Overview
Legislation
Recently Introduced
Behavioral Health News
State-of-the-State

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Overview

The January State Policy Focus is devoted to state pre-filed and carried over legislation for the 2008 legislative session. Seventeen states pre-filed 114 pieces of legislation to date. The states that have pre-filed are: Alabama, Alaska, Florida, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, New Mexico, South Carolina, South Dakota, Utah, Vermont, Virginia, Washington and Wyoming.

The following 25 states and the District of Columbia Council will carry-over legislation from 2007 to 2008, so many of these states did not pre-file bills this year: Alaska, California, Delaware, District of Columbia, Georgia, Hawaii, Illinois, Iowa, Kansas, Maine, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Washington and Wisconsin. Arkansas, Montana, North Dakota, Nevada, Oregon and Texas are not scheduled to hold a regular session in 2008.

Based on the carried over and pre-filed bills, the following will likely be hot topics for the 2008 legislative session:  universal healthcare, the reauthorization and funding of the State Children’s Health Insurance Program (SCHIP) and Medicaid.

Twenty-eight states passed or considered new health care laws or proposals to change the system in 2007, some inching toward the goal of universal or affordable coverage. Many observers were waiting to see what happened in California, where Republican Gov. Arnold Schwarzenegger made healthcare reform a major issue this year. But Governor Schwarzenegger and Democratic leaders in the Legislature have yet to reach an agreement on a funding mechanism, and with the state budget inching toward a $14 billion deficit, that compromise may not happen.

New York Democratic Gov. Eliot Spitzer, however, recently set up a task force to explore bringing universal care to the state, so the issue will remain a hot topic no matter what happens in California. New Mexico lawmakers have said they will consider a new universal health care coverage bill this year. Hawaii and Illinois will also resume a universal health care coverage debate begun last year.

President Bush vetoed the SCHIP reauthorization bill for a second time on December 12 and later authorized an extension but not expansion of the existing program until 2009. Bush opposes Congressional plans to expand SCHIP so the long-term fate of the immensely popular federal program is unclear. Some six million children are currently covered by SCHIP. If Congress fails to expand SCHIP funding, states could face a funding shortfall of between $2.9 billion to $3.7 billion by 2012. Twenty-one states are expected to experience federal funding shortfalls in 2008, and nine states will hit those shortfalls by March.

Medicaid will be at the top of at least 19 states’ legislative priority list according to the NCSL. Rising Medicaid costs and the escalating rate of uncompensated care has savaged many state budgets. South Carolina, a tobacco growing state, ironically will consider a tobacco tax increase in 2008 to fully fund Medicaid. Iowa, Mississippi, New Mexico and Vermont all face structural deficits driven by enrollment in their Medicaid budgets and are expect to tackle them in 2008 and 2009. California and Maryland have also promised to resume a thorny health care reform debate begun in 2007.

You may also view a more general overview of state legislative trends for 2008.

Tammy Seltzer
Director of State Policy

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Legislation

The following categories contain an example of bills that have been pre-filed in 2008.

Funding

Maine LD 2042, sponsored by Rep. Marilyn Canavan, D-Waterville, was pre-filed on December 19 and referred to the Appropriations and Financial Affairs Committee. This bill would provide an ongoing General Fund appropriation of $100,000 beginning in fiscal year 2008-09 to the Judicial Department to continue funding of the Kennebec County Co-Occurring Disorders Court program.

New Mexico SB 12, sponsored by Leonard Lee Rawson, R-Dona Ana/Sierra, was pre-filed on December 21. This bill would appropriate $27,200 from the general fund to the Administrative Office of the Courts to expand and enhance the juvenile drug court in the third judicial district. The funds would be appropriated for fiscal year 2009.

New Mexico HB 30, sponsored by Rep. John Pena, D-McKinley, was pre-filed on January 5. HB 30 would appropriate $100,000, from the general fund, to the Department of Health to implement a Native American youth-led peer-to-peer suicide prevention program in McKinley and San Juan counties. This appropriation would be contingent upon the receipt of matching funds in at least an equal amount from a non-state source and be distributed for fiscal year 2009.

Wyoming SF 10 was pre-filed by the Select Committee on Mental Health and Substance Abuse Services on December 7. This bill would appropriate the following general funds to the Department of Health for the biennium beginning July 1, 2008, and ending June 30, 2010:

• $600,000 to the Strategic Prevention Framework State Incentive Grant Program to be used to prevent the onset and reduce the progression of substance abuse, reduce substance abuse related problems in communities, and build prevention capacities and infrastructure at community levels.
• $1,693,600 to allow the mental health and substance abuse services division of the department to fund not more than 16 beds and the reasonable start up costs related to those beds in the southeast region of the state for women who need substance abuse treatment services and their children.
• $5,177,430 to provide crisis stabilization services in four regions of the state. The services include community based, short-term intervention for adults who are experiencing an acute mental health crisis and are in need of 24-hour intensive mental health treatment and stabilization, and may include persons with co-occurring disorders.
• $40,000 to provide specialized training to judges, attorneys and mental health, substance abuse and other providers who work with persons who may need mental health or alcohol or substance abuse treatment services.

