Presented to: "TEXAS LEGISLATURE - WHAT HAPPENED WITH MENTAL HEALTH?"

Transcription

1 "TEXAS LEGISLATURE - WHAT HAPPENED WITH MENTAL HEALTH?" PRESENTED BY: GREG HANSCH, PUBLIC POLICY DIRECTOR, NAMI TEXAS PUBLICPOLICY.DIRECTOR@NAMITEXAS.ORG; PHONE: Presented to:

2 A BIT ABOUT NAMI TEXAS Founded by volunteers in 1984 Our offices are at Austin State Hospital We do education, support, and advocacy Significant focus on affiliate support (we work for you) Significant focus on public policy 2017 conference dates and location: November 2-4 in Austin

3 WHAT DOES IT MEAN TO BE AN ADVOCATE? Advocate comes from the Latin word, vocare to call, to voice, to speak When you speak out to influence circumstances or services for yourself or someone you care about, you are engaging in personal advocacy. When you advocate to improve circumstances for others, you are engaging in policy advocacy.

4 WHY TELL YOUR STORY TO AN AUDIENCE OF POLICYMAKERS? Because your story has inherent value Because we need a seat at the table Because policymakers work for us Because your story illustrates what is needed, what helps, and what the gaps are Because this is a movement Because it helps Greg Because it allows policymakers to understand that treatment works and that recovery is possible that they will get return on their investment Because we deserve better

5 WHAT DOES NAMI TEXAS ADVOCACY LOOK LIKE? Policy analysis Education Testimony Direct Lobbying Grassroots Advocacy Coordination Media Engagement Bill Drafting Planning Mental Health Rally Coalition-Building

6 HOW TO STAY INFORMED ON CAPITOL ACTIVITY me to get on my distribution list Make sure your local NAMI affiliate keeps you updated Watch hearings and floor activity online Create an account on T.L.O. Follow on Twitter at #txlege Read the Texas Tribune and Quorum Report Be there!

7 #grassroots #speakup #NAMISMARTS #NAMITexas What are the policy issues that matter the most to YOU?

8 NAMI TEXAS PUBLIC POLICY PLATFORM Expand mental health system capacity and best practices Close the health insurance coverage gap and retain the 1115 Waiver Pair jail diversion and reentry strategies with increased access to quality care Expand the availability of safe Permanent Support Housing Maintain medication access and continuity across treatment systems Support children s mental health Strengthen suicide prevention and public safety policies Ensure mental health parity

9 KEY DATES FOR TEXAS ADVOCATES Bill signing deadline: Sunday, June 18 th Special session: July 18 th August 18 th Bill effective date (usually) September 1 st Voter registration deadline - October 10 th Election Day 2017 November 7 th Election Day 2018 November 6 th

10 EXPAND MENTAL HEALTH SYSTEM CAPACITY AND BEST PRACTICES POLICY PRIORITY

11 STATE BUDGET: SENATE BILL 1 GENERAL APPROPRIATIONS ACT Only piece of legislation that is required Two-year budget that goes into effect 9/1/17 Size: $216.8 billion. About half is general revenue $400 million increase from previous budget 2015: Tax cut and large investment in highways Withdraws $1 billion from Rainy Day Fund; accounting trick to free up nearly $2 billion from state highway fund Spends nearly $2 billion less on Medicaid than previous budget Medicaid shortfall of $1 billion expected

12 STATE BUDGET FOR MENTAL HEALTH Inpatient Outpatient Crisis Schools Housing Foster Care Medicaid.. Supports Criminal Justice Veterans Insurance

13 CRISIS SERVICES Services for individuals in psychiatric crisis Available to individuals whether or not they are enrolled in ongoing care Legislature has expanded investment in recent years approximately 1,500 more people served from FY 2014 to 2015 Examples of services include crisis hotline, mobile crisis outreach, crisis stabilizations, extended observation, crisis residential, crisis respite, etc.

