Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H146 Compare Versions

Only one version of the bill is available at this time.

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2	2	HOUSE DOCKET, NO. 3059 FILED ON: 1/20/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 146
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Marjorie C. Decker
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act ensuring access to behavioral health services for children involved with state agencies.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Marjorie C. Decker25th Middlesex1/20/2023Samantha Montaño15th Suffolk1/23/2023David Paul Linsky5th Middlesex3/2/2023 1 of 9
16	16	HOUSE DOCKET, NO. 3059 FILED ON: 1/20/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 146
18	18	By Representative Decker of Cambridge, a petition (accompanied by bill, House, No. 146) of
19	19	Marjorie C. Decker, Samantha Montaño and David Paul Linsky relative to ensuring access to
20	20	behavioral health services for children involved with state agencies. Children, Families and
21	21	Persons with Disabilities.
22	22	The Commonwealth of Massachusetts
23	23	_______________
24	24	In the One Hundred and Ninety-Third General Court
25	25	(2023-2024)
26	26	_______________
27	27	An Act ensuring access to behavioral health services for children involved with state agencies.
28	28	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
29	29	of the same, as follows:
30	30	1 SECTION 1. Section 21 of chapter 19 of the General Laws, as appearing in the 2020
31	31	2Official Edition, is hereby amended by striking out the fifth sentence and inserting in place
32	32	3thereof the following two sentences:-
33	33	4 Pursuant to such agreements the department of mental health shall assume responsibility
34	34	5for individuals requiring specialized mental health services, including, but not limited to,
35	35	6inpatient mental health services, community-based acute treatment, intensive community-based
36	36	7acute treatment, mobile crisis intervention, intensive residential treatment programs, and crisis
37	37	8stabilization services. Pursuant to such agreements the department of mental health may assume
38	38	9responsibility for the provision of other non-mental health services to the department of
39	39	10developmental services. 2 of 9
40	40	11 SECTION 2. Section 33C of chapter 119 of the General Laws, as so appearing, is hereby
41	41	12amended by inserting after subsection (b) the following four new subsections: -
42	42	13 (c) The department, in consultation with the department of public health and the
43	43	14department of mental health, shall develop a model emergency response plan that includes both
44	44	15medical and behavioral health crisis response in order to promote best practices for congregate
45	45	16care settings, including clear guidelines for the roles and responsibilities of staff in congregate
46	46	17care settings, including but not limited to, protocols to access mobile crisis intervention, and,
47	47	18where applicable, youth crisis stabilization services, and community-based mental health
48	48	19providers; provided, however, that such model plan shall be designed to limit referrals to law
49	49	20enforcement in congregate care settings to cases in which an imminent risk of death or serious
50	50	21physical, emotional, or mental harm to individuals or damage to congregate care property
51	51	22necessitates such referral.
52	52	23 The model plan shall be made available to all congregate care settings, provided the
53	53	24department shall support the congregate care setting in adapting said plan for implementation. In
54	54	25developing the model plan, the department shall consult with the department of mental health,
55	55	26the department of public health, the executive office of health and human services, the office of
56	56	27the child advocate, and other relevant organizations that identify the essential components of an
57	57	28emergency response plan. The department shall biennially review and update the model plan,
58	58	29publicly post the model plan on its website, and provide technical assistance to congregate care
59	59	30settings to review and implement changes to model emergency response plan. The model plan
60	60	31shall include, but not be limited to, required access to training in behavioral health for staff in
61	61	32behavioral and mental health competencies, including, but not limited to, de-escalation
62	62	33strategies, trauma-informed, culturally, and linguistically congruent care, suicide prevention, 3 of 9
63	63	34peer support, and available resources and methods of outreach to non-clinical and clinical
64	64	35services related to behavioral and mental health.
65	65	36 (d) A congregate care program under contract to provide foster care to children in the
66	66	37care or custody of the department, in consultation with the department, shall ensure the
67	67	38implementation
68	68	39 of an emergency response plan for said setting; provided the congregate care program
69	69	40may adapt the department’s model emergency response plan to fit the needs of the setting;
70	70	41provided further, the congregate care program shall biennially review the plan. The plan shall be
71	71	42made available to the department upon request.
72	72	43 (e) A child in the care or custody of the department has the right to return to their
73	73	44congregate care program under contract to provide foster care to children in the care or custody
74	74	45of the department following a medical or non-medical leave of absence if it is determined
75	75	46appropriate for the child to return to the congregate care setting. The department shall reimburse,
76	76	47at the prevailing rate of reimbursement, the congregate care program to hold the bed of a child
77	77	48for each day of their hospitalization or other leave of absence from the program.
