Assembly Bill No. 346–Assemblymen Tiffany, Leslie, Berman, Gibbons, Angle, Bache, Beers, Brown, Cegavske, Chowning, Collins, Giunchigliani, Goldwater, Hettrick, Koivisto, Lee, Manendo, Marvel, McClain, Mortenson, Neighbors, Parks, Price, Von Tobel and Williams

 

March 13, 2001

____________

 

Referred to Committee on Ways and Means

 

SUMMARY—Provides for establishment of pilot program in southern Nevada for provision of program of intensive and integrated community services to adults who are seriously mentally ill and homeless. (BDR S‑990)

 

FISCAL NOTE:            Effect on Local Government: No.

                                    Effect on the State: Contains Appropriation not included in Executive Budget.

 

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EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to mental illness; providing for the establishment of a pilot program in southern Nevada for the provision of a program of intensive and integrated community services to adults who are seriously mentally ill and homeless; making an appropriation; and providing other matters properly relating thereto.

 

   Whereas, Recent estimates indicate that there are more than 7,000 adults in southern Nevada who are homeless and that more than 31 percent of those adults have a severe and persistent mental illness; and

   Whereas, Adults who are seriously mentally ill and homeless who do not have access to the services they need or who are not able to utilize those services because of their mental illness are much more likely to enter the criminal justice system and be incarcerated or to require hospitalization and emergency medical services than such adults who receive extensive community services; and

   Whereas, The recovery of adults who are seriously mentally ill and homeless and their financial means are important for all levels of government, business and the community; and

   Whereas, Adults who are seriously mentally ill and homeless may receive services from many different state and county agencies, particularly those agencies that provide services relating to criminal justice, employment, housing, public welfare, health and mental health; and

   Whereas, A system of care for adults who are seriously mentally ill and homeless is vital for successful management of mental health care in Nevada; and

   Whereas, A system of care which ensures culturally competent care for adults who are seriously mentally ill and homeless in the most appropriate, least restrictive manner is necessary to achieve the desired outcomes; and

   Whereas, A comprehensive and coordinated system of care includes community-based treatment, outreach services and other early intervention strategies, case management, and the coordination of services that are provided by governmental agencies and which are required by adults who are seriously mentally ill and homeless; and

   Whereas, The availability of transitional and permanent housing is critical to the successful treatment and stabilization of adults who are seriously mentally ill and homeless; and

   Whereas, This community-oriented approach to mental health care will save public money by reducing expenses incurred by law enforcement agencies in arresting or transporting for treatment adults who are seriously mentally ill and homeless, curtailing expensive hospital stays, and helping to get such adults off the streets and into stabilizing treatment; and

   Whereas, A regional pilot program is the most cost-efficient method of developing and testing the most effective manner of delivering intensive and integrated community services to adults who are seriously mentally ill and homeless in this state; and

   Whereas, The funding provided for such a pilot program must be sufficient to provide mental health services, medically necessary medications to treat severe mental illnesses, services for the prevention and treatment of alcohol abuse, supportive housing and other housing assistance, coordination of vocational rehabilitation services, assistance in accessing veterans’ services and other health care and in obtaining federal income and housing support; now, therefore,

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

1-1    Section 1. 1.  The Administrator of the Division of Mental Health

1-2  and Developmental Services of the Department of Human Resources shall

1-3  establish a pilot program in southern Nevada for the provision of a program

1-4  of intensive and integrated community services to adults who are seriously

1-5  mentally ill and homeless.

1-6    2.  The Administrator shall establish standards of service for the pilot

1-7  program. The standards must ensure that adults in southern Nevada who

1-8  are seriously mentally ill and homeless are identified and services provided

1-9  to assist them to live independently, work and reach their potential as

1-10  productive residents of Nevada. The standards must include, without

1-11  limitation, a service planning process with regard to such adults that

1-12  includes:

1-13    (a) The determination of the number of clients to be served under the

1-14  program and the services that will be provided to meet their needs.

2-1    (b) Plans for services to be provided under the program, including

2-2  outreach services, mental health services, substance abuse services,

2-3  transitional housing or other housing assistance, vocational rehabilitation,

2-4  veterans’ services and coordination of and access to medications. The plans

2-5  must also contain evaluation strategies, which must consider cultural and

2-6  linguistic differences, and factors such as gender, age and the special needs

2-7  of minorities, and provide for the utilization of personnel with the cultural

2-8  background and linguistic skills necessary to remove barriers to mental

2-9  health services resulting cultural differences, including the limited ability

2-10  of a client to speak English.