14 CRISIS SERVICES IN SB 1 The funding for crisis services seems to have increased significantly, but the new sum includes several new initiatives that fall outside of traditional crisis services. Therefore, more analysis is needed to determine how traditional crisis services fared in this budget. FY crisis services line item: $252 million FY crisis services line item: $324 million

15 INPATIENT SERVICES Hospitalization Voluntary and involuntary Involuntary: Civil and forensic Provided by state, community, and private hospitals to children, adolescents, and adults Challenges

16 STATE BUDGET: INPATIENT No state hospital closures Consistent base budget $300 million more for the new construction of state hospitals $160 million more for deferred maintenance at state hospitals and state supported living centers $24.8 million more to maintain state hospital service levels $20.7 million more to purchase additional community psychiatric hospital beds $10.3 million more to increase maximum security bed capacity Bottom line: Significant increase in state support for inpatient services

17 OUTPATIENT SERVICES Communitybased mental health and substance use disorder services for children and adults

18 STATE BUDGET: OUTPATIENT BASE BUDGET $62.6 million in new funds to increase access to community mental health services HHSC Rider # $30 million for a matching grant program for community mental health programs (HB 13) HHSC Rider # $25 million for Healthy Community Collaborative homeless service programs (including $10 million for rural areas) HHSC Rider # $3.4 million for peer services (HB 1486) HHSC Rider # over $1.5 million for Clubhouses HHSC Rider # several targeted initiatives related to mental illness in the foster care system (relating to HB 7 and other initiatives)

19 FOSTER CARE (TWO OF MANY ITEMS OF INTEREST) HHSC Rider 172: $2 million for a grant program to increase access to targeted case management and rehabilitative services for high-needs children in foster care Slightly over $1 million to implement provisions of HB 7 relating to addressing inappropriate hospitalization of children in foster care

20 STATE BUDGET: OTHER HHSC RIDERS OF INTEREST Increase Consumer-Directed Services Rider authorizing HHSC to partner with other entities to develop a master plan for the design of neuropsychiatric healthcare delivery systems in the area served by each facility. New Rider directs HHSC to develop and procure a managed care program to serve individuals with serious mental illness 2 full-time employees to establish ombudsman for behavioral health New Rider directs HHSC to pursue federal funds for screening and treatment of postpartum depression pursuant to the 21st Century Cures Act. New Rider directs HHSC to study the workforce at the 10 state hospitals and provider recommendations to reduce turnover and vacancy rates to the LBB and the Governor by August 31, New rider requiring HHSC to collaborate with a third-party entity to identify opportunities to improve the efficiency of behavioral health care delivery

21 STATE BUDGET: CRIMINAL JUSTICE New rider adds $37.5 million (biennium) for funding jail diversion matching grants New rider directs TDCJ to use $743,000 to extend prescriptions for released offenders to 30 days, requires emphasis on mental health and medical issues impacted by a lapse. Rider adds $262,000 GR for the biennium to providing judicial training on indigent defendants and mental health. Allocates $1 million (biennium) for Mental Health Peer Support Re-entry Pilot

22 STATE BUDGET: VETERANS Existing Rider directing $5 million (each year of the biennium) is amended to expand access to licensed mental health professionals for volunteer coordinators and peers. Base bill includes an additional $20 million to continue Veterans and Family Grant Program (SB 55, 84th session) for FY18-19 biennium.

23 ISSUE IN FOCUS: UNMET NEED FOR COMMUNITY-BASED SERVICES Number of adults on waiting list for all community mental health services Percent of adults waiting for all community mental health services Issue: significant unmet need for communitybased mental health services across Texas 80% 70% 60% 50% 40% 30% 20% 10% 72%71%71% 70%68% 69% 5,893 67% 68%68%68% 5,8255,7455,618 65% 62% 5,401 61% 61% 5,264 60% 5,1615,156 4,991 4,8384,873 4,751 54% 4,196 3,620 2,901 1,931 44% 1,132 37% 29% 27% 24%24%24% 32% 37% 42% 46% 54%54% 51% %69% 71% 66% 63% 60% 1,326 1,412 1, ,000 6,000 5,000 4,000 3,000 2,000 1,000 0% FY FY FY

24 HB 13 MATCHING GRANT PROGRAM FOR COMMUNITY MENTAL HEALTH PROGRAMS SIGNED INTO LAW 6/14/17 H.B. 13 encourages local stakeholders to create locally driven solutions to mental health challenges within their respective communities by providing for a matching grant program to support community mental health programs -Nonprofits are eligible; must receive approval from local mental health authority -Matching funds cannot be from state or federal sources -County population less than 250,000: local match must be 50% of grant award -County population more than 25,000: local match much be 100% of grant award -50% of funds reserved for counties less than 250,000 Opportunity for NAMI Texas and/or local NAMI affiliates?

