House Bill 1313

AN ACT TO AMEND SECTION 43-14-1, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT THE COORDINATED INTERAGENCY SYSTEM OF SERVICES FOR CHILDREN WITH SERIOUS EMOTIONAL/BEHAVIORAL DISORDERS SHALL BE DESIGNED TO REDUCE THE RELIANCE ON STATE-RUN AND PRIVATE INSTITUTIONS FOR CHILDREN AND YOUTH AND EXPAND THE AVAILABILITY OF INTENSIVE HOME-AND COMMUNITY-BASED SERVICES; TO PROVIDE THAT ONE OF THE OUTCOMES OF THE PROGRAM IS TO PERMANENTLY REDUCE THE NUMBER OF STATE-RUN PSYCHIATRIC BEDS AND DIVERT FUNDING TO COMMUNITY-BASED SERVICES; TO PROVIDE THAT THE COMMUNITY MENTAL HEALTH CENTERS AND COUNTY FIELD OFFICES OF THE DEPARTMENT OF HUMAN SERVICES SHALL BE RESPONSIBLE FOR CONDUCTING EPSDT SCREENINGS AND ENSURING THAT ELIGIBLE CHILDREN AND YOUTH RECEIVE MEDICALLY NECESSARY SERVICES UNDER THE PROGRAM; TO REMOVE THE LIMITATION ON "A" TEAMS PROVIDING SYSTEM OF CARE SERVICES ONLY FOR NONVIOLENT YOUTHFUL OFFENDERS WHO HAVE SERIOUS BEHAVIORAL OR EMOTIONAL DISORDERS; TO PROVIDE THAT THE INTERAGENCY SYSTEM OF CARE COUNCIL SHALL DEVELOP A PRE-SCREENING EVALUATION TOOL TO IDENTIFY CHILDREN AND YOUTH WITH SERIOUS BEHAVIORAL AND EMOTIONAL DISORDERS WHO CAN BE SERVED WITH INTENSIVE HOME- AND COMMUNITY-BASED SERVICES AND DIVERTED FROM A STATE-RUN OR PRIVATE INSTITUTIONAL PLACEMENT; TO PROVIDE THAT THE DEPARTMENT OF MENTAL HEALTH MAY NOT ACCEPT ANY CHILD FOR AN INSTITUTIONAL PLACEMENT WITHOUT A COMPLETED PRE-SCREEN EVALUATION; TO PROVIDE THAT THE INTERAGENCY SYSTEM OF CARE COUNCIL SHALL PROVIDE EDUCATIONAL AND PROMOTIONAL ACTIVITIES REGARDING THE PRE-SCREENING TOOL THAT ARE AIMED AT REDUCING THE COMMITMENTS TO OAK CIRCLE CENTER, THE BRADLEY A. SANDERS ADOLESCENT COMPLEX AND THE SPECIALIZED TREATMENT FACILITY FOR THE EMOTIONALLY DISTURBED; TO PROVIDE THAT THE INTERAGENCY SYSTEM OF CARE COUNCIL SHALL DESIGNATE PERSONS TO SERVE ON AN INTENSIVE HOME-BASED SERVICES TEAM, WHICH SHALL PLAN AND IMPLEMENT AN EXPANSION OF INTENSIVE HOME-BASED SERVICES TO FACILITATE DIVERSION FROM HOSPITALS AND RESIDENTIAL FACILITIES AND REDUCE INSTITUTIONAL COMMITMENTS AND BEDS; TO PROVIDE THAT THE INTENSIVE HOME-BASED SERVICES TEAM SHALL REDUCE THE OCCUPANCY OF STATE INSTITUTIONS BY IDENTIFYING YOUTH WHO HAVE BEEN IN A STATE FACILITY FOR NINETY DAYS OR MORE AND DEVELOPING FOR EACH CHILD A UNIQUE TEAM THAT SHALL IDENTIFY THE SERVICES THAT WOULD BE REQUIRED TO RETURN THE YOUTH TO HIS OR HER HOME COMMUNITY; TO PROHIBIT THE DEPARTMENT OF HUMAN SERVICES FROM USING PUBLIC OR PRIVATE PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES AS A PLACEMENT FOR CHILDREN WHO COULD BE SERVED IN A LESS-RESTRICTIVE ENVIRONMENT; TO EXTEND THE DATE OF THE REPEALER ON THAT SECTION; TO AMEND SECTIONS 43-14-3 AND 43-14-5, MISSISSIPPI CODE OF 1972, TO EXTEND THE DATE OF THE REPEALERS ON THE POWERS AND DUTIES OF THE INTERAGENCY COORDINATING COUNCIL FOR CHILDREN AND YOUTH AND THE FUND FOR THE OPERATION OF A STATEWIDE SYSTEM OF CARE; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. Section 43-14-1, Mississippi Code of 1972, is amended as follows:

43-14-1. (1) The purpose of this chapter is to provide for the development and implementation of a coordinated interagency system of necessary services and care for children and youth up to age twenty-one (21) with serious emotional/behavioral disorders including, but not limited to, conduct disorders, or mental illness who require services from a multiple services and multiple programs system, and who can be successfully diverted from inappropriate institutional placement. This program is designed to reduce the reliance on state-run and private institutions for children and youth and expand the availability of intensive home-and community-based services. This program is to be done in the most fiscally responsible (cost efficient) manner possible, based on an individualized plan of care which takes into account other available interagency programs, including, but not limited to, Early Intervention Act of Infants and Toddlers, Section 41-87-1 et seq., Early Periodic Screening Diagnosis and Treatment, Section 43-13-117(5), waivered program for home- and community-based services for developmentally disabled people, Section 43-13-117(29), and waivered program for targeted case management services for children with special needs, Section 43-13-117(31), those children identified through the federal Individuals with Disabilities Education Act of 1997 as having a serious emotional disorder (EMD), the Mississippi Children's Health Insurance Program Phase I and Phase II and waivered programs for children with serious emotional disturbances, Section 43-13-117(46), and is tied to clinically appropriate outcomes. Some of the outcomes are to reduce the number of inappropriate out-of-home placements inclusive of those out-of-state; permanently reduce the number of state-run psychiatric beds and divert funding to community-based services; and to reduce the number of inappropriate school suspensions and expulsions for this population of children. From and after July 1, 2001, this coordinated interagency system of necessary services and care shall be named the System of Care program. Children to be served by this chapter who are eligible for Medicaid shall be screened through the Medicaid Early Periodic Screening Diagnosis and Treatment (EPSDT) and their needs for medically necessary services shall be certified through the EPSDT process. The community mental health centers and county field offices of the Department of Human Services shall be responsible for conducting EPSDT screenings and ensuring that eligible children and youth receive medically necessary services. For purposes of this chapter, a "System of Care" is defined as a coordinated network of agencies and providers working as a team to make a full range of mental health and other necessary services available as needed by children with mental health problems and their families. The System of Care shall be:

(a) Child centered, family focused and family driven;

(b) Community based;

(i) Service coordination or case management;

(ii) Prevention and early identification and intervention;

(iii) Smooth transitions among agencies, providers, and to the adult service system;

(iv) Human rights protection and advocacy;

(v) Nondiscrimination in access to services;

(vi) A comprehensive array of services;

(vii) Individualized service planning;

(viii) Services in the least restrictive environment;

(ix) Family participation in all aspects of planning, service delivery and evaluation; and

(x) Integrated services with coordinated planning across child-serving agencies.

(2) There is established the Interagency Coordinating Council for Children and Youth (hereinafter referred to as the "ICCCY"). The ICCCY shall consist of the following membership: (a) the State Superintendent of Public Education; (b) the Executive Director of the Mississippi Department of Mental Health; (c) the Executive Director of the State Department of Health; (d) the Executive Director of the Department of Human Services; (e) the Executive Director of the Division of Medicaid, Office of the Governor; (f) the Executive Director of the State Department of Rehabilitation Services; and (g) the Executive Director of Mississippi Families as Allies for Children's Mental Health, Inc. The council shall meet before August 1, 2001, and shall organize for business by selecting a chairman, who shall serve for a one-year term and may not serve consecutive terms. The council shall adopt internal organizational procedures necessary for efficient operation of the council. Each member of the council shall designate necessary staff of their departments to assist the ICCCY in performing its duties and responsibilities. The ICCCY shall meet and conduct business at least twice annually. The chairman of the ICCCY shall notify all persons who request such notice as to the date, time and place of each meeting.

