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SENATE DOCKET, NO. 965 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 72
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Brendan P. Crighton
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act ensuring access to behavioral health services for children involved with state agencies.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Brendan P. CrightonThird Essex 1 of 9
SENATE DOCKET, NO. 965 FILED ON: 1/18/2023
SENATE . . . . . . . . . . . . . . No. 72
By Mr. Crighton, a petition (accompanied by bill, Senate, No. 72) of Brendan P. Crighton for
legislation to ensure access to behavioral health services for children involved with state
agencies. Children, Families and Persons with Disabilities.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act ensuring access to behavioral health services for children involved with state agencies.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Section 21 of chapter 19 of the General Laws, as appearing in the 2020
2Official Edition, is hereby amended by striking out the fifth sentence and inserting in place
3thereof the following two sentences:-
4 Pursuant to such agreements the department of mental health shall assume responsibility
5for individuals requiring specialized mental health services, including, but not limited to,
6inpatient mental health services, community-based acute treatment, intensive community-based
7acute treatment, mobile crisis intervention, intensive residential treatment programs, and crisis
8stabilization services. Pursuant to such agreements the department of mental health may assume
9responsibility for the provision of other non-mental health services to the department of
10developmental services.
11 SECTION 2. Section 33C of chapter 119 of the General Laws, as so appearing, is hereby
12amended by inserting after subsection (b) the following four new subsections: - 2 of 9
13 (c) The department, in consultation with the department of public health and the
14department of mental health, shall develop a model emergency response plan that includes both
15medical and behavioral health crisis response in order to promote best practices for congregate
16care settings, including clear guidelines for the roles and responsibilities of staff in congregate
17care settings, including but not limited to, protocols to access mobile crisis intervention, and,
18where applicable, youth crisis stabilization services, and community-based mental health
19providers; provided, however, that such model plan shall be designed to limit referrals to law
20enforcement in congregate care settings to cases in which an imminent risk of death or serious
21physical, emotional, or mental harm to individuals or damage to congregate care property
22necessitates such referral.
23 The model plan shall be made available to all congregate care settings, provided the
24department shall support the congregate care setting in adapting said plan for implementation. In
25developing the model plan, the department shall consult with the department of mental health,
26the department of public health, the executive office of health and human services, the office of
27the child advocate, and other relevant organizations that identify the essential components of an
28emergency response plan. The department shall biennially review and update the model plan,
29publicly post the model plan on its website, and provide technical assistance to congregate care
30settings to review and implement changes to model emergency response plan. The model plan
31shall include, but not be limited to, required access to training in behavioral health for staff in
32behavioral and mental health competencies, including, but not limited to, de-escalation
33strategies, trauma-informed, culturally, and linguistically congruent care, suicide prevention,
34peer support, and available resources and methods of outreach to non-clinical and clinical
35services related to behavioral and mental health. 3 of 9
36 (d) A congregate care program under contract to provide foster care to children in the
37care or custody of the department, in consultation with the department, shall ensure the
38implementation of an emergency response plan for said setting; provided the congregate care
39program may adapt the department’s model emergency response plan to fit the needs of the
40setting; provided further, the congregate care program shall biennially review the plan. The plan
41shall be made available to the department upon request.
42 (e) A child in the care or custody of the department has the right to return to their
43congregate care program under contract to provide foster care to children in the care or custody
44of the department following a medical or non-medical leave of absence if it is determined
45appropriate for the child to return to the congregate care setting. The department shall reimburse,
46at the prevailing rate of reimbursement, the congregate care program to hold the bed of a child
47for each day of their hospitalization or other leave of absence from the program.
48 (f) If a child requires care in another setting, including, but not limited to an emergency
49department visit or a stay in an inpatient setting, community behavioral health center, intensive
50community based acute treatment, community based acute treatment, or community crisis
51stabilization, a congregate care program, under contract to provide foster care to children in the
52care or custody of the department, shall not refuse to readmit a child living in that congregate
53care program after a medical or non-medical leave of absence, including an emergency or acute
54behavioral or psychiatric circumstance, provided that the child has been determined medically
55and psychiatrically stable and provided further, it is appropriate for the child to be discharged to
56return to their congregate care program. A congregate care program may deny readmission to a
57child whose needs have been determined by the program’s director or clinical director to exceed
58the program’s capability at the time readmission is sought; provided the program reports the 4 of 9
59denial of readmission of the child to said program to the department of children and families
60pursuant to section 33D. The determination shall be recorded in writing and shall include the
61factors justifying the denial and why mitigating efforts would have been inadequate to address
62the care needs of the child.