25 ISSUE IN FOCUS: SHORTAGE OF PSYCHIATRISTS Issue: Texas has a severe shortage of psychiatrists

26 SB 674 EXPEDITED LICENSING FOR HIGHLY-QUALIFIED OUT OF STATE PSYCHIATRISTS EFFECTIVE 9/1/17 SB 674 creates an expedited licensing process for out-of-state psychiatrists. It requires the Texas Medical Board to create an expedited licensing process for applicants who hold an unrestricted license to practice medicine issued in another state, are board certified in psychiatry, and meet other general eligibility requirements.

27 HB 3083 AND HB 3808 STUDENT LOAN REPAYMENT FOR MENTAL HEALTH PROFESSIONALS EFFECTIVE 9/1/17 HB 3083: Adds Licensed Chemical Dependency Counselor s to professionals eligible for Student Loan Repayment Assistance Program for Mental Health Professionals HB 3808: Adds Licensed Marriage and Family Therapists to professionals eligible for Student Loan Repayment Assistance Program for Mental Health Professionals.

28 ISSUE IN FOCUS: PEER SERVICES Issue: Peer specialists assist individuals experiencing mental health or substance use disorders by helping the individuals focus on recovery, wellness, self-direction, responsibility, and independent living. Without a defined scope of services, the services peer specialists provide are not reimbursable under the Medicaid program in certain settings (outside of local mental health authorities)

29 HB 1486 PEER SERVICES SIGNED INTO LAW 6/15/17 HB requires HHSC to establish with appropriate input training requirements, certification requirements, supervision requirements, and scope of services for peer specialist. -Requires HHSC to include peer services in Medicaid -Rider 211 in HHSC budget: $3.6 million for HB 1486

30 ISSUE IN FOCUS: VETERANS MENTAL HEALTH Issue: Most communities do not have dedicated staff with specific knowledge or licensure to provide mental health services to veterans.

31 SB 27 IMPROVING THE VETERAN MENTAL HEALTH PROGRAM EFFECTIVE 9/1/17 SB 27 requires HHSC to include training and technical assistance for peer service coordinators and licensed mental health professionals in the mental health program for veterans. It will increase access to mental health services, provide support to veterans in crisis, and decrease the overall cost associated with military-related traumas. SB 27 establishes a trauma affected veterans clinical care and research center at The University of Texas Health Science Center at San Antonio.

32 ISSUE IN FOCUS: INSUFFICIENT MEDICAL RESIDENCY SLOTS Issue: Without an adequate number of graduate medical education slots to satisfy the number of Texas medical school graduates each year, some graduates are forced to leave the state to complete their residencies.

33 SB 1066: PLANNING FOR INCREASED GRADUATE MEDICAL RESIDENCY EFFECTIVE 6/12/17 SB 1066: Requires a public institution of higher education to provide a specific plan regarding the addition of first-year residency positions for the graduate medical education program to be offered in connection with certain new MD or DO education programs. Plan must include an increase in residency slots.

34 ISSUE: ACCESS TO CHILD PSYCHIATRISTS Issue: Access to pediatric subspecialists, such as child psychiatrists, is severely limited in some areas of the state and is possible only by medical transport over long distances, which is disruptive to families and potentially expensive.