SF 10 would also appropriate $60,000 from the general fund to the Legislative Service Office for the period beginning July 1, 2008, and ending December 31, 2009. The funds would be used to pay the costs and expenses of the Select Committee on Mental Health and Substance Abuse Services. The committee will continue its study of issues during the 2008 and 2009 legislative interims and to propose legislation for a more cost effective and accessible delivery system of services for persons in need of mental health or alcohol or substance abuse treatment.

Wyoming HB 12, sponsored by the Select Committee on Mental Health and

Substance Abuse Services, was also pre-filed on December 7. This bill would appropriate $848,000 from the general fund to the Department of Health for the biennium beginning July 1, 2008, and ending June 30, 2010. The department would be required to use the appropriated funds as follows:

• $440,000 to contract with two people whose duties would include the detection and identification of soldiers returning Iraq or Afghanistan and their families who may be in need of mental health or substance abuse treatment services.
• $68,000 to reimburse physicians who provide assessment screenings to soldiers and their families who otherwise would not be paid for the screening tools used in the assessment.
• $250,000 to reimburse soldiers and their families for travel, childcare and other expenses necessary to access mental health or substance abuse treatment resources.
• $40,000 to provide training to physicians and other health care providers on war related injuries and illnesses.
• $50,000 to provide training to community leaders and employers to improve reintegration and transition into the community and employment for soldiers.

Medicaid/Access to Services

Alaska SB 212, a bill regarding eligibility requirements for medical assistance, was pre-filed by Sen. Bettye Davis, D-Anchorage, on January 4. This bill amends Section 47.07.020(b) of the Alaska Statutes by stating that a person younger than 19 and pregnant women who are not covered by Medicaid whose household income does not exceed 200 percent of the federal poverty level (FPL) are eligible for medical assistance. Current law states the household income cannot exceed 175 percent FPL.

In addition this bill amends Section 47.07.42(d), adding that the Department of Health and Human Services could require premiums or cost-sharing contributions from the person younger than 19 whose household income is between 150 and 200 percent FPL. The household income under current law is between 150 and 175 percent FPL.

Florida SB 988, a bill relating to transitional services for youth and young adults with Disabilities within the Department of Health, was pre-filed on January 7 by Sen. Stephen Wise, R-Clay.

This bill would require the Department of Health to create a statewide Health Care Transition Services Task Force for Youth and Young Adults with Disabilities. The 13 member task force would:

• Convene by August 31, 2008.
• Obtain input from key stakeholders, public agencies, the medical practice community, and youth who have chronic special health care needs and disabilities and their families to assess the need for health care transition services.
• Identify barriers that impede access to comprehensive medical treatment and health care for youth and young adults who have chronic special health care needs and disabilities.
• Develop a statewide plan to promote the development of health care transition services. The plan should:
  • Put forth different models that accommodate the geographic and cultural diversity in the state.
  • Adapt to the local needs of communities and to local health services delivery systems.
  • Promote the integration of health care transition services with transition programs for education, vocation, and independent living.
• Identify common or comparable performance measures for all entities that serve the needs for health care transition services of youth and young adults who have chronic special health care needs and disabilities.
• Collect and disseminate information concerning best practices in health care transition services for youth and young adults who have chronic special health care needs and disabilities.
• Identify existing and potential funding sources to create health care transition services within communities.

The task force would need to present a final report to the governor, the Senate president and the House speaker by January 1, 2009.

SB 988 would also create the Don Davis Health and Transition Services Program of Jacksonville. This program would assist adolescents and young adults who have special needs relating to health care, educational and vocational services in making a smooth transition from the child health care and educational system to the adult health care system and to employment. The program would also provide services for persons who are 14 to 26 years of age residing in Baker, Clay, Duval, Nassau and St. Johns Counties and who have chronic special health care needs or developmental disabilities.

The following elements must be in place in order to ensure the success of the Don Davis Health and Transition Services Program of Jacksonville:

• A consultative partnership between adult and pediatric health care providers in a major medical health care organization or academic medical setting for the purpose of training and transferring adolescents and young adults to adult health care services.
• A primary care clinic established in a major medical health care organization for the purpose of fostering the partnership between adult and pediatric health care providers.
• Community-based health care services that are provided pursuant to agreements with major health care organizations or academic medical centers for purposes of providing consultation concerning the management of special health care needs.
• Community-based support organizations that can provide assistance with services such as supported living and employment, health insurance and support services to maintain the young adult in the community.

The Don Davis Health and Transition Services Program of Jacksonville would offer the following services:

• An assessment of health needs, educational and vocational status and needs, and health insurance status.
• In coordination with the educational system, community-based organizations and the vocational system, a plan for transition which includes adult health services, education, habilitative services, independent living, adult employment and health insurance.
• A medical home that provides for coordinated and multidisciplinary care and focuses on engaging adult health care providers in the care and treatment of the adolescent or young adult.
• Self-management of specific health conditions, preventive health services, and the use of primary care and specialty health care services.