(3) The Interagency System of Care Council is created to serve as the state management team for the ICCCY, with the responsibility of collecting and analyzing data and funding strategies necessary to improve the operation of the System of Care programs, and to make recommendations to the ICCCY and to the Legislature concerning such strategies on or before December 31, 2002. The System of Care Council also has the responsibility of coordinating the local Multidisciplinary Assessment and Planning (MAP) teams and may apply for grants from public and private sources necessary to carry out its responsibilities. The Interagency System of Care Council shall be comprised of one (1) member from each of the appropriate child-serving divisions or sections of the State Department of Health, the Department of Human Services, the State Department of Mental Health, the State Department of Education, the Division of Medicaid of the Governor's Office, the Department of Rehabilitation Services, a family member representing a family education and support 501(c)3 organization, a representative from the Council of Administrators for Special Education/Mississippi Organization of Special Education Supervisors (CASE/MOSES) and a family member designated by Mississippi Families as Allies for Children's Mental Health, Inc. Appointments to the Interagency System of Care Council shall be made within sixty (60) days after the effective date of this act. The council shall organize by selecting a chairman from its membership to serve on an annual basis, and the chairman may not serve consecutive terms.

(4) (a) There is established a statewide system of local Multidisciplinary Assessment and Planning Resource (MAP) teams. The MAP teams shall be comprised of one (1) representative each at the county level from the major child-serving public agencies for education, human services, health, mental health and rehabilitative services approved by respective state agencies of the Department of Education, the Department of Human Services, the Department of Health, the Department of Mental Health and the Department of Rehabilitation Services. Three (3) additional members may be added to each team, one (1) of which may be a representative of a family education/support 501(c)3 organization with statewide recognition and specifically established for the population of children defined in this section. The remaining members will be representatives of significant community-level stakeholders with resources that can benefit the population of children defined in this section.

(b) For each local existing MAP team that is established pursuant to paragraph (a) of this subsection, there

shall also be established an "A" (Adolescent) team which shall work with a MAP team. The "A" teams shall provide System of Care services for * * * youthful offenders who have serious behavioral or emotional disorders. Each "A" team shall be comprised of, at a minimum, the following five (5) members:

(i) A school counselor;

(ii) A community mental health professional;

(iii) A social services/child welfare professional;

(iv) A youth court counselor; and

(v) A parent who had a child in the juvenile justice system * * *.

(5) The Interagency Coordinating Council for Children and Youth may provide input relative to how each agency utilizes its federal and state statutes, policy requirements and funding streams to identify and/or serve children and youth in the population defined in this section. The ICCCY shall support the implementation of the plans of the respective state agencies for comprehensive multidisciplinary care, treatment and placement of these children.

(6) The ICCCY shall oversee a pool of state funds that may be contributed by each participating state agency and additional funds from the Mississippi Tobacco Health Care Expenditure Fund, subject to specific appropriation therefor by the Legislature. Part of this pool of funds shall be available for increasing the present funding levels by matching Medicaid funds in order to increase the existing resources available for necessary community-based services for Medicaid beneficiaries.

(7) The local coordinating care MAP team will facilitate the development of the individualized System of Care programs for the population targeted in this section.

(8) Each local MAP team shall serve as the single point of entry to ensure that comprehensive diagnosis and assessment occur and shall coordinate needed services through the local coordinating care entity for the children named in subsection (1). Local children in crisis shall have first priority for access to the MAP team processes and local System of Care programs.

(9) The Interagency Coordinating Council for Children and Youth shall facilitate monitoring of the performance of local MAP teams.

(10) Each state agency named in subsection (2) of this section shall enter into a binding interagency agreement to participate in the oversight of the statewide System of Care programs for the children and youth described in this section. The agreement shall be signed and in effect by July 1 of each year.

(11) The Interagency System of Care Council shall develop a pre-screening evaluation tool to identify children and youth with serious behavioral and emotional disorders who can be served with intensive home- and community-based services and diverted from a state-run or private institutional placement. The tool shall be developed to identify youth who are (a) at risk for unnecessary institutional placement; and (b) have a medical need for community-based mental health services.

(12) The Department of Mental Health may not accept any child for an institutional placement without a completed pre-screen evaluation, to evaluate youth referred for inpatient commitment or residential treatment to prevent unnecessary institutional placement and reduce the overall use of inpatient treatment throughout the state. The following entities are responsible for administering the pre-screen evaluation: case managers with the Department of Human Services, community mental health centers and crisis stabilization units.