35 HB 1697 PEDIATRIC TELECONNECTIVITY RESOURCE PROGRAM EFFECTIVE 9/1/17 Goal of H.B is to improve access to pediatric subspecialist care and connect rural hospitals to the state's advanced pediatric specialists Requires the Texas Health and Human Services Commission (HHSC) with any necessary assistance of pediatric tele-specialty providers to establish a pediatric tele-connectivity resource program for rural Texas Grants to non-urban health care facilities counties less than 50,000

36 PAIR CRIMINAL JUSTICE DIVERSION AND REENTRY STRATEGIES WITH ACCESS TO QUALITY CARE POLICY PRIORITY

37 ISSUE IN FOCUS: COUNTY JAIL INVOLVEMENT Issue Tens of thousands of people with serious mental illness are in county jails across Texas right now People are in jail for long periods of time waiting for access to a hospital bed Jail can be deeply counterproductive to recovery

38 SB 292 JAIL DIVERSION MATCHING GRANT PROGRAM EFFECTIVE 9/1/17 SB 292 requires HHSC to establish a jail diversion grant program -Eligible entities: county-based collaboratives -County population less than 250,000: local match must be 50% of grant award -County population more than 250,000: local match much be 100% of grant award -40% of funds reserved for counties less than 250,000 Goals: -Reduce recidivism, arrests and incarceration of people with mental illness. -Reduce waiting time for hospital bed

39 ISSUE IN FOCUS: FORENSIC HOSPITAL BED WAITLIST Issue: -There is a waiting list for a defendant who is or may be a person with a mental illness or an intellectual disability to be admitted to a state hospital for competency restoration services. -This situation can result in a defendant having to spend the often lengthy waiting period in jail. -Decreases availability of beds for civil patients. -The state is being sued.

40 SB 1326 FORENSIC HOSPITAL BED WAITLIST RELIEF EFFECTIVE 9/1/17 SB 1326: -authorizes counties to create jail-based competency restoration programs -requires jails to notify judges of mental illness within 12 hours rather than 72 hours -makes it easier to release on personal bond -restricts competency restoration for Class B misdemeanors -collects mental health data for Office of Court Administration

41 PERSON IN FOCUS: SANDRA BLAND Considerations: -High incarceration rates of individuals with mental illness dangerous and counterproductive -Race -Law Enforcement Practices

42 SB 1849 SANDRA BLAND ACT SIGNED INTO LAW 6/15/17 SB quicker notification of magistrate if incarcerated person may have a mental illness -Healthy Community Collaboratives program funds can be used for substance abuse treatment; can go to rural areas ($25 million) -24 hour mental health service access in jails through telemedicine -Establishes prisoner safety fund -Prescription medication continuity -Jail administrator training -40 hour law enforcement mental health training -8 hour jailer mental health training

43 ISSUE IN FOCUS: JAIL RELEASE CONTINUITY OF CARE Issue: Medicaid benefits are often terminated when people are in county jails this requires a person to reapply when they are released from jail, potentially causing a delay in treatment.

44 HB 337 JAIL RELEASE CONTINUITY OF CARE 9/1/17 HB 337 provides a mechanism by which the Medicaid benefits of an individual confined in a county jail may be suspended, rather than terminated, and then reinstated within 48 hours of the individual's release as long as the individual remains eligible while confined in county jail.

45 VETOED: HB 1426 HB 1426 would have allowed certain previously incarcerated individuals who have completed their community supervision to access a certificate of relief from collateral consequences. With this certificate, a person s criminal history could not be factored in when the person applies for certain occupational licenses. It was vetoed by Governor Abbott.

46 ISSUE IN FOCUS: EMERGENCY DETENTION TRANSPORT Issue: Law enforcement are the only entities authorized to provide emergency detention transport of a person with mental illness. This may not be the most appropriate form of transport, and it may draw a law enforcement officer away from their primary duty of protecting public safety.

47 SB 344 EMERGENCY DETENTION TRANSPORT EFFECTIVE 6/9/17 SB 344 allows law enforcement to transfer emergency detention transport to EMS Requires memorandum of understanding (MOU) between law enforcement and EMS, MOU must address cost Requires that the transfer be safe for person and personnel

48 ISSUE IN FOCUS: LAW ENFORCEMENT MENTAL HEALTH percent of police officers have symptoms of posttraumatic stress disorder. Police officers show significantly higher rates of stress, alcoholism, and divorce than most other occupations They are more likely to die by suicide than in the line of duty.

