SB2145 SD2.DOC

PART I

SECTION 1. The legislature finds that the department of health recently implemented administrative rules that narrow the scope of people who are eligible to receive continuing services from the adult mental health division. The legislature further finds that these restrictive rules leave many people who have mental health needs without access to mental health services.

The legislature further finds that these rules provide that even if an individual otherwise has a qualifying diagnosis, that individual is ineligible for any services if the individual has any form of health insurance coverage. Yet, most health insurance policies pay only for medical or psychiatric treatment as opposed to the range of services otherwise offered by the department of health. Certainly, it is appropriate for the State to be the payer of last resort, such that if private insurance covers the cost of psychiatric treatment, there is no reason for the department of health to provide or pay for the treatment. However, this results in an arbitrary, irrational situation whereby an individual who otherwise has a severe and persistent mental illness will not receive any services (such as case management, clubhouse services, or supported housing) from the adult mental health division, simply because they happen to have private insurance, notwithstanding the fact that the private insurance they possess does not cover those services that they may be seeking.

The purpose of this part is to:

(1) Require the adult mental health division of the department of health to provide services to persons who have a qualifying diagnosis;

(2) Allow the department of health to bill an insurer for treatment services provided by the State pursuant to chapter 334, Hawaii Revised Statutes;

(3) Make the department of health eligible to receive reimbursement from an insurer in exchange for treatment services provided by the State pursuant to chapter 334, Hawaii Revised Statutes; and

(4) Provide that a person who has a qualifying diagnosis shall be eligible to receive services that are offered by the adult mental health division and that are not covered by an insurance policy.

SECTION 2. Section 334-1, Hawaii Revised Statutes, is amended by adding two new definitions to be appropriately inserted and to read as follows:

""Qualifying diagnosis" means one of the following diagnoses:

(1) Schizophrenia and other psychotic disorders;

(2) Mood disorders, including recurrent major depressive disorder and bipolar disorders;

(3) Anxiety disorders, including panic disorder with agoraphobia, obsessive-compulsive disorder, and post-traumatic stress disorder;

(4) Borderline personality disorder;

(5) Substance-related disorders that do not resolve in thirty days, including alcohol-induced psychotic disorder; amphetamine-induced psychotic disorder; cannabis-induced psychotic disorder; cocaine-induced psychotic disorder; hallucinogen-induced psychotic disorder; inhalant-induced psychotic disorder; opioid‑induced psychotic disorder; phencyclidine‑induced psychotic disorder; sedative-, hypnotic-, or anxiolytic-induced psychotic disorder; and other or unknown substance-induced psychotic disorders; and

(6) Co-occurring disorders, including persons with severe and persistent mental illness and a substance abuse disorder, and persons with severe and persistent mental illness and diagnosis of mild intellectual disability.

"Severe and persistent mental illness" means a qualified diagnosis, as defined in this section, that results in emotional, cognitive, or behavioral functioning that is so impaired as to substantially interfere with a person's capacity to remain in the community without treatment, and that results in a long-term limitation in a person's functional capacities for the primary activities of daily living."

SECTION 3. Section 334-3, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

"(c) The department shall specifically:

(1) Perform statewide assessments of the need for prevention, treatment, and rehabilitation services in the areas of mental or emotional disorders and substance abuse;

(2) Adopt rules pursuant to chapter 91 for establishing the number and boundaries of the geographical service areas for the delivery of services in the areas of mental or emotional disorders and substance abuse. The department shall periodically review the effectiveness of the geographical service areas in promoting accessibility and continuity of appropriate care to all residents of that geographical area;

(3) Appoint a service area administrator in each county who shall be responsible for the development, delivery, and coordination of services in that area;

(4) Ensure statewide and community-based planning for the ongoing development and coordination of the service delivery system as guided by needs assessment data and performance related information;

(5) Establish standards and rules for psychiatric facilities and their licensing, where applicable;

(6) Establish standards and rules for services in the areas of mental health and substance abuse treatment, including assurances of the provision of minimum levels of accessible service to persons of all ages, ethnic groups, and geographical areas in the State;

(7) Ensure community involvement in determining the service delivery arrangements appropriate to each community of the State;

(8) Cooperate with public and private health, education, and human service groups, agencies, and institutions in establishing a coordinated system to meet the needs of persons with mental or emotional disorders and substance abuse difficulties;

(9) Evaluate and monitor all services in the fields of mental health and substance abuse where [~~such~~] the services are supported fully or in part by state resources;

(10) Promote and conduct research, demonstration projects, and studies concerned with the nature, prevention, intervention, and consequences of mental or emotional disorders and substance abuse;

(11) Keep records, statistical data, and other information as may be necessary in carrying out the functions of the mental health system and this chapter;

(12) Advocate patients' rights in all psychiatric facilities in the State and investigate any grievances submitted to the department by any patient in a psychiatric facility, except as provided in section 334E-2(d). The department shall establish rules and procedures for the purpose of this paragraph within one year after January 1, 1985, and post the rules in a conspicuous manner and accessible place;

(13) Promote and conduct a systematic program of accountability for all services provided, funds expended, and activities carried out under its direction or support in accordance with sound business, management, and scientific principles;

