RSA 169-C:34, II-a 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.  Upon initiating an assessment, the department may offer the family ameliorative services to reduce risk and address child safety concerns.

8  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.

9  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.

10  Appropriation.  The sum of $1,500,000 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.

11  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.

12  Appropriation.  The sum of $1,500,000 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

13  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, 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.

14  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.

15  New Section; Rescission of Involuntary Admission.  Amend RSA 135-C by inserting after section 29 the following new section:

135-C:29-a  Rescission of Involuntary Admission.

I.  Following completion of an involuntary emergency admission certificate under RSA 135-C:28 and before custody of the person is accepted by a law enforcement officer pursuant to RSA 135-C:29, the certificate may be rescinded and the person who is the subject of the certificate released in any of the following circumstances:

(a)  A mobile crisis team under contract with the department of health and human services accepts transfer of the person's care.

(b)  An assertive community treatment team operated by a community mental health program accepts transfer of the person's care.

(c)  A community-based provider accepts transfer of the person's care.

II.  Following completion of an involuntary emergency admission certificate under RSA 135-C:28 and before custody of the person is accepted by a law enforcement officer pursuant to RSA 135-C:29, the certificate shall be rescinded and the person who is the subject of the certificate released if the physician or APRN who completed the certificate, or any other physician or APRN authorized to complete such certificates, finds that the person no longer meets the criteria of RSA 135-C:27.

III.  No civil action shall be maintained against a person who rescinds an involuntary admission pursuant to paragraph I or II, provided that the person is acting in good faith within the limits of his or her authority.

16  Appropriation; Department of Health and Human Services; Division for Children, Youth and Families; Attorneys.  The sum of $310,000 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 money in the treasury not otherwise appropriated.

17  Appropriation; Department of Health and Human Services; Developmental Disabilities Wait List.  The sum of $1,162,135 for the fiscal year ending June 30, 2018, is hereby appropriated to the department of health and human services for the purposes of funding the developmental disabilities wait list.  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 money in the treasury not otherwise appropriated.

18  10-Year Plan for Mental Health Services.  Amend 2017, 112:2, III to read as follows:

III.  The commissioner of the department of health and human services shall submit the plan to the speaker of the house of representatives, the president of the senate, and the governor on or before [July 1, 2018] October 15, 2018.  The department shall provide interim reports to the oversight committee on health and human services, established under RSA 126-A:13, on or before October 1, 2017 and on or before March 1, 2018.  Thereafter, the department shall report quarterly to the health and human services oversight committee providing an update on the progress of the development and implementation of the plan.

19  Department of Health and Human Services; Behavioral Health Crisis Treatment Center.  Amend 2017, 156:188 to read as follows:

156:188  [Mobile Crisis Teams and Apartments] Behavioral Health Crisis Treatment Center.  The commissioner of the department of health and human services shall issue a request for proposals (RFP) for a [mobile crisis team and apartments] behavioral health crisis treatment center from qualified vendors.  The RFP for the [mobile crisis team and apartments] treatment center shall be issued no later than June 30, 2017 and operational no later than [January] July 1, 2018.  Any new [mobile crisis teams] behavioral health crisis treatment center shall be established in a geographic [locations] location that [have] has high rates of admissions to and discharges from New Hampshire hospital.

20  Department of Health and Human Services; Mobile Crisis Teams and Apartments.  The commissioner of the department of health and human services shall issue a request for proposals (RFP) for qualified vendors to establish an additional mobile crisis team and apartments.  The RFP for the mobile crisis team and apartments shall be issued contingent upon available funding for the biennium ending June 30, 2019.  Before issuing the RFP, the commissioner shall present to the fiscal committee of the general court, established under RSA 14:30-a, the source of the funds to be used to support the new mobile crisis team and apartments.

21  Designated Receiving Facilities; Residential Beds.  The section heading and paragraph I of 2017, 156:186 are repealed and reenacted to read as follows:

156:186  Supported Housing; Residential Beds.

I.  The commissioner of the department of health and human services shall contract with programs that enable individuals with serious mental illness to attain and maintain integrated, affordable, supported housing. The department shall use funding not to exceed $500,000 from existing appropriations for the biennium ending June 30, 2019.