49 HB 1794 MENTAL HEALTH ACCESS FOR FIRST RESPONDERS EFFECTIVE 9/1/17 HB 1794 requires HHSC to establish the Work Group on Mental Health Access for First Responders to develop and make recommendations for improving access to mental health care services for first responders.

50 HB 2619 GRANTS FOR POLICY MENTAL HEALTH AND CRITICAL INCIDENT STRESS DEBRIEFING EFFECTIVE 9/1/17 creating a peace officer mental health grant program in the criminal justice division of the governor's office. division to establish and administer a grant program to assist law enforcement agencies in providing critical incident stress debriefing to peace officers who experience critical incidents while performing official duties. (these grants can go to agencies other than law enforcement) Both won t cost the state all federal funds

51 ENSURE MENTAL HEALTH PARITY POLICY PRIORITY

52 ISSUE IN FOCUS: INSURANCE DENIALS Having mental health parity means that health insurance companies cover mental health in a way that is comparable to other health conditions NAMI parity report finds the insurance companies denial medical care for mental health conditions on the basic of medical necessity twice as often as they deny other medical care on the basic of medical necessity NAMI parity report people with insurance had more difficulty locating in-network providers and facilities for mental health care compared to general or specialty medical care. Complex policy and regulatory landscape limited state authority.

53 HB 10 MENTAL HEALTH PARITY EFFECTIVE 9/1/17 Expanding authority for the Texas Department of Insurance (TDI) to regulate and enforce the requirements of the existing parity law and regulations, so that all consumers with state-regulated health insurance can be assisted by TDI. Improving consumer assistance to Texans who encounter obstacles when trying to access MH/SUD services, including consumers who encounter mental health parity violations Fostering stakeholder dialog about mental health parity and crossagency collaboration using a stakeholder workgroup. Collecting data to help understand consumer s current experience with parity protections and identify any areas of concern.

54 EXPAND THE AVAILABILITY OF SAFE PERMANENT SUPPORT HOUSING POLICY PRIORITY

55 ISSUE IN FOCUS: HOUSING AND MENTAL ILLNESS At least 1 in 4 people experiencing homelessness are living with a mental health issue Over 60% of people who are chronically homeless have a long-term mental health issue Supporting housing is proven to interrupt the cycle Boarding homes in Texas remain largely unregulated

56 HEALTHY COMMUNITY COLLABORATIVES Existing grant program establishing or expanding community collaboratives providing services to individuals experiencing issues related to mental health and homelessness. $25 million from state; requires local match Existing funding for entities in Austin, Houston, Dallas, San Antonio, and Fort Worth SB 1849 allows funds to be used for substance abuse services, eliminates requirement that 5 grants be given, eliminates requirements that grants go to large counties, allows smaller counties to team up with each other, brings in law enforcement perspective, and requires diversion efforts SB 1 (budget) sets aside $10 million of total $25 million for rural counties

57 HB 3019 CRIMINAL OFFENSE FOR BAD OPERATORS OF BOARDING HOMES EFFECTIVE 9/1/17 Provides that a person commits an offense if the person is an owner, operator, or employee of a group home or certain facilities, including a boarding home facility or intermediate care facility for persons with an intellectual or developmental disability, rather than mental retardation, and the person intentionally, knowingly, recklessly, or with criminal negligence by omission causes to a certain individual who is a resident of that group home or facility serious bodily injury, serious mental deficiency, impairment, or injury, or bodily injury. Offense can be first or second degree felony

58 MAINTAIN MEDICATION ACCESS AND CONTINUITY ACROSS TREATMENT SYSTEMS POLICY PRIORITY

59 HB 1227 FORMULARY TRANSPARENCY EFFECTIVE 9/1/17 Requires a health benefit plan issuer to display on a public Internet website maintained by the issuer formulary information for each of the issuer's individual health benefit plans as required.