The program would need to conduct an evaluation that is formative and cumulative and must include program process and outcome measures as well as client outcomes. The results of the evaluation may be used to improve and develop other health and transition programs statewide.

This bill would also require to Legislature to allocate $100,000 to offset expenses incurred by the task force, and appropriate $650,000 from the General Revenue Fund to the Division of Children’s Medical Services Network within the Department of Health for operation and expansion costs for the program during the 2008-2009 fiscal year.

Florida HB 461 was pre-filed by Rep. Jimmy Patronis, R-Panama City, on January 7. This bill would amended Section 408.909 subsections (5) and (10) by stating that a resident who is 64 years or younger who has a family income of  equal or less than 300 percent FPL would be eligible to enroll in an approved health flex plan. The family income under current law is 200 percent FPL.

Children

Virginia HB 121 was pre-filed by Del. L. Scott Lingamfelter, R-Fauquier, on December 17 and referred to the Health, Welfare and Institutions committee. This bill would require any state or local employee providing mental health services, including suicide prevention services, to a minor child to notify a parent, legal guardian or person standing in loco parentis of the provision of those services.

Notification could be made in person, by telephone, by certified mail or by electronic means within five days of the provision of services, except when the service provider determines that notice to the parent, guardian, or person standing in loco parentis would be likely to cause substantial harm to the minor or another person.

This bill would also stipulate that if the state or local provider issues the required notice within the required time, that provider would not be liable for any civil damages resulting from failure of the parent, legal guardian or person standing in loco parentis to receive the notice.

Medicare Part D/Access to Medications

Utah HB 74, sponsored by Rep. David Litvack, D-Salt Lake, was pre-filed on December 14. This bill would require the Department of Health to explore the feasibility of expanding the use of 340B drug pricing programs in the state Medicaid program.

The department would be required to report, by May 21, 2008 and annually thereafter, to the Health and Human Services Interim Committee and Health and Human Services Appropriations Subcommittee regarding the following:

• Potential cost savings to the state Medicaid program from expansion of the use of 340B drug pricing programs.
• State Medicaid plan amendments or waivers necessary to implement increased use of 340B drug pricing programs by the state Medicaid program.
• Projected implementation of the 340B drug pricing programs identified by the bill.
• Progress towards implementing an expansion of the use of the 340B drug pricing program by community health centers.

The department would also need to work with the Association for Utah Community Health to identify and assist community clinics that do not have 340B drug pricing programs. The task would be to determine whether the patients of the community health center would benefit from establishing a 340B drug pricing program either on site, or through a contract with a pharmacy provider, and whether the center can provide price savings to the community health center’s Medicaid patients.

Virginia HB 85, sponsored by Del. Steven Landes, R-Weyers Cave, was pre-filed on December 13 and referred to the Health, Welfare and Institutions Committee. The measure would establish the Prescription Medication Donation Program to accept and dispense prescription medications. The program would be administered by the state Board of Pharmacy. Prescription medications other than controlled substances would be accepted and re-dispensed when medications remain in the manufacturer’s packaging, individual-dose packaging, or unit-dose packaging that is original, sealed and tamper-evident.

The program would not accept medications that:

• Are supposed to expire within six months after the donation.
• May be adulterated pursuant to § 54.1-3461.

Prescription medications that have been accepted under the program could be dispensed by a pharmacy to patients of clinics organized in whole or in part for delivery of health care services indigent or without charge, if the following procedures are satisfied:

• The dispensing pharmacy and the clinic comply with all federal and state laws and regulations regarding storage and prescription of medications.
• The drug name, strength, and expiration date or beyond-use date is on the medication package label.
• Physical transfer of the prescription medications are accomplished by a person authorized to carry out the transfer by the pharmacy.
• An inventory list of all drugs transferred from the pharmacy to the clinic should accompany the drugs. The inventory should include, but not be limited to, the medication names, strengths, expiration dates and quantities.

Reentry/Diversion/Justice 

Virginia SB 16 was pre-filed by Sen. John Edwards, D-Craig, on December 12 and referred to the Courts of Justice Committee. This bill would require the Department of Criminal Justice Services to establish crisis intervention team pilot programs in areas of the state by January 1, 2009. The pilot programs would be designed to assist law-enforcement officers in responding to crisis situations involving persons with mental illness, substance abuse problems or both.

The goals of the crisis intervention team pilot programs would be:

• Providing immediate response by specially trained regular patrol duty law-enforcement officers.
• Reducing the amount of time officers spend out of service awaiting assessment and disposition.
• Affording persons with mental illness, substance abuse or both, a sense of dignity in crisis situations.
• Reducing the likelihood of physical confrontation.
• Decreasing arrests and use of force.
• Identifying underserved populations with mental illness, substance abuse or both, and linking them to appropriate care.
• Providing support and assistance for mental health treatment professionals.
• Decreasing the use of temporary detention.
• Providing a therapeutic location for officers to bring individuals in crisis for assessment that is not a law-enforcement or jail facility.
• Increasing public recognition and appreciation for the mental health needs of a community.
• Decreasing injuries to law-enforcement officers during crisis events.
• Reducing inappropriate arrests of individuals with mental illness in crisis situations.
• Decreasing the need for mental health treatment in jail.

