TITLE X
PUBLIC HEALTH

Chapter 135-F
SYSTEM OF CARE FOR CHILDREN'S MENTAL HEALTH

Section 135-F:1

    135-F:1 Purposes. –
The purposes of this chapter are to:
I. Increase service effectiveness and improve outcomes for children with behavioral health challenges and their caretakers.
II. Reduce the cost of providing services by leveraging funding sources other than general funds, reducing the need for costly out-of-home placements, and reducing duplication across agencies.
III. Coordinate care for children involved in multiple systems and children at risk of court involvement and out-of-home placement.

Source. 2016, 203:2, eff. June 6, 2016.

Section 135-F:2

    135-F:2 Statement of Policy. – It is the policy of New Hampshire to implement a system of care model for providing behavioral health services to children in all of the publicly-funded service systems in the state.

Source. 2016, 203:2, eff. June 6, 2016.

Section 135-F:3

    135-F:3 Definition; System of Care. –
I. In this chapter, "system of care" means an integrated and comprehensive delivery structure for the provision of publicly funded behavioral health services to New Hampshire children and youth.
II. The system of care is to provide services to all children and youth receiving publicly-funded behavioral health services, including, but not limited to, children and youth in any of the following systems:
(a) Children in need of services under RSA 169-D.
(b) Juvenile delinquency under RSA 169-B.
(c) Child protection under RSA 169-C.
(d) Children with disabilities under RSA 186-C.
(e) Children and youth eligible for services under RSA 135-C.
(f) Children eligible for early intervention pursuant to Part C of the Individuals with Disabilities Education Act and He-M 510.
(g) Children eligible for the child care scholarship program under He-C 6910 due to disability.
III. The system of care shall have the following characteristics:
(a) A comprehensive behavioral health program with a flexible benefit package that includes clinically necessary and appropriate home and community-based treatment services and comprehensive support services in the least restrictive setting.
(b) An absence of significant gaps in services and barriers to access services.
(c) Community-based care planning and service delivery, including services and supports for children from birth through early childhood.
(d) Service planning and implementation based on the needs and preferences of the child or youth and his or her family which places an emphasis on early identification, prevention, and treatment and uses an individualized wraparound approach for children with complex needs.
(e) Services that are family-driven, youth-guided, community-based, trauma-informed, and culturally and linguistically competent.
(f) An efficient balance of local participation and state wide administration.
(g) Integration of funding streams.
(h) A performance measurement system for monitoring quality and access.
(i) Accountability for quality, access, and cost.
(j) Comprehensive children and youth behavioral health training for agency and system staff and interested parents and guardians.
(k) Effective identification of youth in need of transition services to adult systems.
(l) Statewide use of the multi-tiered system of supports for behavioral health and wellness, or MTSS-B, in New Hampshire schools to address New Hampshire students' social, emotional, and behavioral health needs in order to improve students' educational outcomes and keep students in their home schools and communities. For the purposes of this chapter, a "multi-tiered system of supports for behavioral health and wellness" or "MTSS-B" shall include:
(1) A school wide system of evidence-based behavioral practices for all students;
(2) A targeted system of practices for youth who need additional support; and
(3) A tertiary system of intensive and individualized interventions for students with the greatest behavioral needs.

Source. 2016, 203:2, eff. June 6, 2016. 2019, 44:2, eff. Aug. 2, 2019; 346:330, eff. July 1, 2019. 2020, 38:28, eff. Sept. 27, 2020.

Section 135-F:4

    135-F:4 Duties of Commissioner of the Department of Health and Human Services. –
The commissioner of the department of health and human services shall:
I. To the extent possible within existing statutory and budgetary constraints, modify the policies and practices of the department of health and human services to establish a system of care; and
II. Develop a plan for full establishment and maintenance of a system of care. Such plan shall be reviewed and amended annually. It shall include sufficient detail to allow compliance with the reporting requirements of RSA 126-A:5, XXXIII, and shall address at least the following elements:
(a) System capacity, including workforce sufficiency.
(b) Federal funding participation, including but not limited to Medicaid waivers and plan amendments.
(c) Changes to statutes, administrative rules, and structure of appropriations, and department policy, practice, and structure.
(d) Projections of cost savings from increased service effectiveness and reductions in costly forms of care and use of such savings to close existing gaps in children's behavioral health services.
(e) Recommended modifications to law, practice, and policy to prepare for and accommodate the participation of privately funded service providers in the system of care.
(f) Coordination with the plans and activities of the commissioner of the department of education to implement the system of care.
III. Establish and maintain at least one care management entity to oversee and coordinate the care for children with complex behavioral health needs who are at risk for residential, hospital, or corrections placement or involved in multiple service systems. In this section, "care management entity" means an organizational entity that serves as a centralized entity to coordinate all care for youth with complex behavioral health challenges who are involved in multiple systems and their families.
(a) The care management entity shall oversee and manage residential treatment, psychiatric hospitalization, and the development of a continuum of community-based services and supports for children and youth with more complex needs.
(b) Beginning January 1, 2020, the care management entity shall coordinate behavioral health services in no less than 25 percent of cases involving referrals for residential treatment. Beginning January 1, 2021, the care management entity shall coordinate services in no less than 50 percent of such cases, and, beginning January 1, 2022 and thereafter, the care management entity shall coordinate services in no less than 75 percent of such cases.