63 The congregate care program shall participate in the emergency team pursuant to section
6433D; provided further the department shall assume responsibility to coordinate care for the child.
65 SECTION 3. Chapter 119, as so appearing, is hereby amended by inserting after section
6633C, the following new section: -
67 33D. (a) The department of children and families shall collect data on the instances when
68a congregate care program, under contract to provide foster care to children in the care or
69custody of the department, denies to readmit a child after a circumstance requiring care in
70another setting, including, but not limited to an emergency department visit or a stay in an
71inpatient setting, community behavioral health center, intensive community based acute
72treatment, community based acute treatment, or community crisis stabilization. A congregate
73care program shall report to the department when it denies readmission to a child after a medical
74or non-medical leave of absence, including an emergency or acute behavioral or psychiatric
75circumstance. Such report shall include, but not be limited to, i) instances when a congregate
76care program denies readmission of a child following a medical or non-medical leave of absence,
77(ii) the underlying factors justifying denial of readmission of the child to a congregate care
78program, and (iii) why mitigating efforts would have been insufficient.
79 The department shall post to the department’s website, on a quarterly basis, a report on
80the data collected in this section. To the extent feasible, all data shall be disaggregated by race, 5 of 9
81ethnicity, gender identity, age and other demographic information. The department shall provide
82a copy of the report to the executive office of health and human services; the joint committee on
83mental health, substance use and recovery; and the joint committee on children, families and
84persons with disabilities.
85 (b) At the request of the congregate care program or the setting where the child is
86awaiting discharge from, the department shall convene an emergency team within two business
87days to conduct planning discussions to facilitate child placement in an appropriate setting. The
88emergency team shall include, but not be limited to, a representative from the child’s clinical
89care team, including, but not limited to, the team currently caring for the child; the child’s
90current behavioral health provider and primary care provider, as applicable; a representative of
91the relevant congregate care program; a representative of the department; and the child’s legal
92guardian, if applicable. If the team does not determine an appropriate placement within 7 days of
93convening, or earlier if the department deems additional state-agency involvement is necessary,
94the department may refer the child to the complex case resolution panel pursuant to section 16R
95of chapter 6A, as inserted by chapter 177 of the Acts of 2022, provided the department report to
96the panel a written summary of the team’s determination to refer the case to the complex case
97resolution panel.
98 SECTION 4. Notwithstanding any general or special law to the contrary, the department
99of children and families shall prepare a comprehensive plan to address access to behavioral and
100mental health services for individuals in their custody or care. The plan shall include, but not be
101limited to: (i) strategies to expand access to post-hospitalization settings, including but not
102limited to, services for transitional age youth, youth with complex behavioral health needs, youth
103with autism spectrum disorders, youth with intellectual or developmental disabilities, youth with 6 of 9
104co-occurring behavioral and substance use disorders, youth with co-occurring behavioral and
105medical needs, school-based services, and respite services; (ii) strategies to reduce the wait times
106for patients awaiting discharge so that the patients determined appropriate for congregate care,
107intensive residential treatment programs, community-based programs or other appropriate
108settings would be admitted to the appropriate setting within fourteen days of their application;
109and iii) strategies to facilitate care coordination between the department and local education
110agencies including, but not limited to, recommendations for streamlined communications
111between local and out-of-district schools, community partners, and other residential-educational
112settings. The department of children and families shall submit a copy of the plan, including any
113budgetary needs, to the executive office of health and human services; the clerks of the senate
114and house of representatives; the joint committee on mental health, substance use, and recovery,
115and; the joint committee on children, families, and persons with disabilities within 60 days of the
116effective date of this act.