The department, in consultation with the Department of Mental Health, Mental Retardation and Substance Abuse Services and law-enforcement, would need to establish a training program for all persons involved in the pilot programs. The curriculum would include Department-certified training for selected law-enforcement officers from each crisis intervention team that must include four hours of mandatory training in legal issues.

Each crisis intervention team would need to develop a protocol that permits law-enforcement officers to release persons with mental illness, substance abuse or both, whom they encounter in crisis situations from their custody when the crisis intervention team has determined the person is sufficiently stable and to refer them for emergency treatment services.

By November 1, 2008, the department would need to submit to the Joint Commission on Health Care a report outlining the plan for the program, including copies of any requests for proposals and the criteria developed for selection of pilot areas. The department would also need to evaluate and report, on November 15, 2009 and annually thereafter, on the impact and effectiveness of the crisis intervention team pilot programs.

Virginia SB 18 was also pre-filed by Sen. John Edwards, D-Craig, on December 12 and referred to the Courts of Justice Committee. This bill would direct the office of the executive secretary of the Supreme Court to establish at least two and no more than five mental health courts for nonviolent offenders with serious mental illnesses to begin operation by January 1, 2009.

The office would need to apply for any federal grants or other funding available to establish such courts. The executive secretary would need to report to the General Assembly on the effectiveness and utilization of the mental health courts by January 1, 2011.

Virginia SB 138, a bill relating to medical and psychiatric benefits for prisoners, was pre-file by Sen. Linda Toddy Puller, D-Fairfax, and referred to the Committee on Rehabilitation and Social Services on January 4.

This bill would require the Department of Correction to take all reasonable steps to identify any medical or psychiatric benefits, including Social Security or Veterans Administration benefits, to which a prisoner would be entitled to upon release and to assist the prisoner in securing those benefits. The department would need to ensure that any benefits identified as available to the prisoner are available at the time of release.

Involuntary Commitment

Virginia SB 78, sponsored by Sen. Ken Cuccinelli, R-Fairfax, was pre-filed on December 26 and referred to the Committee for the Courts of Justice. This bill would require that the examination of a person who is the subject of an involuntary commitment hearing be completed within 48 hours of the execution of the temporary detention order, but sufficiently in advance of the hearing so as to ensure sufficient time for a thorough examination.

Virginia SB 177, a bill establishing an outpatient treatment program for the severely mentally ill, was pre-field by Sen. Henry Marsh, D-Chesterfield on January 7 and referred to the Committee for the Courts of Justice. This bill would create an assisted outpatient treatment program so that mentally ill persons who are capable of being maintained safely in the community with the help of such a program can receive those services. A district court judge or special justice would be able to order a person to obtain assisted outpatient treatment if the judge or special justice finds:

• The person is suffering from a mental illness.
• The person has a history of lack of compliance with treatment for mental illness that has:
  • At least twice been a significant factor in necessitating hospitalization or receipt of services in a mental health unit of a correctional facility, not including any period during which the person was hospitalized or incarcerated immediately preceding the filing of the petition.
  • Resulted in one or more acts of violent behavior toward self or others or threats of, or attempts at, physical harm to self or others within the last 48 months, not including any period in which the person was hospitalized or incarcerated immediately preceding the filing of the petition.
• In view of the persons treatment history and current behavior, the person now needs treatment in order to prevent a relapse or deterioration that would be likely to result in the person meeting the inpatient commitment criteria specified in § 37.2-817.
• As a result of the person’s mental illness, the person is unlikely to seek or comply with needed treatment unless the court enters an order for assisted outpatient treatment.
• A written treatment plan has been prepared that sets forth the specific type, amount, duration, and frequency of treatment and services the person is to obtain.
• The proposed treatment is in the person’s best medical interest and constitutes the least restrictive appropriate treatment for the person, taking into consideration all relevant circumstances, including any reasonably possible alternative treatments preferred by the person, as expressed in an advance directive or otherwise.
• The treatment and services providers are identified in and have agreed to the treatment plan.
• The community services board that serves the jurisdiction where the person resides has the capacity to provide the prescribed treatment or services.

A sworn petition for assisted outpatient treatment of a person could be filed by any responsible person. The petition would need to be supported by an affirmation/affidavit of a mental health professional licensed in Virginia through the Department of Health Professions and qualified in the diagnosis of mental illness.

Upon receipt of the sworn petition for treatment, an employee or designee of the local community services board would need to develop a proposed treatment plan. The plan would recommend a specific course of treatment and programs. In developing the treatment plan, the board would need to seek the active participation of the person who is the subject of the petition and consider the person’s treatment preferences, as expressed in an advance directive or otherwise. The hearing would need to be held within five days of the filing of the petition with the magistrate, and notice of the hearing would need to be served on the person who is the subject of the petition and to the petitioner.