Source. 2016, 203:2, eff. June 6, 2016. 2019, 44:3, eff. Aug. 2, 2019; 346:331, eff. July 1, 2019. 2021, 91:397, eff. July 1, 2021.

Section 135-F:5

    135-F:5 Duties of Commissioner of the Department of Education. –
The commissioner of the department of education shall:
I. To the extent possible within existing statutory and budgetary constraints, support the system of care established under this chapter through:
(a) The development of a multi-tiered system of supports for New Hampshire schools and support for school districts implementing MTSS-B through technical assistance and professional development, including the use of external consultation training and coaching services.
(b) Alignment of federal funding to support local school districts implementing a multi-tiered system of support.
(c) Technical assistance to local school districts regarding the use of federal funds to implement and maintain MTSS-B.
(d) Technical assistance to local school districts on the use of research- and data-driven decision-making, organized and shared leadership, support for personnel through embedded professional development, and purposefully planned implementation cycles with continuous evaluation for improvement of outcomes.
II. Develop a plan for full support and participation of the department of education in the establishment and maintenance of a system of care. Such plan shall be reviewed and amended annually. It shall include sufficient detail to allow compliance with the reporting requirements of RSA 126-A:5, XXXIII, and shall address at least the following elements:
(a) Development of a multi-tiered system of supports in all New Hampshire schools.
(b) System capacity, including workforce sufficiency.
(c) Applicable federal funding participation, shall include but not be limited to state set-aside funds received from the federal government under the Individuals with Disabilities Education Act (IDEA) and Titles I, II, IV-A, and IV-B under the Elementary and Secondary Education Act (ESEA).
(d) Changes to statutes, administrative rules, and structure of appropriations, and department policy, practice, and structure.
(e) Projections of cost savings from increased service effectiveness and reductions in costly forms of care and use of such savings to close existing gaps in children's behavioral health services.
(f) Coordination with the commissioner of the department of health and human services to implement the system of care.

Source. 2016, 203:2, eff. June 6, 2016. 2020, 38:29, eff. Sept. 27, 2020. 2021, 91:398, eff. July 1, 2021.

Section 135-F:6

    135-F:6 Repealed by 2021, 91:396, eff. July 1, 2021. –

Section 135-F:7

    135-F:7 Joint Responsibilities of the Commissioner of the Department of Education and the Commissioner of the Department of Health and Human Services. –
I. The commissioner of the department of education and the commissioner of the department of health and human services shall enter into an interagency agreement which supports full implementation of a system of care. The agreement shall be completed no later than December 1, 2017, and shall be amended as necessary and renewed no less frequently than every 2 years. The agreement shall provide for:
(a) Coordination of a delivery system of behavioral health services across the life span of children, youth, and adults with behavioral health needs.
(b) Maximum federal reimbursement and revenue.
(c) Coordination of care and funding among agencies.
(d) Assistance to local education and behavioral health providers, including but not limited to:
(1) Development of model agreements to be utilized by school districts, other education providers, area agencies, community mental health centers, and other entities participating in the system of care.
(2) Provision of technical assistance to support development of coordinated services by area agencies, community mental health centers, and other entities participating in the system of care.
(3) Provision of technical assistance to school districts and other education providers to support implementation of MTSS-B.
II. The commissioners may apply for any federal waivers, plan amendments, or other changes or expansion of federal funding mechanisms necessary to implement the provisions of the agreement.

Source. 2016, 203:2, eff. June 6, 2016. 2020, 38:30, eff. Sept. 27, 2020.

Section 135-F:8

    135-F:8 Family Support Clearinghouse. –
I. The department of health and human services shall establish and maintain an information clearinghouse for families seeking information regarding children's behavioral health services. The clearinghouse functions required by this section may be assigned to an entity that has responsibilities in addition to those required by this section.
II. The information provided shall be available on the department of health and human services website and shall include:
(a) Access to mobile crisis and stabilization services.
(b) Insurance coverage and other reimbursement sources.
(c) The results of assessments of the quality of service providers and whether they utilize evidence-based practices.
(d) Referral information for legal service organizations.
(e) Referral information, including links to websites and contact telephone numbers, for behavioral health service providers, organized by region.
(f) Advice and guidance regarding family navigation of the behavioral health system.

Source. 2019, 44:4, eff. Aug. 2, 2019; 346:332, eff. July 1, 2019.

Section 135-F:9

    135-F:9 System of Care Advisory Committee. – The department of education and the department of health and human services shall create a system of care advisory committee to improve the well-being of children and families; promote coordination across state agencies; identify cost-savings, opportunities to increase efficiency, and improvements to the service array and service delivery system and effectiveness; and assist and advise the commissioners of the department of education and the department of health and human services on the system of care principles and values and implementation of RSA 135-F. The committee shall include youth and families with relevant experience and members of the child-serving public and private agencies, including experts in education, community-based and facility-based behavioral health services, and effective administration of private and public educational and health services. The committee shall meet at least 6 times per year and at such other times as the chairperson deems necessary.

Source. 2019, 44:4, eff. Aug. 2, 2019; 346:332, eff. July 1, 2019.