(13) The Interagency System of Care Council shall provide educational and promotional activities regarding the pre-screening tool that are aimed at reducing by thirty percent (30%) the commitments to Oak Circle Center, the Bradley A. Sanders Adolescent Complex at East Mississippi State Hospital, and the Specialized Treatment Facility for the Emotionally Disturbed by July 1, 2012. It is the intent that the Department of Mental Health reduce by thirty percent (30%) the total number of beds at Oak Circle Center, the Bradley A. Sanders Adolescent Complex at East Mississippi State Hospital, and the Specialized Treatment Facility for the Emotionally Disturbed by July 1, 2012.

(14) The Interagency System of Care Council shall designate one (1) individual from the Department of Mental Health, Department of Human Services, the Division of Medicaid, State Department of Health, State Department of Education, the Department of Rehabilitation Services, a child advocacy 501(c)(3) organization, and a family member designated by Mississippi Families as Allies for Children's Mental Health, Inc. to serve on an Intensive Home-Based Services Team. The Intensive Home-Based Services Team shall plan and implement an expansion of intensive home-based services to facilitate diversion from hospitals and residential facilities and a thirty percent (30%) reduction in institutional commitments and beds by July 1, 2012. The Intensive Home-Based Services Team shall review commitments to state-run facilities to identify youth who should be served through intensive home-based services and shall identify youth currently in a state-run facility who should be served with intensive home-based services. The Intensive Home-Based Services Team also shall review the placement of foster children in private psychiatric residential treatment facilities and therapeutic group homes to identify youth who should be served through intensive home-based services and/or therapeutic foster care.

(15) The Intensive Home-Based Services Team also shall reduce the occupancy of state institutions by identifying youth who have been in a state facility for ninety (90) days or more and developing for each child a unique team comprised of the child, his or her family, a Department of Human Service social worker (when appropriate), a youth court counselor (when appropriate), an attorney (when appropriate), and a representative from the community mental health center/service provider. The team shall identify the services, such as in-home supports or therapeutic foster care, that would be required to return the youth to his or her home community. The Department of Mental Health shall implement policies and procedures to ensure that on or before her ninetieth day of commitment, a unique child and family team is developed for each youth committed to the custody of the department that, within ninety (90) days, identifies the services needed to support the youth in the community and accesses those services for the youth, if available.

(16) The Department of Human Services is prohibited from using public or private psychiatric residential treatment facilities as a placement for children who could be served in a less-restrictive environment; and is required to provide children in department custody with medically necessary home- and community-based services. The department is further prohibited from using secure detention facilities to hold children in its custody that are awaiting placement at a group home, shelter, therapeutic group home or treatment facility.

(17) The expansion of intensive home- and community-based services will be funded directly through the money saved from the closure of state-run facilities and/or reduction of inpatient beds.

(18) This section shall stand repealed from and after July 1, 2011.

SECTION 2. Section 43-14-3, Mississippi Code of 1972, is amended as follows:

43-14-3. In addition to the specific authority provided in Section 43-14-1, the powers and responsibilities of the Interagency Coordinating Council for Children and Youth shall be as follows:

(a) To serve in an advisory capacity and to provide state level leadership and oversight to the development of the System of Care programs; and

(b) To insure the creation and availability of an annual pool of funds from each participating agency member of the ICCCY that includes the amount to be contributed by each agency and a process for utilization of those funds.

This section shall stand repealed from and after July 1, 2011.

SECTION 3. Section 43-14-5, Mississippi Code of 1972, is amended as follows:

43-14-5. There is created in the State Treasury a special fund into which shall be deposited all funds contributed by the Department of Human Services, State Department of Health, Department of Mental Health, State Department of Rehabilitation Services insofar as recipients are otherwise eligible under the Rehabilitation Act of 1973, as amended, and State Department of Education for the operation of a statewide System of Care by MAP teams and "A" teams utilizing such funds as may be made available to those MAP teams through a Request for Proposal (RFP) approved by the ICCCY.

This section shall stand repealed from and after July 1, 2011.

SECTION 4. This act shall take effect and be in force from and after July 1, 2010.