SB138: (New Title) relative to the waiting list for services to persons with developmental disabilities and acquired brain disorders.

03/22/07 0626s

03/22/07 0912s

06Jun2007 1862h

06/27/07 2324eba

2007 SESSION

07-1161

01/05

SENATE BILL 138-FN-A

AN ACT relative to the waiting list for services to persons with developmental disabilities and acquired brain disorders.

SPONSORS: Sen. Estabrook, Dist 21; Sen. Hassan, Dist 23; Sen. Sgambati, Dist 4; Rep. Donovan, Sull 4

COMMITTEE: Health and Human Services

AMENDED ANALYSIS

This bill:

I. Requires the department of health and human services to provide services to persons with developmental disabilities and acquired brain disorders within certain time limits.

II. Increases the salaries for certain direct care support staff of area agencies.

III. Establishes a committee to develop a plan to address long-term workforce and related human resource issues and to develop a quality assurance and enhancement plan.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/22/07 0626s

03/22/07 0912s

06Jun2007 1862h

06/27/07 2324eba

07-1161

01/05

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Seven

AN ACT relative to the waiting list for services to persons with developmental disabilities and acquired brain disorders.

Be it Enacted by the Senate and House of Representatives in General Court convened:

363:1 Statement of Purpose. The general court finds that:

I. Undue delays in providing services to eligible persons with developmental disabilities and acquired brain disorders are contrary to the welfare of such individuals, their families, and the citizens of New Hampshire. Undue delays frequently cause individuals to lose skills acquired as part of their education, places them at risk of other physical and emotional harm and unnecessary and costly institutionalization, creates untold stress on families, temporarily or permanently hinders such individuals ability to become as independent and productive as possible, and is otherwise contrary to the purposes of this chapter.

II. It is essential that sufficient funding be provided to the department of health and human services and the area agencies to ensure that persons with developmental disabilities and acquired brain disorders who are eligible to receive services in the state s developmental services system receive initial, modified, or additional necessary services without undue delay.

III. It is equally essential that supports and services afforded eligible individuals with developmental disabilities and acquired brain disorders meet their individual existing and changing needs, and to that end services provided, contracted, or otherwise arranged by area agencies be of sufficient quality and amount and offer a sufficient range of choices to meet the needs of eligible individuals and assure that the purposes and requirements of this chapter are met. A principal element in the provision of quality services is the recruitment and retention of a sufficient number of qualified personnel at all levels, which in turn requires that personnel be well trained and reasonably compensated.

IV. Comprehensively addressing access and delay issues as well as the related service quality and cost effectiveness issues provides an excellent guidepost for necessary improvements to the developmental services system in keeping with the findings and recommendations of the Governor s Commission to Study Area Agencies and Their Role in Providing Service to New Hampshire s November 2005 report, hereinafter the governor s commission report.

V. Current capacity of the developmental service system to immediately take all eligible individuals off the waiting list and provide a full complement of services is limited. It is therefore necessary to phase in a plan which will address the waitlist backlog of undue delays and at the same time prevent a new backlog from developing.

363:2 Limits on Waiting Lists; Full Funding. RSA 171-A:1-a is repealed and reenacted to read as follows:

171-A:1-a Full Funding of Services Budget; Limits of Waiting Lists.

I. The department of health and human services and area agencies shall provide services to eligible persons under this chapter and persons eligible for the brain injury program under RSA 137-K in a timely manner. The department and area agencies shall provide services in such a manner that:

(a) For persons in school and already eligible for services from the area agencies, funds shall be allocated to them 90 days prior to their graduating or exiting the school system or earlier so that any new or modified services needed are available and provided upon such school graduation or exit.

(b) For newly found eligible adults, the period between the time of completion of an individual service agreement pursuant to RSA 171-A:12 and the allocation by the department of the funds needed to carry out the services required by the agreement shall not exceed 90 days.

(c) For persons already receiving services who experience significant life changes, such as a significant change in their medical conditions, the period of time for initiation of new services shall not exceed 90 days from the amendment of the individual service agreement except by mutual agreement between the area agency and the person specifying a time limited extension.

