HBA-NIK H.B. 2952 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2952 By: Maxey Corrections 4/5/1999 Introduced BACKGROUND AND PURPOSE The Texas Department of Mental Health and Mental Retardation (MHMR) provides mentally ill clients with residential and community-based programs located throughout the state. A critical element of either type of treatment is often medication, which can form the basis for long-term treatment success. With the increased number of available options, however, uniformity in treatment has declined. The inconsistency in treatment has led to a wide variation in both the quality of care received and its cost, with newer medications costing far more than older ones. An advantage of some newer medications is that there are fewer side effects, which is encouraging to those who would otherwise refuse to take the medication. MHMR estimates that, between community-based and residential programs, more than 86,000 patients were served monthly in fiscal 1998. Although about 76 percent of those served suffered from either major depression, schizophrenia, or manic-depression, MHMR found that it had inconsistent medication practices for clients with similar diagnoses. A treatment algorithm, as defined by the National Association of State Mental Health Program Directors, is a "series of steps, each of which, in turn, is defined by the clinical response of the patient to the preceding step." In other words, a consistent medication and treatment plan that can move with the consumer from inpatient-to-outpatient and from doctor-to-doctor. Well constructed algorithms (sometimes called "standards of care") allow care providers to establish multiple treatment options for each illness, each one supported with information regarding symptoms, typical levels, and side effects. In 1995, MHMR and the University of Texas Southwestern Medical Center Department of Psychiatry began discussions that led to the Texas Medication Algorithm Project (project), which is intended to bring uniformity to state mental health care treatment, so that quality can be guaranteed and costs controlled. H.B. 2952 instructs MHMR, the Texas Department of Criminal Justice, Texas Youth Commission, Texas Juvenile Probation Commission, and the Department of Protective and Regulatory Services to work together to improve treatment of offenders with mental illness by establishing and participating in pilot programs, some of which include the Texas Medication Algorithm Project or the Children's Medication Algorithm Project. This bill also requires any state agency participating in either algorithm project to cooperate with the comptroller's office in developing a cost/benefit analysis of medical treatment algorithms for offenders with mental illness. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Criminal Justice in SECTION 1 (Subsection (c), Testing of Medication Algorithms at Corrections Facility) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. TESTING OF MEDICATION ALGORITHMS AT CORRECTIONS FACILITY. Requires the Texas Department of Criminal Justice (TDCJ), in cooperation with the Texas Department of Mental Health and Mental Retardation (MHMR), to select a site at a state corrections facility and permit mentally ill inmates at the site to participate in pilot testing of the Texas Medication Algorithm Project (project). Provides that the site selected must be conducive to the project's evaluation of the costs and benefits of treatment algorithms for persons with mental illness. Requires the TDCJ to pay the costs for inmate participation in the project from money appropriated for inmate mental health care to the Correctional Managed Care Advisory Committee. Requires the Texas Board of Criminal Justice to adopt rules necessary to implement this section. SECTION 2. INCLUSION OF JUVENILES IN MEDICATION ALGORITHM PROJECT. Requires the MHMR to include mentally ill persons who have been committed to a facility under the jurisdiction of the Texas Youth Commission in the Children's Medication Algorithm Project. Requires MHMR to select the participants in cooperation with the Texas Youth Commission, the Texas Juvenile Probation Commission, and the Department of Protective and Regulatory Services. SECTION 3. REPRESENTATIVE PAYEE PROJECT FOR RELEASED INMATES. (a) Requires the Texas Council on Offenders with Mental Impairments, in cooperation with MHMR, to establish a pilot project in one or more counties to assist former inmates with mental illness who receive federal disability benefits following their release from a corrections facility. (b) Provides that the pilot project must establish procedure under which a local mental health care provider is authorized to serve as the representative payee, as provided by 42 U.S.C. section 405, for former inmates with mental illness who receive disability benefits. Authorizes a provider that serves as a representative payee to include a community mental health center or a regional clinic. (c) Provides that while serving as a representative payee, a mental health care provider must use the federal benefits it receives for the provision of services to the former inmate including the enumerated services. (d) Requires the Texas Council on Offenders with Mental Impairments to evaluate the project and report its results to the 77th Legislature. Requires the council, in its report, to recommend whether the project should be discontinued, continued, or expanded. SECTION 4. COOPERATION WITH COMPTROLLER'S OFFICE. Requires a state agency that participates in the project or the Children's Medication Algorithm Project to cooperate with the comptroller in developing an analysis of the costs and benefits of medical treatment algorithms for inmates and former inmates with mental illness. Requires the comptroller to report on the results of the analysis to the 77th Legislature. SECTION 5. EXPIRATION. Expiration date: January 17, 2001. SECTION 6. EMERGENCY. Emergency clause. Effective date: upon passage.