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.