(d) Notwithstanding subparagraphs I(a)-(c) of this section, for fiscal years 2008 and 2009, the timelines set forth in each such subparagraph may be exceeded, provided that best efforts shall be made to meet the timelines for children graduating or exiting school and for other individuals the department determines most in need and to minimize delays with respect to others within the limits of available funding and to provide them interim services when the timelines have been exceeded by 60 days for fiscal year 2008 and 30 days for fiscal year 2009.

II. Beginning with the fiscal year ending June 30, 2010, and thereafter, the department of health and human services shall incorporate the cost of fully funding services to eligible persons, in accordance with the requirements of paragraph I, and as otherwise required under RSA 171-A, and the legislature shall appropriate sufficient funds to meet such costs and requirements.

363:3 New Section; Improvements in Capacity of Service Delivery System. Amend RSA 171-A by inserting after section 1-c the following new sections:

171-A:1-d Improvements in Capacity of Service Delivery System.

I. To ensure that the service delivery system has the capability of recruiting and retaining a sufficient number of qualified personnel at all levels and to address related issues, the following shall occur:

(a) The average salary of direct support staff employed by area agencies or providers with which area agencies contract shall increase by at least 2 percent beginning on July 1, 2007 and at least 2 percent on January 1, 2009.

(b) The reimbursement rate for enhanced family care providers shall increase by at least 2 percent beginning on July 1, 2008.

II.(a) Within 30 days of the effective date of this section, the department shall convene a committee which shall develop a plan to address long-term workforce and related human resources issues. The members of the committee shall be:

(1) Two representatives from the department, appointed by the commissioner.

(2) A representative of the New Hampshire Developmental Disabilities Council, appointed by the council.

(3) A representative of the Institute on Disability, university of New Hampshire, appointed by the institute.

(4) A representative of the Disabilities Rights Center, appointed by the center.

(5) A representative of the Community Support Network, appointed by the network.

(6) A representative of the New Hampshire Brain Injury Association, appointed by the association.

(7) A representative of a private provider network, appointed by the commissioner.

(8) A representative of People First of New Hampshire, appointed by such organization.

(9) Three representatives of local family support councils, appointed by the state Family Support Council.

(10) Three representatives of area agency boards of directors, appointed by the Community Support Network.

(b) The plan shall at a minimum:

(1) Provide for annual or periodic salary increases and recommendations for salary differentials or increments based on amount of experience or other factors for all staff positions at the area agency and provider level, in addition to the salary increases for direct support staff positions required by subparagraph I(a). With respect to direct support staff, the plan shall provide for a method to increase their salaries so that they are at least at parity with the mental health worker I position at New Hampshire hospital by July 1, 2011, and remain so thereafter.

(2) Provide for increased enhanced family care rates and rate structure, in addition to the rate increase specified in subparagraph I(b).

(3) Address whether and how free college tuition programs should be made available or increased to help attract and retain a qualified workforce.

(4) Address whether and how affordable health insurance should be made available to workers employed at the area agency or provider level as well as to enhanced family care providers.

(c) The department shall submit the plan to the oversight committee established in RSA 171-A:1-c, by December 1, 2007. Any members of the committee may submit additional or dissenting comments and recommendations to the committee by December 15, 2007.

III.(a) By November 1, 2008, the committee appointed in paragraph II shall develop a quality assurance and enhancement plan by building on, modifying, and improving upon the New Hampshire quality outcomes partnership process providing for:

(1) Rigorous, and where possible, measurable standards of performance expected of area agencies and providers in accordance with the purposes and requirements of RSA 171-A.

(2) Multiple procedures and processes in accordance with professionally recognized program evaluation and quality assurance standards to render determinations as to whether such standards of performance are being met.

(3) Examination of the effects of an area agency as sole provider on service delivery.

(4) Identification of the type and number of employed or contracted staff at the department and area agency level necessary to initiate and then carry out activities in subparagraph II(b), and if new staff are needed, whether they can be added through redeployment, reorganization, use of federal funding, information technology enhancements, or other initiatives without impairing other department responsibilities, and if not, the amount of new funding that will be needed.

(5) Where such quality assurance and enhancement system capacity shall be located and report to in order to ensure maximum independence and effectiveness.