If the subject of the petition has refused to be examined by a physician, the district court judge or special justice could request the subject to consent to an examination by a physician appointed by the court. If the subject does not consent and the judge or special justice finds reasonable cause to believe that the allegations in the petition are true, the judge or special justice could order members of an authorized police department or of a sheriff's department, to take the subject into custody and transport him to a hospital for examination by a physician. The subject could not be held for more than 24 hours.

The subject could not be ordered to receive assisted outpatient treatment unless a mental health professional testifies at the hearing and explains the rationale for the recommended assisted outpatient treatment. If the recommended treatment includes medication, the petition must be supported by the affidavit or testimony of a psychiatrist who is licensed in Virginia by the Board of Medicine. The affidavit or testimony would be required to describe the types or classes of medication, the beneficial and detrimental physical and mental effects of such medication, and establish that there is no appropriate less restrictive alternative treatment reasonably possible for the person.

If the judge or special justice finds that each of the criteria for treatment has been established by clear and convincing evidence, he/she would enter an order granting the petition, and directing the person and the treatment and service providers to comply with the approved treatment plan for a period not to exceed 180 days.

If the subject fails to comply with the order, the board or treatment provider would need to make reasonable efforts to contact the person and to secure the person’s compliance with the order. If the board or treatment provider determines that such reasonable efforts have been made, and that the person without good cause has substantially failed to comply with the order, the board or treatment provider could report the noncompliance and a temporary detention order could be issued. The board would need to report to the judge or special justice promptly in writing and recommend an appropriate disposition. The judge or special justice would than schedule a supplemental hearing to occur within 48 hours of the execution of the temporary detention order.

After hearing evidence of the person’s current condition and compliance with the order for assisted outpatient treatment, the judge or special justice would make whichever of the following dispositions is appropriate:

• Upon finding that the person meets the criteria for involuntary admission and treatment, the judge or special justice could order that the person be placed in a hospital or other facility for a period of treatment not to exceed 180 days from the date of the order.
• Upon finding that the person continues to meet the criteria for assisted outpatient treatment, and that a continued period of assisted outpatient treatment appears warranted, the judge or special justice could renew the order for assisted outpatient treatment, making any necessary modifications that are acceptable to the treatment provider or facility responsible for the person’s treatment.
• Upon finding that neither of these dispositions is appropriate, the judge could rescind the order for assisted outpatient treatment.

At any time at least 45 days after the most recent hearing, a person who is subject to an order for assisted outpatient treatment could petition the court to terminate the order. At any time within 30 days before the expiration of an order, the community services board or treatment provider that is monitoring the person’s compliance could petition the court to extend the order for a period of 180 days or less.

Substance Abuse

Wyoming HB 2, a bill increasing a tax on alcohol, was pre-filed by the Select Committee on Mental Health and Substance Abuse Services on December 5.

The Commission - the Wyoming Liquor Division within the Department of Revenue - is required to collect all excise taxes relating to alcohol and malt beverages. This bill requires the collected excise taxes to be transferred to the state treasurer who would deposit the tax into a substance abuse account within the special revenue fund. Monies within the account would be used only upon legislative appropriation to the Department of Health for substance abuse prevention, assessment and treatment programs as specified in the legislation making the appropriation.

If enacted this bill would take effect July 1, 2008.

Parity

Virginia HB 83, a bill relating to coverage for habilitative services, was pre-filed by Del. Robert Marshall, R-Loudon, on December 11 and referred to the Committee on Commerce and Labor.

This bill would require each insurer proposing to issue individual or group accident or sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; corporation providing individual or group accident or sickness subscription contracts; and health maintenance organization providing a health care plan for health care services to provide coverage, on and after July 1, 2008, for medically necessary habilitative services for persons younger than 19..

HB 83 defines “habilitative services” as health and social services directed toward increasing and maintaining the physical, intellectual, emotional, and social functioning of developmentally delayed individuals, including occupational, physical, and speech therapy; assistance, training, supervision, and monitoring in the areas of self-care, sensory and motor development, interpersonal skills, communication, and socialization; and reduction or elimination of maladaptive behavior. The bill also defines “medically necessary habilitative services” as services that are certified by the Department of Mental Health, Mental Retardation and Substance Abuse Services as designed to help an individual attain or retain the capability to function age appropriately within the individual’s environment, and would include habilitative services that enhance functional ability without effecting a cure.

An insurer, corporation, or health maintenance organization subject to this section would not be required to provide coverage for medically necessary habilitative services to the extent that such services are provided through the individual’s school.

The provisions of this bill would not apply to short-term travel, accident-only, limited or specified disease policies, contracts designed for issuance to persons eligible for coverage under Medicare or any other similar coverage under state or federal governmental plans, or to short-term nonrenewable policies of not more than six months duration.