78	78	49 (f) If a child requires care in another setting, including, but not limited to an emergency
79	79	50department visit or a stay in an inpatient setting, community behavioral health center, intensive
80	80	51community based acute treatment, community based acute treatment, or community crisis
81	81	52stabilization, a congregate care program, under contract to provide foster care to children in the
82	82	53care or custody of the department, shall not refuse to readmit a child living in that congregate
83	83	54care program after a medical or non-medical leave of absence, including an emergency or acute
84	84	55behavioral or psychiatric circumstance, provided that the child has been determined medically 4 of 9
85	85	56and psychiatrically stable and provided further, it is appropriate for the child to be discharged to
86	86	57return to their congregate care program. A congregate care program may deny readmission to a
87	87	58child whose needs have been determined by the program’s director or clinical director to exceed
88	88	59the program’s capability at the time readmission is sought; provided the program reports the
89	89	60denial of readmission of the child to said program to the department of children and families
90	90	61pursuant to section 33D. The determination shall be recorded in writing and shall include the
91	91	62factors justifying the denial and why mitigating efforts would have been inadequate to address
92	92	63the care needs of the child.
93	93	64 The congregate care program shall participate in the emergency team pursuant to section
94	94	6533D; provided further the department shall assume responsibility to coordinate care for the child.
95	95	66 SECTION 3. Chapter 119, as so appearing, is hereby amended by inserting after section
96	96	6733C, the following new section: -
97	97	68 33D. (a) The department of children and families shall collect data on the instances when
98	98	69a congregate care program, under contract to provide foster care to children in the care or
99	99	70custody of the department, denies to readmit a child after a circumstance requiring care in
100	100	71another setting, including, but not limited to an emergency department visit or a stay in an
101	101	72inpatient setting, community behavioral health center, intensive community based acute
102	102	73treatment, community based acute treatment, or community crisis stabilization. A congregate
103	103	74care program shall report to the department when it denies readmission to a child after a medical
104	104	75or non-medical leave of absence, including an emergency or acute behavioral or psychiatric
105	105	76circumstance. Such report shall include, but not be limited to, i) instances when a congregate
106	106	77care program denies readmission of a child following a medical or non-medical leave of absence, 5 of 9
107	107	78(ii) the underlying factors justifying denial of readmission of the child to a congregate care
108	108	79program, and (iii) why mitigating efforts would have been insufficient.
109	109	80 The department shall post to the department’s website, on a quarterly basis, a report on
110	110	81the data collected in this section. To the extent feasible, all data shall be disaggregated by race,
111	111	82ethnicity, gender identity, age and other demographic information. The department shall provide
112	112	83a copy of the report to the executive office of health and human services; the joint committee on
113	113	84mental health, substance use and recovery; and the joint committee on children, families and
114	114	85persons with disabilities.
115	115	86 (b) At the request of the congregate care program or the setting where the child is
116	116	87awaiting discharge from, the department shall convene an emergency team within two business
117	117	88days to conduct planning discussions to facilitate child placement in an appropriate setting. The
118	118	89emergency team shall include, but not be limited to, a representative from the child’s clinical
119	119	90care team, including, but not limited to, the team currently caring for the child; the child’s
120	120	91current behavioral health provider and primary care provider, as applicable; a representative of
121	121	92the relevant congregate care program; a representative of the department; and the child’s legal
122	122	93guardian, if applicable. If the team does not determine an appropriate placement within 7 days of
123	123	94convening, or earlier if the department deems additional state-agency involvement is necessary,
124	124	95the department may refer the child to the complex case resolution panel pursuant to section 16R
125	125	96of chapter 6A, as inserted by chapter 177 of the Acts of 2022, provided the department report to
126	126	97the panel a written summary of the team’s determination to refer the case to the complex case
127	127	98resolution panel. 6 of 9
128	128	99 SECTION 4. Notwithstanding any general or special law to the contrary, the department
129	129	100of children and families shall prepare a comprehensive plan to address access to behavioral and
130	130	101mental health services for individuals in their custody or care. The plan shall include, but not be
131	131	102limited to: (i) strategies to expand access to post-hospitalization settings, including but not
132	132	103limited to, services for transitional age youth, youth with complex behavioral health needs, youth
133	133	104with autism spectrum disorders, youth with intellectual or developmental disabilities, youth with
134	134	105co-occurring behavioral and substance use disorders, youth with co-occurring behavioral and
135	135	106medical needs, school-based services, and respite services; (ii) strategies to reduce the wait times
136	136	107for patients awaiting discharge so that the patients determined appropriate for congregate care,
137	137	108intensive residential treatment programs, community-based programs or other appropriate
138	138	109settings would be admitted to the appropriate setting within fourteen days of their application;
139	139	110and iii) strategies to facilitate care coordination between the department and local education
140	140	111agencies including, but not limited to, recommendations for streamlined communications
141	141	112between local and out-of-district schools, community partners, and other residential-educational
142	142	113settings. The department of children and families shall submit a copy of the plan, including any
143	143	114budgetary needs, to the executive office of health and human services; the clerks of the senate
144	144	115and house of representatives; the joint committee on mental health, substance use, and recovery,
145	145	116and; the joint committee on children, families, and persons with disabilities within 60 days of the
146	146	117effective date of this act.