(b) The department shall submit the plan to the oversight committee, established in RSA 171-A:1-c, by November 1, 2008. Any members of the committee may submit additional or dissenting comments and recommendations to the committee by November 15, 2008. The committee may choose to consult with an independent, nationally recognized organization in program evaluation and quality assurance to evaluate and report on the effectiveness of the quality assurance and enhancement system.

IV. The plans required by paragraphs II and III shall include a breakdown of all costs of implementation of and operation for each component and any recommendations for legislation or rules changes. The oversight committee established in RSA 171-A:1-c, shall review the plans, provide feedback to the department, and submit any proposals for legislation it deems necessary. Nothing in this section shall be construed to preclude the department from engaging in rulemaking or taking other initiatives within its authority to implement the components of the plan.

363:4 New Paragraph; Definition Added. Amend RSA 171-A:2 by inserting after paragraph I-c the following new paragraph:

I-d. Assistive technology means assistive technology as defined by 29 U.S.C. section 3002(3).

363:5 New Paragraph; Definition Added. Amend RSA 171-A:2 by inserting after paragraph V the following new paragraph:

V-a. Direct support staff means any person employed by an area agency or contract provider in which at least 50 percent of the person s time is providing direct care or support to a client.

363:6 Entry Into Service Delivery System. Amend RSA 171-A:6, II to read as follows:

II. A comprehensive screening evaluation, coordinated by the staff of the area agency, shall determine the scope of the person s disability and the locus and nature of services to be provided and shall include an assistive technology evaluation both as part of the person s initial evaluation and at least on an annual basis thereafter when the person is screened for an assistive technology evaluation. The commissioner shall adopt rules pursuant to RSA 541-A relative to the evaluation. The initial evaluation shall include, but not be limited to, a physical examination and individual intellectual assessment and functional behavior scales and shall take into account the provisions of and services established under RSA 186-A.

363:7 Oversight Committee. Amend RSA 171-A:1-c to read as follows:

171-A:1-c Oversight Committee; Establishment.

I. There shall be an oversight committee to review the allocation of funds to persons with [severe] developmental disabilities [classified as priority A or B consisting] or acquired brain disorders and to assure that eligible persons receive services in a timely manner and in accordance with their needs. Such committee shall consist of 6 members as follows:

(a) Three members of the house of representatives, one of whom shall be a member of the house health, human services and elderly affairs committee, appointed by the speaker of the house.

(b) Three members of the senate, appointed by the president of the senate.

II. Membership on the oversight committee shall be for the biennium and shall be coterminous with membership in the general court.

III. The oversight committee shall have a chairperson who shall be chosen by vote from among the committee membership. The chairperson s term of office shall be for the biennium. The committee shall have a clerk who shall be chosen by vote by members of the committee. The clerk s term of office shall be for the biennium. The legislative members of the committee shall receive legislative mileage when in performance of their duties.

IV. The committee s duties shall include, but not be limited to:

(a) Reviewing the allocation of funds to persons with [severe] developmental disabilities [classified as priority A or B] and acquired brain disorders and to monitor whether such eligible persons are having funding allocated and receiving those services in accordance with the timelines set forth in RSA 171-A:1-a, II.

(b) Monitoring whether such eligible persons are experiencing undue delays in the other parts of the service development and implementation process from the time of application to the eligibility determination and from allocation of funds to service implementation.

(c) Monitoring systems improvements and safeguards at the department and area agency levels designed to ensure service quality and options.

[(b)] (d) Making recommendations to the commissioner.

[(c)] (e) Submitting quarterly reports, together with any recommendations for legislation, to the speaker of the house of representatives, the senate president, and the governor. Each report shall address the items described under subparagraphs IV(a) and (b), and semi-annually the report shall address the items in subparagraph IV(c).

V. The department shall make quarterly reports to the oversight committee on the status of subparagraphs IV(a) and (b) in a form prescribed by the committee. Semi-annually the report shall address the items in subparagraph IV(c).

363:8 Effective Date. This act shall take effect July 1, 2007.

Approved: July 17, 2007

Effective: July 1, 2007