60 HB 1917 SINGLE MEDICAID FORMULARY EFFECTIVE 6/15/17 If HB 1917 not passed, state loses ability to set own Medicaid formulary: control goes to Managed Care Organizations (companies) Patient protections lost if HB 1917 not passed Potential loss of access to Prescription Assistance Program funds if HB 1917 not passed Medication access disrupted if not passed HB 1917 maintains Vendor Drug Program

61 ISSUE IN FOCUS: STEP THERAPY Step therapy protocols, also known as fail first requirements, are used by insurance companies to review the use of prescription drugs and control costs. A patient may be required to try, then fail on lower-cost or older drugs selected by their insurance company before coverage is granted for the drug prescribed by the patient s health care provider. Step therapy protocols can vary widely. An example of this is seen in the number of steps a patient must cycle through, or the duration a patient must try the medication selected by the insurance company before they can access their health care provider s first choice of treatment. Health plans exemption criteria and appeal procedures are not consistently transparent or accessible and it may take a patient up to 53 calendar days to complete an appeal. Step therapy protocols limit a health care provider s ability to tailor care to individual patient needs. For patients living with serious or chronic illnesses, prolonging ineffective treatment (and delaying access to the right treatment) may result in increased disease activity, loss of function and possible irreversible progression of disability.

62 SB 680 STEP THERAPY REFORM EFFECTIVE 9/1/17 Ensure step therapy protocols are based on widely-accepted clinical guidelines so that medicine not cost - dictate requirements. Create a clear and expeditious process to protect patients from being required to try or stay on a step therapy medication if it would create a significant barrier to compliance; worsen a comorbid condition; is contraindicated or will decrease the patient s ability to achieve or maintain reasonable function. Protect patients whose conditions are well-controlled on a prescription, from being required to try a new medication, if step therapy protocols are added to the formulary at contract renewal. Prohibit insurers from requiring patients to fail on a prescribed medication more than once, even if the patient switches to a different health insurance company.

63 HB 1296 MEDICATION SYNCHRONIZATION EFFECTIVE 9/1/17 Many patients with chronic diseases struggle to adhere to their prescribed drug therapies Medication synchronization seeks to increase patient adherence to prescribed drug therapies by having all the patient's prescriptions ready for pick up on the same date each month One of the biggest challenges to medication synchronization is the upfront costs to the patient H.B allows physicians, working in conjunction with the patient's health plan and the pharmacy, to determine which medications should be aligned in order to properly treat chronic diseases. It also eliminates barriers to medication synchronization by requiring health plans to prorate any cost-sharing amount charged for a prescription drug dispensed in a quantity that is less than the full amount as part of a recommended medication synchronization program, resulting in reduced upfront costs for patients.

64 SB 1633 TELEPHARMACY SERVICES EFFECTIVE 9/1/17 In certain parts of the state, especially in small communities, there are no local pharmacies because the demand for filling prescriptions in those areas is too low to support a pharmacy staffed by a pharmacist. S.B amends the Occupations Code to expand the locations at which a telepharmacy system may be located to include a remote dispensing site

65 SUPPORT CHILDREN AND YOUNG ADULT MENTAL HEALTH POLICY PRIORITY

66 ISSUE IN FOCUS: EARLY IDENTIFICATION Half of all mental health conditions begin by age 14. Suicide is the 2nd leading cause of death among adolescents. Nationally, an estimated $257 billion is spent annually on childhood mental disorders Children with mental health disorders more often have: Chronic health conditions such as asthma and obesity; Higher risk for poor educational outcome; Higher risk of involvement in the child welfare and juvenile justice systems; Higher instance of mental illness as adults.

67 HB 1600 MENTAL HEALTH SCREENINGS IN TEXAS HEALTH STEPS EFFECTIVE 9/1/17 Annual mental health screenings help ensure mental health conditions do not fly under the radar. Currently, Medicaid requires a mental health screening to be performed once during the 12 through 18 year range. However, Medicaid will not reimburse for more than one such screening over those six years. This optional annual mental health screening in HB 1600 has no significant fiscal implication to the state, but can help reduce the longterm detrimental personal and financial outcomes that can result when mental illness goes undetected or untreated

68 ISSUE IN FOCUS: POSTPARTUM DEPRESSION Maternal depression affects 1 in 6 Texas moms and can begin during pregnancy or up to a year after childbirth. Studies show that maternal depression goes largely undetected, making increased access to screening even more crucial. Maternal depression can have devastating effects on a child s health, development, and school success. It can interfere with early bonding and maternal-child interaction, leading to delayed language and cognitive development. Mothers experiencing maternal depression are less likely to implement injury prevention measures such as putting the baby on his or her back to sleep.