Veterans

Virginia HB 475, a bill relating to mental health and rehabilitative services for veterans, was pre-filed by Del. M. Kirkland Cox, R-Chesterfield and referred to the Committee on General Laws on January 7.

This bill would require the Department of Veterans Affairs, in cooperation with the Department of Mental Health, Mental Retardation and Substance Abuse Services and the Department of Rehabilitative Services, to establish a program to monitor and coordinate mental health and rehabilitative services support for Virginia veterans, members of the Virginia National Guard and Virginia residents in the Armed Forces Reserves not in active federal service. The program would also support family members affected by covered military members’ service and deployments.

The purpose of the program would be to ensure that adequate and timely assessment, treatment and support are available to veterans, service members, and affected family members. The program would need to ensure that covered individuals are provided the following:

• Timely assessment and treatment for stress-related injuries and brain disorders resulting from service in combat areas.
• Case management services.
• Inpatient, outpatient, family support and other appropriate mental health and brain injury services.

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 Recently Introduced

The following bills had been pre-filed but were recently introduced due to the legislative session convening:

Cost-of-Living-Adjustment

West Virginia HB 2984, a bill to provide a cost-of-living adjustment for comprehensive community mental health care providers, was introduced and referred to the House Finance Committee on January 9.

This bill states that in each fiscal year in which the Department of Revenue estimates or projects a personal income growth of two percent or more, the fees paid by the Department of Health and Human Resources to a comprehensive community behavioral health care provider for approved services rendered to an eligible individual, would need to be adjusted annually by the rate of change in the medical component of the Consumer Price Index for All Consumers published by the United States Department of Labor for West Virginia. The annual rate of change could not exceed a maximum of five percent.

HB 2984 defines “comprehensive community behavioral health care provider” as a community-based program approved by the Department of Health and Human Resources.

Children

Missouri SB 768 was read twice and referred to the Senate Seniors, Families and Public Health Committee on January 10. The bill is sponsored by Sen. Scott Rupp, R-Lincoln. SB 768 would create the Missouri Commission on Autism Spectrum Disorders within the Department of Mental Health. The bill defines Autism Spectrum Disorder as “pervasive developmental disorder, Asperger’s syndrome, childhood disintegrative disorder, Rett’s syndrome, fragile X syndrome and autism.”

The 23-member commission would advise and make recommendations to the governor, general assembly, and relevant state agencies regarding matters concerning all state levels of autism spectrum disorder services, including healthcare, education, and other adult and adolescent services.

The commission would also need to make recommendations for developing a comprehensive statewide plan for an integrated system of training, treatment, and services for individuals of all ages with autism spectrum disorder. By July 1, 2009, the commission would need to issue preliminary findings and recommendations to the general assembly.

In preparing the state plan, the commission would specifically perform the following responsibilities and report on them accordingly, in conjunction with state agencies and the Office of Autism Services:

• Study and report on the means for developing a coordinated system of care delivery across the state to address the increased and increasing presence of autism spectrum disorder and ensure that  resources are created, well-utilized and appropriately spread across the state.
• Determine the need for the creation of additional centers for diagnostic excellence in designated sectors of the state, which could provide clinical services, including assessment, diagnoses and treatment of patients.
• Plan for effectively evaluating regional service areas and their capacity, including outlining personnel and skills that exist within the service area, other capabilities that exist and resource needs that may be unmet.
• Assess the need for additional behavioral intervention capabilities and, as necessary, the means for expanding those capabilities in a regional service area.
• Develop recommendations for expanding these services in conjunction with hospitals after considering the resources that exist in terms of specialty clinics and hospitals and hospital inpatient care capabilities.
• Conduct an assessment of the need for coordinated, enhanced and targeted special education capabilities within each region of the state.
• Develop a recommendation for enlisting appropriate universities and colleges to ensure support and collaboration in developing certification or degree programs for students specializing in autism spectrum disorder intervention. This may include degree programs in education, special education, social work and psychology.
• Provide recommendations regarding training programs and the content of training programs being developed.
• Recommend individuals to participate in a committee of major stakeholders charged with developing screening, diagnostic, assessment and treatment standards for Missouri.
• Participate in recommending a panel of qualified professionals and experts to review existing models of evidence-based educational practices for adaptation specific to Missouri.
• Examine the barriers to accurate information of the prevalence of individuals with autism spectrum disorder across the state and recommend a process for accurate reporting of demographic data.
• Explore the need for the creation of interagency councils and evaluation of current councils to ensure a comprehensive, coordinated system of care for all individuals with autism spectrum disorder.

If enacted this bill would become effective on August 28, 2008.

Missouri SB 799 was read twice and referred to the Senate Health and Mental Health Committee on January 10. This bill would require every school district, in collaboration with the Office of Child Mental Health, to develop a policy of incorporating social and emotional development into the district’s educational program. The policy would address teaching and assessing social and emotional skills and protocols for responding to children with social, emotional or mental health problems that impact early learning. Each district would need to submit this policy to the Missouri State Board of Education by January 1, 2009.