22  New Section; Guardianship of Minors and Estates of Minors; Guardianship of Minors in Foster Care and Consent for Medical Treatment.  Amend RSA 463 by inserting after section 12 the following new section:

463:12-a  Guardianship of Minors in Foster Care and Consent for Medical Treatment.  For any guardianship granted to the department of health and human services for a minor in foster care, or for any minor in the legal custody of the department receiving foster care services, the department's authority to consent to medical treatment for the minor may be established by, but not limited to, any of the following:

I.  A duly executed "Authorization for Medical Treatment" signed by the minor's parent or guardian;

II.  For the provision of ordinary medical care, including behavioral, mental health, or developmental health services, a copy of that portion of the court order transferring legal custody of the minor to the department under RSA 169-C; or

III.  A copy of the letter of guardianship issued to the department that authorizes the department to consent to medical or other treatment of the minor.

23  Effective Date.

I.  Sections 7-12 of this act shall take effect July 1, 2018.

II.  The remainder of this act shall take effect upon its passage.

 

LBAO

18-2835

Amended 4/3/18

 

SB 590-FN-A- FISCAL NOTE

AS AMENDED BY THE SENATE (AMENDMENTS #2018-0991s and #2018-1061s)

 

AN ACT making a supplemental appropriation to the state loan repayment program and relative to emergency involuntary admissions, the child protection act, and the developmental disabilities wait list and making appropriations therefor.

 

FISCAL IMPACT:      [ X ] State              [    ] County               [    ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2019

FY 2020

FY 2021

FY 2022

   Appropriation

$5,572,135

$0

$0

$0

   Revenue

$0

$0

$0

$0

   Expenditures

Indeterminable

Indeterminable

Indeterminable

Indeterminable

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [ X ] Other - Federal Funds

 

METHODOLOGY:

This bill contains various provisions impacting the Department of Health and Human Services, as follows:

  • Sections 1-6 make certain changes to RSA 135-C as recommended by the Governor's workshop on behavioral health and the involuntary emergency admission (IEA) process. The Department anticipates that these sections will create greater efficiencies in the delivery of behavioral health and IEA services, however the fiscal impact is indeterminable at this time.
  • Section 7 requires that prior to issuing a confidential letter of concern, the Department refer the minor and minor's family to ameliorative services or offer voluntary services.  The Department assumes that the cost of these provisions will be consistent with the appropriations found in sections 10 and 12 of the bill.
  • Sections 8 and 9 remove the parents' responsibility to reimburse the State for the cost of voluntary services.  The Department assumes these provisions will result in a small but indeterminable increase in costs.
  • Section 10 appropriates $1.5 million in General Funds in FY19 for the purpose of funding voluntary services.  The Department states there is a potential federal match of an indeterminable amount.
  • Sections 11 and 12 reinstate the incentive fund program under RSA 170-G:4 and appropriate $1.5 million in General Funds in FY19 for the purpose of funding community-based programs and services.  The Department states there is a potential federal match of an indeterminable amount.
  • Section 13 appropriates $1.5 million in General Funds in FY19 for the purpose of adding funds for the state loan repayment program (SLRP).
  • Section 14 provides that the NH Home Visiting Program shall be available to Medicaid-eligible families without restriction.  The Department projects increased General Fund expenditures of $60,000 in FY19 as a result of this section.  The bill does not make a new appropriation for this purpose.  
  • Section 15 amends RSA 135-C by creating a new section regarding rescission of an involuntary emergency provision.  The Department is unable to determine the fiscal impact of this section.
  • Section 16 appropriates $310,000 in General Funds in FY19 for the purpose of hiring three attorneys within the Division for Children, Youth, and Families (DCYF).  The  Department anticipates a federal match of $99,200, for a total expenditure of $409,200 in FY19.
  • Section 17 appropriates $1,162,135 in General Funds in FY19 for the purpose of funding the developmental disabilities wait list.  The Department anticipates a federal match of the same amount, for total expenditures of $2,324,270.
  • Section 18 changes the reporting date for the Department's submission of the 10-year plan for mental health services from July 1, 2018 to October 15, 2018.  The Department anticipates no fiscal impact.
  • Sections 19 and 20 require the Department to issue requests for proposals for a behavioral health crisis treatment center and, contingent upon available funding, an additional mobile health crisis treatment team and apartments.  The Department anticipates no fiscal impact.    
  • Section 21 requires the Department to contract with programs that enable individuals with serious mental illness to attain and maintain integrated housing.  The contracts shall be funded from existing appropriations not to exceed $500,000, hence there is no fiscal impact.  
  • Section 22 clarifies the process for documenting consent for medical treatment for minors receiving foster care and related services.  The Department anticipates no fiscal impact.

 

AGENCIES CONTACTED:

Department of Health and Human Services