69 HB 2466 POSTPARTUM DEPRESSION SCREENING EFFECTIVE 9/1/17 Promotes increased screening for postpartum depression by creating a postpartum depression screening benefit for the mothers of current Children's Health Insurance Plan and Medicaid enrollees. Requires the covered services under the child health plan to include a maternal depression screening for an enrollee's mother, regardless of whether the mother is also an enrollee, that is performed during a covered well-child or other office visit for the enrollee that occurs before the enrollee's first birthday. Requires HHSC to seek federal 21 st Century Cures funds

70 VETOED: SB 1743 MENTAL HEALTH AND INTELLECTUAL AND DEVELOPMENTAL DISABILITIES Texas Office for the Prevention of Developmental Disabilities does much work around co-occurring mental illness and IDD in children. They were previously eliminated as a state agency. This bill would have moved them to UT Austin. It was vetoed.

71 ISSUE IN FOCUS: KINSHIP CARE Children who are placed with certain relative or other designated caregivers have more stability and permanency in their lives and have better outcomes than children placed in non-relative caregiver or non-designated caregiver foster care. Approximately 300,000 grandparents in Texas have the primary responsibility of caring for their grandchildren. Grandparents caring for their grandchildren have higher levels of emotional distress and indicated needs for more financial and emotional support.

72 HB 4 KINSHIP CAREGIVER SUPPORT SIGNED INTO LAW 5/31/17 Requires caregiver assistance to be based on family s individual need Financial assistance for those up to 300% of Federal Poverty Line Financial assistance no more than 50% of foster care rate no longer meager one-time payment Eliminates $1000 cap on assistance

73 ISSUE IN FOCUS: HOSPITALIZATION OF CHILDREN IN FOSTER CARE Children in foster care can be voluntarily to an inpatient mental health facility only with the child s consent. It has become common practice for children in foster care to be admitted to inpatient mental health facilities voluntarily following placement breakdowns and to be left there longer than medically necessary when DFPS cannot find alternative placement. were not designed to be respite care for children with behavioral issues until CPS can find an appropriate placement Texas Tribune article

74 HB 7 HOSPITALIZATION OF CHILDREN IN FOSTER CARE SIGNED INTO LAW 5/31/17 -deletes consent portion of voluntary admissions -allows admission by DFPS only with physician s opinion that a minor is a person (1) with a mental illness and (2) who presents with risk of serious harm to self if not immediately restrained or hospitalized; -requires DFPS to notify all parties entitled to notice under Texas Family Code and to the court of continuing jurisdiction of the minor s admission to an inpatient mental health facility within 3 business days following admission; and -requires DFPS to periodically review the need for continued inpatient treatment of the minor. If following the review, DFPS determines there is no longer a need for continued inpatient treatment, DFPS shall notify the facility administrator that the minor may no longer be detained unless pursuant to an application for court-ordered mental health services.

75 ISSUE IN FOCUS: SPECIAL EDUCATION Texas Education Agency policy set an 8.5 percent performance target for the total number of children receiving special education services in a school district. The policy effectively serves as a cap, drastically lowering the number of students receiving special education services. Student with mental illness are one of the top groups affected.

76 SB 160 ACCESS TO SPECIAL EDUCATION SERVICES EFFECTIVE 5/22/17 Prohibits TEA from adopting a policy evaluating school districts based on the total number of students in that district receiving special education services. TEA is not impaired in its ability to monitor disproportionality Helps address concerns about IDEA compliance

77 MANY OTHER SPECIAL EDUCATION REFORMS NAMI TX put together a presentation on special education reforms made in the 85 th legislative session. We will presented it on July 11 th. Please let us know if you would like more information.