2-11    (c) The provision of services that are client-directed and which employ

2-12  pyschosocial rehabilitation and recovery principles.

2-13    (d) The requirement that each client be provided with a designated

2-14  mental health case manager who, or a multidisciplinary treatment team

2-15  which, is responsible for providing needed services to the client or ensuring

2-16  that the client receives such services. The responsibilities of the case

2-17  manager or treatment team must include a complete assessment of the

2-18  needs of the client, the development, with the participation of the client and

2-19  any other persons requested by the client, of a personal services plan for

2-20  the client, the referral of the client to all appropriate community services,

2-21  and necessary advocacy on behalf of the client to ensure that the client

2-22  receives the services agreed to in his personal services plan.

2-23    (e) The requirement that a personal services plan ensure that the client

2-24  receive, to the extent practicable, services that are appropriate for the

2-25  client’s age, gender and cultural background, and which are designed to

2-26  enable the client to:

2-27      (1) Live in the most independent, least restrictive housing feasible in

2-28  the region;

2-29      (2) Engage in the highest level of work or productive activity

2-30  appropriate to his abilities and experience;

2-31      (3) Create and maintain a support system consisting of friends, family

2-32  and participation in community activities;

2-33      (4) Access an appropriate level of academic education or vocational

2-34  training;

2-35      (5) Obtain an adequate income;

2-36      (6) Self-manage his illness and exert as much control as possible over

2-37  both the day-to-day and long-term decisions which affect his life;

2-38      (7) Access necessary physical health care and maintain the best

2-39  possible physical health;

2-40      (8) Reduce or eliminate antisocial or criminal behavior and thereby

2-41  reduce or eliminate his contact with the criminal justice system; and

2-42      (9) Reduce or eliminate the distress caused by the symptoms of

2-43  mental illness.

2-44    3.  The Administrator shall, on or before October 1, 2001, develop and

2-45  issue a request for proposals from all interested persons to operate the

2-46  program.

2-47    4.  The Administrator shall review all bids received pursuant to the

2-48  request for proposals and shall award a contract for the operation of the

3-1  program to the bidder who the Administrator determines is the most

3-2  qualified to operate the program.

3-3    5.  The criteria for the awarding of the contract must include, without

3-4  limitation:

3-5    (a) An applicant’s plan for providing a program of intensive and

3-6  integrated community services to adults who are seriously mentally ill and

3-7  homeless in a cost appropriate manner;

3-8    (b) The local population to be served, the ability of the applicant to

3-9  administer an effective program of such services, and the degree to which

3-10  local agencies and mental health advocates will support and collaborate

3-11  with the applicant in its provision of services; and

3-12    (c) The number of anticipated contacts with adults who are homeless or

3-13  at risk of homelessness, and the number of such adults who are seriously

3-14  mentally ill and who are likely to be successfully referred for treatment and

3-15  to remain in treatment until successfully discharged.

3-16    6.  The contract must require the person to whom it is awarded to:

3-17    (a) Coordinate the eligibility of adults who are seriously mentally ill and

3-18  homeless for social services.

3-19    (b) Coordinate the access of adults who are seriously mentally ill and

3-20  homeless to:

3-21      (1) Medically necessary medications to treat severe mental illnesses;

3-22      (2) Alcohol and drug abuse services;

3-23      (3) Other health care;

3-24      (4) Housing assistance;

3-25      (5) Federal income and housing support; and

3-26      (6) Veterans’ services.

3-27    (c) Provide adults who are seriously mentally ill and homeless with:

3-28      (1) Intensive outreach services to identify and engage eligible clients;

3-29      (2) Psychiatric evaluations;

3-30      (3) Mental health services, including, without limitation, individual

3-31  and group therapy;

3-32      (4) The monitoring of their medications; and

3-33      (5) Intensive personal case management 24 hours a day, 7 days a

3-34  week.

3-35    (d) Refer adults who are seriously mentally ill and homeless to

3-36  programs that offer vocational rehabilitation.

3-37    (e) Perform all other duties specified by the Administrator in the request

3-38  for proposals.

3-39    (f) Employ sufficient employees to carry out the contract.