SB 799 would require the Missouri State Board of Education to develop and implement a plan to incorporate social and emotional development standards for the purpose of enhancing and measuring children’s school readiness and ability to achieve academic success in time for the 2009-2010 school year. The plan would need to be submitted to the Governor, General Assembly, and the Children’s Services Commission by July 1, 2009. The Children’s Services Commission would receive annual reports from the state Board of Education on the implementation and effects of the plan so that the commission would be able to issue recommendations for improvements to the General Assembly as needed.

This bill would also provide that the Department of Social Services require the screening and assessment of a child prior to any MO HealthNet-funded admission to an inpatient licensed hospital for psychiatric services. The screening and assessment would need to include a determination of the appropriateness and availability of out-patient support services for necessary treatment. The department would need to establish methods and standards of payment for the screening, assessment and necessary alternative support services. The Department of Social Services would also need to attempt to secure federal financial participation to fund such screening and assessments to the extent allowable under federal law.

If enacted this bill would take effect August 28, 2008.

Medicaid

New Hampshire HB 1418, a bill to extend Medicaid to prevent gaps in coverage under the New Hampshire healthy kids program, was introduced and referred to the House Health, Human Services and Elderly Affairs Committee on January 2. The committee has scheduled an executive session meeting for January 29 at 10:00 a.m. HB 1418 is sponsored by Rep. Jennifer Daler, D-Hillsborough.

This bill would require Department of Health and Human Services to amend state Medicaid eligibility criteria to ensure that there is no gap in health insurance for children in the New Hampshire healthy kids program who transition from “healthy kids gold” to “healthy kids silver” by extending the eligibility period for children enrolled in the “gold” program to the end of the month.

Medications Access

Missouri HB 1414, sponsored by Rep. Joseph Fallert, D-Ste. Genevieve, was introduced and read twice on January 10. The bill is currently pending further action. HB 1414 would expand eligibility for the Missouri Rx Plan to retired persons 65 and older with incomes of up to $25,000 for individuals and $50,000 for married couples.

New Hampshire HB 1167, sponsored by Rep. Fran Wendelboe, R-New Hampton, is scheduled for a public hearing on January 17 at 2:00 p.m. and an executive session on January 22 at 10:00 a.m.

HB 1167 would allow pharmacies, including mail-order pharmacies, to substitute generically equivalent drug products for all legend and non-legend prescriptions unless the prescribing practitioner specifies, in writing, electronically, orally, or by any other means, the brand name drug product is medically necessary. The bill would take effect 60 days after enactment.

New Hampshire HB 1540, a bill regarding coverage for clinical trials under the children’s health insurance program and the state Medicaid program, was introduced and referred to the House Commerce Committee on January 2. The bill is sponsored by Rep. Shawn Mickelonis, D-Strafford.

The measure would require the State Children’s Health Insurance Program (SCHIP) and the state Medicaid program to cover the cost of qualified clinical trials for cancer or other life threatening conditions. The bill does not apply to the state Medicare program.

New Hampshire HB 1560, a bill allowing nursing home residents who are enrolled in Medicare Part D or a Medicare Advantage Plan with prescription coverage to participate in the New Hampshire pharmaceutical assistance program, was discussed in a public hearing on January 3. The Health, Human Services and Elderly Affairs Committee is scheduled to discuss the bill in an executive session on January 15 at 10:00 a.m.

This bill would also appropriate $500,000 to the Department of Health and Human Services, for the fiscal year ending June 30, 2009, to purchase pharmaceuticals for nursing home residents who are eligible for services under both Medicaid and Medicare.

Vermont SB 328, sponsored by Sen. Kevin Mullin, R-Rutland, was introduced and referred to the Senate Health and Welfare Committee on January 8. The measure would expand access to discounted prescription drug prices under the federal 340B program for Medicaid beneficiaries and individuals in the custody of the Department of Corrections.

“State pharmaceutical assistance programs” would include the following:

• Medicaid
• Vermont health access plan
• The employer-sponsored premium assistance program
• The Catamount Health assistance program.

Veterans

Kentucky SB 39, a bill relating to alcohol and substance abuse treatment for active duty members of the United States Armed Forces, was introduced by Sen. Joey Pendleton, D-Christian on January 8. The bill was referred to the Senate Veterans, Military Affairs and Public Protection Committee.

This bill would establish the “Alcohol or Substance Abuse Treatment Fund” for active duty members of the military. The fund would be administered by the director of the Division of Mental Health and Substance Abuse of the Department for Mental Health and Mental Retardation Services, and would receive appropriations from the General Fund.

SB 39 would allow active duty members of the military who are based in Kentucky and are referred to an alcohol or substance abuse treatment program by a qualified health professional, and who receive alcohol or substance abuse services from the treatment program to qualify to have the cost of their treatment covered by the fund. Funding would be subject to the following:

• Monies from the fund would not be used to pay for treatments or services covered by TRICARE.
• The maximum amount paid for any treatment or service would not exceed the average rate charged for comparable alcohol or substance abuse treatment or services provided by the Regional Community Health Centers.