78 ISSUE IN FOCUS: MENTAL HEALTH IN SCHOOLS Promotion of programs to address students' mental health needs must be a priority Many innovating and promising programs out there NAMI support groups, Mental Health First Aid, school-based clinics, etc. DSHS and Texas Education Agency (TEA), already compiles a list of best practices programs for addressing mental health concerns, but the list of program topics could be strengthened

79 HB 4056 MENTAL HEALTH IN SCHOOLS EFFECTIVE 6/12/17 Requires that the list include programs and practices in certain areas, including building skills related to managing emotions, establishing and maintain positive relationships, and responsible decision-making, rather than mental health promotion and positive youth development; trauma-informed practices; positive school climates; and positive behavior supports. Requires the suicide prevention programs on the list to include components that provide for training counselors, teachers, nurses, administrators, and other staff, as well as law enforcement officers and social workers who regularly interact with students to identify certain student interactions.

80 ISSUE IN FOCUS: MEDICAID SERVICES FOR CHILDREN WITH MENTAL ILLNESS Core Medicaid mental health services for children targeted case management and psychosocial rehabilitation continue to be delivered almost entirely through Local Mental Health Authorities This is serving a barrier to these vital services reaching children Medicaid managed care companies need additional authorities to contract with a range of private providers

81 SB 74 MORE CONTRACT OPTIONS FOR CHILDREN S MENTAL HEALTH SERVICES 6/9/17 Authorizes MCOs to contract with providers outside of LMHAs for these children s mental health services prohibits contracts that require providers to provide 24 hour crisis hotlines, for example

82 HB HIGHER ED MENTAL HEALTH RESOURCES EFFECTIVE 9/1/17 Too few institutions of higher education have complied with the requirement to create a web page dedicated to information regarding the mental health resources available to students at the institution. Requires reporting to the Higher Education Coordinating Board Requires that the link to mental health resources be placed on in a conspicuous place on the school s homepage.

83 SB 1533 MENTAL HEALTH FIRST AID FOR UNIVERSITY EMPLOYEES EFFECTIVE 5/19/17 State s Mental Health First Aid program (a grant program) not available to university employees. Expand eligibility of program to university employees (currently it s for high schools, middle schools, elementary schools employees) Allows local mental health authorities to contract with agencies to provide training to university employees

84 STRENGTHEN SUICIDE PREVENTION AND PUBLIC SAFETY POLICIES POLICY PRIORITY

85 ISSUE IN FOCUS: VETERAN SUICIDE Texas is home to nearly 1.7 million veterans 11,413 reported veteran suicides from 2010 to 2013 Nationally, 20 per day Veterans account for 18 percent of all suicide deaths among U.S. adults

86 SB 578 VETERANS SUICIDE PREVENTION PLAN EFFECTIVE 6/9/17 S.B. 578 attempts to strengthen the state's resolve in addressing veteran suicides by directing the development of a comprehensive action plan to increase access to and availability of professional veteran health services to prevent veteran suicides. S.B. 578 requires specific short-term and long-term recommendations to the legislature and the governor on policy initiatives and reforms necessary to implement the action plan.

87 SB 179 CYBERBULLYING PREVENTION Amends TEC to redefine bullying and define cyberbullying, specify applicable settings, and increase requirements on school district bullying policies. Authorizes each school district to establish a district-wide policy to assist in the prevention and mediation of bullying incidents between students that interfere with a student's educational opportunities or substantially disrupt the orderly operation of a classroom, school, or schoolsponsored or school-related activity. Authorizes a student who bullies to be removed from class and placed in a disciplinary alternative education program or expelled under certain circumstances Adds reporting to local law enforcement of certain conduct constituting assault or harassment.

88 SB 179 CYBERBULLYING PREVENTION Authorizes continuing education requirements for a classroom teacher or a principal to include instruction regarding how grief and trauma affect student learning and behavior and how evidence-based, grief-informed, and trauma-informed strategies support the academic success of students affected by grief and trauma. Requires the TEA and HHSC to establish and maintain an Internet website to provide resources for school district or open-enrollment charter school employees regarding working with students with mental health conditions. Requires the school counselor to serve as an impartial, nonreporting resource for interpersonal conflicts and discord involving two or more students Injunctive relief for cyberbullying of child Cyberbullying that has serious consequences - Class A Misdemeanor

89 Our lives begin to end the day we become silent about things that matter. -Martin Luther King, Jr.