3-40    Sec. 2.  1.  The person to whom the contract is awarded shall submit

3-41  reports at the times and in the manner prescribed by the Administrator of

3-42  the Division of Mental Health and Developmental Services of the

3-43  Department of Human Resources to the Southern Nevada Regional

3-44  Planning Coalition, the board of county commissioners of Clark County,

3-45  the city council of each city whose residents are being served by the

3-46  program, and the Administrator. The reports must include such

3-47  performance indicators as specified by the Administrator, including,

3-48  without limitation:

4-1    (a) The number of adults who are seriously mentally ill and homeless

4-2  who have been contacted by the program, and the number of such adults

4-3  who:

4-4       (1) Have been provided services; and

4-5       (2) Have refused services.

4-6    (b) Of the number of adults who are seriously mentally ill and homeless

4-7  who have been provided services under the program, the number of such

4-8  adults who have received:

4-9       (1) Psychological assessments;

4-10      (2) Medical evaluations; and

4-11      (3) Medication.

4-12    (c) The percentage by which the hospitalization, incarceration and

4-13  homelessness of the adults who have been provided services under the

4-14  program has decreased since they began to receive such services.

4-15    (d) All other information required by the Administrator to assist him in

4-16  preparing his report to the Nevada Legislature pursuant to section 3 of this

4-17  act.

4-18    2.  The Administrator shall report quarterly to the Interim Finance

4-19  Committee concerning the success of the program and the reports

4-20  submitted to him pursuant to subsection 1.

4-21    Sec. 3.  The Administrator of the Division of Mental Health and

4-22  Developmental Services of the Department of Human Resources shall, on

4-23  or before February 1, 2003, submit a report concerning the pilot program to

4-24  the Director of the Legislative Counsel Bureau for transmittal to the 72nd

4-25  session of the Nevada Legislature. The report must include, without

4-26  limitation, an evaluation of the effectiveness of the program in providing

4-27  successful outreach services, reducing homelessness, reducing costs and

4-28  the use of beds in hospital emergency rooms, and reducing crimes

4-29  committed by adults who are seriously mentally ill and homeless, and may

4-30  include such other measures of success as determined by the Administrator

4-31  to be relevant. The evaluation must include as much of the following

4-32  information as possible:

4-33    1.  The number of adults who are seriously mentally ill and homeless

4-34  who are being served through the pilot program and the number of those

4-35  adults who:

4-36    (a) Have been able to maintain housing;

4-37    (b) Have been able to maintain taking appropriate medication and

4-38  whose behavior has been stabilized through the use of such medication;

4-39    (c) Continue to receive mental health services and remain in the

4-40  program; and

4-41    (d) Receive extensive community mental health services, which

4-42  includes having a designated mental health case manager or

4-43  multidisciplinary treatment team, and a personal services plan.

4-44    2.  The extent to which the hospitalization of adults who are seriously

4-45  mentally ill and homeless has been reduced or avoided.

4-46    3.  The number of adults who are seriously mentally ill and homeless

4-47  who are being served by the pilot program who are participating in

4-48  employment service programs, including, without limitation, competitive

4-49  employment.

5-1    4.  The effect of the pilot program on the number of adults who are

5-2  seriously mentally ill and homeless who are being served by the pilot

5-3  program who have been arrested or incarcerated, including the extent to

5-4  which the incarceration of such adults has been reduced or avoided on both

5-5  the state and local level.

5-6    5.  The number of adults who are seriously mentally ill and homeless

5-7  who were contacted in outreach efforts provided through the pilot program

5-8  who appear to be severely mentally ill and who have refused treatment

5-9  after completion of all applicable outreach measures.

5-10    Sec. 4.  1.  There is hereby appropriated from the state general fund

5-11  to the Division of Mental Health and Developmental Services of the

5-12  Department of Human Resources to be used to enter into a contract for the

5-13  operation of the pilot program established pursuant to section 1 of this act:

5-14  For the fiscal year 2001-2002.......... $1,000,000

5-15  For the fiscal year 2002-2003.......... $1,000,000

5-16    2.  Any balance of the sums appropriated by subsection 1 remaining at

5-17  the end of the respective fiscal years must not be committed for

5-18  expenditure after June 30 of the respective fiscal years and reverts to the

5-19  state general fund as soon as all payments of money committed have been

5-20  made.

5-21    Sec. 5.  1.  This section and sections 1, 2, and 3 of this act become

5-22  effective upon passage and approval.

5-23    2.  Section 4 of this act becomes effective on July 1, 2001.

 

5-24  H