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Nearly eight months after the Virginia Tech shootings exposed weaknesses in the state’s overburdened mental health system, Democratic Gov. Tim Kaine proposed a package of spending increases and policy changes designed to help fix the problems. Governor Kaine called for new spending to address needs for emergency and outpatient care and policy changes that will improve the state’s ability to treat and monitor individuals who are at risk of harming themselves or others.

The governor’s proposals set the stage for legislative action on one of the major issues lawmakers will face in the 2008 General Assembly session. The April shooting deaths of 32 people by a mentally ill Tech student heightened awareness of problems in Virginia’s mental health system, and lawmakers from both parties joined Kaine last month in promising to push for changes.

“We have to acknowledge, and Virginia Tech showed us in such a startling and stark way, that the system we have has demands that are much more significant than our current capacity to deliver services,” Kaine said in a news conference attended by mental health advocates, legislators and a Tech shooting survivor. “This year we really do have an historic opportunity, and really more of a responsibility, to address those significant gaps in services that we provide to Virginians,” Kaine said.

The governor based many of his proposals on recommendations made by a state panel that investigated the Tech shootings. Some of these policy changes are:

• Allow emergency custody orders to be extended to eight hours.
• Require independent evaluator and treating physician of a temporary detention order patient to be available at a commitment hearing.
• Require community services board staff to participate in commitment hearings.
• Change the criteria for emergency custody and temporary detention from “imminent danger” terminology to: “substantial likelihood that in the near future he will (a) cause serious physical harm to himself or another person, as evidenced by recent behavior causing, attempting, or threatening such harm, or (b) suffer serious harm due to substantial deterioration of his capacity to protect himself from such harm or provide for his basic human needs.”
• Clarify the roles and responsibilities of community services boards and the independent examiner throughout the detention process, commitment hearing and case disposition.
• Explicitly authorize disclosure of information between providers in order to provide, coordinate and monitor treatment; and between providers and the courts to monitor compliance with treatment orders.

The governor also called for $42 million in new spending over the next two years for specific improvements such as hiring new case managers, therapists and clinicians, and improving monitoring and accountability of community services boards. The new spending represents a 13.6 percent increase in community mental health funding from the state and will be part of the budget proposal Kaine formally submits to lawmakers. Kaine said he also will ask lawmakers to authorize bonds to finance “significant capital work” at state mental health facilities. The following are the proposed spending increases over the next two years:

• $14.6 million to improve emergency mental health services, including around-the-clock psychiatric consultation, emergency clinicians and crisis stabilization.
• $8.8 million to add 106 case managers for mental health services provided through community services boards.
• $5.8 million to hire 40 clinicians specializing in children’s mental health.
• $4.5 million to increase availability of outpatient clinicians and therapists at community services boards.
• $875,000 to create four positions to expand monitoring and accountability of community services boards and to develop core standards and service improvement plans.
• $6 million to expand a pilot program for jail diversion services.
• $600,000 to establish a law enforcement training program for crisis intervention.

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 State-of-the-State

Several governors delivered their annual state-of-the-state speeches last week:

California Republican Gov. Arnold Schwarzenegger’s 2008 State of the State Speech, delivered Tuesday, January 8, focused on the state’s sagging economy and he promised to work for budget, education and health care reform in 2008. Governor Schwarzenegger was scheduled to unveil his “Budget Stabilization Act,” late this week as the state begins to work to erase the $14 billion in red ink projected for California in the next two fiscal years.

New York Democratic Gov. Eliot Spitzer gave his Albany 2008 State of the State Speech on January 9. Governor Spitzer used his speech to repair and redirect relations with legislative leaders from both parties that he battled and alienated in 2007. He preached the same themes debated last year: reviving the upstate economy, improving health care, increasing education aid and lowering the cost of doing business. Governor Spitzer will present his budget proposal on January 22 for FY 2008-09.

Virginia Democratic Gov. Tim Kaine gave his 2008 State of the Commonwealth Speech on January 9. Governor Kaine focused on several of his legislative priorities including: mental health reform, illegal immigration, health care access expansion, pre-K education, and the need to invest in higher education.

Six other state governors have delivered their State of the State speeches for the opening of their 2008 legislative sessions. Idaho Republican Gov. C. L. Butch Otter gave his speech on January 7 and focused on the budget and higher education funding. Maine Democratic Gov. James Baldacci gave his speech on January 9 and promised to oppose tax increases, while he promoted government streamlining. New Jersey Democratic Gov. Jon Corzine gave his speech on January 9 and proposed steep toll increases in order to help fix the state’s $32 billion debt. South Dakota Republican Gov. Mike Rounds gave his address on January 8 and warned lawmakers to tighten their belts for 2008. Vermont Gov. Jim Douglas delivered his State of the State on January 9 and promised to pursue “practical, achievable, affordable” goals in 2008. Douglas surprised his GOP base by promising to close the loophole that taxes unearned income at a lower rate than earned income. West Virginia Democratic Gov. Joe Manchin gave his address on January 9 and emphasized education and job creation.