(14) Coordinate mental health resources in each county of the State by the development and presentation of a comprehensive integrated service area plan developed by the service area administrator in conjunction with the service area board. The service area administrator and the service area board, in collaboration with private and public agencies serving their population, shall submit recommendations for the statewide comprehensive integrated service plan, including needs assessment, program planning, resource development, priorities for funding, monitoring, and accountability activities;

(15) Oversee and coordinate service area programs and provide necessary administrative and technical assistance to assist service area programs in meeting their program objectives; [~~and~~]

(16) Provide staffing to the state council and service area boards to assist in the performance of their functions[.]; and

(17) Provide services to persons who have a qualifying diagnosis; provided that notwithstanding any law or rule adopted by the department to the contrary, any person who has a qualifying diagnosis shall be eligible to receive services that are offered by the department of health's adult mental health division and are not covered by any insurance policy held by or for the benefit of that person."

SECTION 4. Section 334-6, Hawaii Revised Statutes, is amended to read as follows:

"§334-6 Fees; payment of expenses for treatment services. (a) Pursuant to chapter 91, the director shall establish reasonable charges for treatment services and may make collections on [~~such~~] the charges. In making the collections on [~~such~~] the charges, the director shall take into consideration the financial circumstances of the patient and the patient’s family including a reciprocal beneficiary, and no collections shall be made where in the judgment of the director, [~~such~~] the collections would tend to make the patient or the patient’s family including a reciprocal beneficiary, a public charge or deprive the patient and the patient’s family including a reciprocal beneficiary, of necessary support.

(b) Every person hospitalized at a psychiatric facility or receiving treatment services through a community mental health center under the jurisdiction of the State or a county, or at a psychiatric facility or through a community mental health center which derives more than fifty per cent of its revenues from the general fund of the State, or pursuant to contract with the director under section 334-2.5, shall be liable for the expenses attending their reception, maintenance, and treatment and any property not exempt from execution belonging to the person shall be subject to sequestration for the payment of the expenses. Every parent or legal guardian of a patient who is a minor and every spouse or reciprocal beneficiary of a patient shall be liable for the expenses attending the reception, maintenance, and treatment of that minor child or spouse or reciprocal beneficiary who is hospitalized at a psychiatric facility or receiving treatment through a community mental health center under the jurisdiction of the State or a county, or at a psychiatric facility or through a community mental health center which derives more than fifty per cent of its revenues from the general fund of the State, or pursuant to contract with the director under section 334-2.5.

(1) May bill an insurer for treatment services provided by the State pursuant to this chapter; and

(2) Shall be eligible to receive reimbursement from an insurer billed in accordance with this section."

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2012-2013 for the department of health to provide additional mental health services.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

PART II

SECTION 6. The legislature finds that youth that are in the justice system and face emotional and behavioral challenges may not have the necessary mental health services and treatments they need. Many of these youth, approximately eighty per cent, are involved in drugs and either dropped out of school or aged out of the educational system. These youth may be directed by the court to obtain mental health services, but are no longer eligible to receive mental health services from the department of health.

The purpose of this part is to require the department of health to ensure that children receive the treatment and rehabilitative services they need to reach their proper and full development regardless of whether the child or youth is enrolled in school.

SECTION 7. Section 321-174, Hawaii Revised Statutes, is amended to read as follows:

"§321-174 Coordination of services with department of education. (a) The children's mental health services team shall cooperate with the schools located in their particular geographic region in identifying and referring for treatment such children or youths in need of mental health services. In conjunction with the children's mental health services team, the department of education and the department of health shall develop a memorandum of agreement, which shall provide for a sharing of responsibilities for the affected agencies and shall include but not be limited to provisions for:

(1) Accepting referrals from the school counselors and diagnostic teams for evaluation and direct treatment of children and youth suffering from mental and emotional disorders;

(2) Providing consultation to enable teachers and other school personnel to aid in the identification and screening of children in need of professional mental health services and the services of psychologists, as defined in chapter 465;

(3) Providing training and education about emotional disturbances of children to teachers, school counselors, and parents;

(4) Assisting the department of education with mental health services and the services of psychologists, as defined in chapter 465 for handicapped children;

(5) Developing an ongoing mechanism to assess, document and report to the legislature and the governor unmet needs for mental health services for students in each geographic region; and

(6) Performing other related services for school personnel, children, and parents.

(b) The department of health and the department of education shall create an individualized education plan or modification plan for children and youth with challenging behaviors who may suffer from mental and emotional disorders. The plan may identify and address challenging behaviors that interfere with a child's or youth's learning and may consist of strategies and supports to help the child or youth benefit from the education received at a school, individualized behavioral supports, intervention strategies, and measurable objectives.

(c) All children and youth, ages three to twenty-one, shall be eligible for an individualized education plan or modification plan to receive mental health services, regardless of school enrollment status."

PART III

SECTION 8. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 9. This Act shall take effect on July 1, 2050.

THE SENATE	S.B. NO.	2145
TWENTY-SIXTH LEGISLATURE, 2012		S.D. 2
STATE OF HAWAII