117 SECTION 5. Notwithstanding any general or special law to the contrary, the department
118of developmental services shall prepare a comprehensive plan to address access to behavioral
119and mental health services for individuals in their custody or care. The plan shall include, but not
120be limited to: (i) strategies to expand access to post-hospitalization settings, including but not
121limited to, services for transitional age youth, youth with complex behavioral health needs, youth
122with autism spectrum disorders, youth with intellectual or developmental disabilities, youth with
123co-occurring behavioral and substance use disorders, youth with co-occurring behavioral and
124medical needs, school-based services, and respite services; (ii) strategies to reduce the wait times
125for patients awaiting discharge so that the patients determined appropriate for congregate care,
126intensive residential treatment programs, community-based programs or other appropriate 7 of 9
127settings would be admitted to the appropriate setting within fourteen days of their application;
128and iii) strategies to facilitate care coordination between the department and local education
129agencies including, but not limited to, recommendations for streamlined communications
130between local and out-of-district schools, community partners, and other residential-educational
131settings. The department of developmental services shall submit a copy of the plan, including
132any budgetary needs, to the executive office of health and human services; the clerks of the
133senate and house of representatives; the joint committee on mental health, substance use, and
134recovery, and; the joint committee on children, families, and persons with disabilities within 60
135days of the effective date of this act.
136 SECTION 6. There shall be a special commission established for the purposes of making
137an investigation and study relative to children and adolescents with intensive behavioral health
138needs whose behavioral health needs, such as acute aggressive, assaultive or otherwise unsafe
139behaviors, are not adequately addressed through inpatient psychiatric hospitalizations,
140community based acute treatment (CBAT) services, or existing residential or community
141treatment models contracted by the Department of Children and Families.
142 The Commission shall consist of 25 members or their designees: the Secretary of Health
143and Human Services or a designee, who shall serve as chair; the Commissioner of Public Health
144or a designee; the Commissioner of the Department of Children and Families or a designee; the
145Commissioner of the Department of Youth Services or a designee; the Commissioner of the
146Department of Developmental Service or a designee; the Commissioner of the Department of
147Early Education and Care or a designee; Chief Justice of the Juvenile Court Department or a
148designee; the Chairs of the Joint Committee on Mental Health, Substance Use and Recovery or
149their designees; the Chairs of the Joint Committee on Children, Families and Persons with 8 of 9
150Disabilities or their designees; a representative from the Office of the Child Advocate; a
151representative from the Association for Behavioral Healthcare, Inc.; a representative from the
152Massachusetts Health & Hospital Association; a representative from the Massachusetts
153Association of Behavioral Health Systems; a representative from the Children’s Mental Health
154Campaign; a representative from the Children’s League of Massachusetts; a representative from
155the Parent/Professional Advocacy League; a representative from the Massachusetts Behavioral
156Health Partnership; 6 members to be appointed by the chair, 2 of whom shall be a family
157member of a child or adolescent with behavioral health needs or who has been involved in the
158juvenile court system; 3 of whom shall be a behavioral health provider specializing in serving
159children and adolescents with intensive behavioral health needs; and 1 of whom shall be a
160clinician or researcher with expertise related to children and adolescents with intensive
161behavioral health needs. In making appointments, the Secretary shall, to the maximum extent
162feasible, ensure that the Commission represents a broad distribution of diverse perspectives and
163geographic regions.
164 The Commission shall: (i) create aggregate demographic and geographic profiles of
165children and adolescents with intensive behavioral health needs; (ii) examine the current
166availability of, and barriers to providing, behavioral health services and treatment to children and
167adolescents with intensive behavioral health needs; (iii) examine existing efforts undertaken by
168healthcare providers and the existing body of research around best practices for treating children
169and adolescents with intensive behavioral health needs; including, but not limited to models that
170promote community involvement and diversion from the juvenile court system; and (iv) examine
171other matters deemed appropriate by the Commission.
172 All appointments shall be made not later than 30 days after the effective date of this act. 9 of 9
173 The Commission shall submit its findings and recommendations to the Clerks of the
174Senate and the House of Representatives, the Joint Committee on Mental Health, Substance Use
175and Recovery, the Joint Committee on Children, Families and Persons with Disabilities and the
176Senate and House Committees on Ways and Means not later than January 1, 2024. The Secretary
177of Health and Human Services shall make the report publicly available on the website of the
178Executive Office of Health and Human Services.