147	147	118 SECTION 5. Notwithstanding any general or special law to the contrary, the department
148	148	119of developmental services shall prepare a comprehensive plan to address access to behavioral
149	149	120and mental health services for individuals in their custody or care. The plan shall include, but not
150	150	121be limited to: (i) strategies to expand access to post-hospitalization settings, including but not 7 of 9
151	151	122limited to, services for transitional age youth, youth with complex behavioral health needs, youth
152	152	123with autism spectrum disorders, youth with intellectual or developmental disabilities, youth with
153	153	124co-occurring behavioral and substance use disorders, youth with co-occurring behavioral and
154	154	125medical needs, school-based services, and respite services; (ii) strategies to reduce the wait times
155	155	126for patients awaiting discharge so that the patients determined appropriate for congregate care,
156	156	127intensive residential treatment programs, community-based programs or other appropriate
157	157	128settings would be admitted to the appropriate setting within fourteen days of their application;
158	158	129and iii) strategies to facilitate care coordination between the department and local education
159	159	130agencies including, but not limited to, recommendations for streamlined communications
160	160	131between local and out-of-district schools, community partners, and other residential-educational
161	161	132settings. The department of developmental services shall submit a copy of the plan, including
162	162	133any budgetary needs, to the executive office of health and human services; the clerks of the
163	163	134senate and house of representatives; the joint committee on mental health, substance use, and
164	164	135recovery, and; the joint committee on children, families, and persons with disabilities within 60
165	165	136days of the effective date of this act.
166	166	137 SECTION 6. There shall be a special commission established for the purposes of making
167	167	138an investigation and study relative to children and adolescents with intensive behavioral health
168	168	139needs whose behavioral health needs, such as acute aggressive, assaultive or otherwise unsafe
169	169	140behaviors, are not adequately addressed through inpatient psychiatric hospitalizations,
170	170	141community based acute treatment (CBAT) services, or existing residential or community
171	171	142treatment models contracted by the Department of Children and Families.
172	172	143 The Commission shall consist of 25 members or their designees: the Secretary of Health
173	173	144and Human Services or a designee, who shall serve as chair; the Commissioner of Public Health 8 of 9
174	174	145or a designee; the Commissioner of the Department of Children and Families or a designee; the
175	175	146Commissioner of the Department of Youth Services or a designee; the Commissioner of the
176	176	147Department of Developmental Service or a designee; the Commissioner of the Department of
177	177	148Early Education and Care or a designee; Chief Justice of the Juvenile Court Department or a
178	178	149designee; the Chairs of the Joint Committee on Mental Health, Substance Use and Recovery or
179	179	150their designees; the Chairs of the Joint Committee on Children, Families and Persons with
180	180	151Disabilities or their designees; a representative from the Office of the Child Advocate; a
181	181	152representative from the Association for Behavioral Healthcare, Inc.; a representative from the
182	182	153Massachusetts Health & Hospital Association; a representative from the Massachusetts
183	183	154Association of Behavioral Health Systems; a representative from the Children’s Mental Health
184	184	155Campaign; a representative from the Children’s League of Massachusetts; a representative from
185	185	156the Parent/Professional Advocacy League; a representative from the Massachusetts Behavioral
186	186	157Health Partnership; 6 members to be appointed by the chair, 2 of whom shall be a family
187	187	158member of a child or adolescent with behavioral health needs or who has been involved in the
188	188	159juvenile court system; 3 of whom shall be a behavioral health provider specializing in serving
189	189	160children and adolescents with intensive behavioral health needs; and 1 of whom shall be a
190	190	161clinician or researcher with expertise related to children and adolescents with intensive
191	191	162behavioral health needs. In making appointments, the Secretary shall, to the maximum extent
192	192	163feasible, ensure that the Commission represents a broad distribution of diverse perspectives and
193	193	164geographic regions.
194	194	165 The Commission shall: (i) create aggregate demographic and geographic profiles of
195	195	166children and adolescents with intensive behavioral health needs; (ii) examine the current
196	196	167availability of, and barriers to providing, behavioral health services and treatment to children and 9 of 9
197	197	168adolescents with intensive behavioral health needs; (iii) examine existing efforts undertaken by
198	198	169healthcare providers and the existing body of research around best practices for treating children
199	199	170and adolescents with intensive behavioral health needs; including, but not limited to models that
200	200	171promote community involvement and diversion from the juvenile court system; and (iv) examine
201	201	172other matters deemed appropriate by the Commission.
202	202	173 All appointments shall be made not later than 30 days after the effective date of this act.
203	203	174 The Commission shall submit its findings and recommendations to the Clerks of the
204	204	175Senate and the House of Representatives, the Joint Committee on Mental Health, Substance Use
205	205	176and Recovery, the Joint Committee on Children, Families and Persons with Disabilities and the
206	206	177Senate and House Committees on Ways and Means not later than January 1, 2024. The Secretary
207	207	178of Health and Human Services shall make the report publicly available on the website of the
208	208	179Executive Office of Health and Human Services.