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Urgent: Legislative Action Needed!
Action Alert: S. 2028, An Act Regarding Flu Pandemic and Emergency Preparedness Posted: August 20, 2009 Legislative News for 2010
MSNO Advocacy Priorities for Legislative Session 2010.doc Summary of Efforts to Enact SB.2455.doc Reforming the Medicaid Children's Mental Health System: What Schools Should Know about Rosie D. Legislator Visit Days January 2010.doc Legislator Tool Kit 2010
Massachusetts Legislative
Tracking Reports (September 2009)
Helpful Legislative Information
School Health Advocacy Day Archives
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Please call your member of the Massachusetts House of Representatives and ask them to support passage of S. 2028 right away given the approaching flu season this fall. Call (617) 722-2000 and ask the operator to connect you to your state representative based on what town you live in. Your phone message should be:
· Authorizing the Commissioner of the Department of Public Health to do what is necessary to protect public health after the Governor has declared an emergency. Such actions may include: closing or evacuating buildings and facilities; decontamination of property and materials; procuring, storing and distributing any anti-toxins, serums, vaccines, immunizing agents, antibiotics, and the isolation or quarantine of individuals; · Authorizing the Department of Public Health to specify responsibilities of health care providers, medical examiners, local public health authorities and others to report diseases, in juries, health conditions and threats to the Department; · Requiring the Department of Public Health to establish a registry of volunteer personnel, the Massachusetts System for Advance Registration, to be activated during an emergency; · Offer liability protections to physicians, pharmacists, nurses, dentists and other health care providers in the event of a public health emergency. This protection would extend to include their volunteer time, expertise and property in response to any such emergency; · Allows for health insurance to waive administrative requirements and other protocols during a public health emergency, implementing a 180 day reconciliation period for charges and reimbursements after the declared end of a public health emergency. |
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What is the Rosie D. case and why is it important? Rosie D. v, Patrick is a class action lawsuit brought on behalf of over fifteen thousand Medicaid-eligible children and adolescents under the age of 21 who need, but are not receiving, the home-based mental health services necessary for them to remain with their families and in their home communities. Without appropriate home-based services, these children can be at risk for prolonged or unnecessary hospitalization, or other out-of-home placement, as well as removal from their local schools and communities. The lawsuit was based on the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) provisions of the federal Medicaid Act, which require the Commonwealth to provide Medicaid-eligible children with access to preventative screening, diagnostic evaluations, and medically necessary behavioral health services. In January 2006, the federal court found the Commonwealth in violation of EPSDT requirements, and in July 2007, it entered a final judgment that included a detailed remedial plan. This plan will dramatically alter the landscape for Medicaid-funded mental health care in Massachusetts, creating a new service delivery system designed to empower and support children and families, and successfully maintain their connections to home, community and school settings. What specific reforms did the Court order and when will they be available? The Commonwealth is undertaking an ambitious system reform effort in coordination with the plaintiffs and under the supervision of the Court and Court Monitor. The remedial plan describes the redesign of the children’s mental health system in Massachusetts and the pathway to obtaining home-based services. It also establishes deadlines for critical steps in the implementation process. These include: • Notice and information to families, providers and the public about Medicaid members’ rights to medically necessary services and Rosie D. reforms (Ongoing since Fall 2007) • Improved mental health screening procedures with primary care providers (In place as of January 1, 2008) • More standardized mental health assessments with specialized training (Operational November 2008) • Provision of medically necessary, intensive home-based behavioral health services (Service system design and implementation in 2008; services available June 2009) What are intensive home-based services and how will children and families access these services? The Commonwealth’s new mental health service system will be based upon an integrated and coordinated approach to treatment planning and service delivery, often called “wraparound treatment.” Home-based services will be highly individualized, child and family centered and strength based. These services can be provided in any appropriate setting where the child is located, including natural or foster homes, community spaces and activities, schools or after-school programs. Families and teams will set goals for each identified service and consider appropriate locations and strategies for their implementation. A single case manager will work closely with the family, conducting a comprehensive home-based assessment. The case manager will, in partnership with the family, identify and coordinate a single treatment team who together develop a single treatment plan guiding the child’s care in the community. This team can include educational service providers, a collaboration which provides opportunities to coordinate Individual Education Plan (IEP) goals with community treatment planning efforts. In addition to this treatment planning process, called intensive care coordination, several new home-based services will be available:
2) in-home behavioral therapy and behavior management supports; 3) in-home therapy services; 4) mentoring; and 5) parent/caregiver supports. Which students will be eligible to receive remedial services under the Court’s order? Currently, any Medicaid-eligible child under 21 years of age with a serious emotional disturbance (SED), as described under federal law (either IDEA regulations or the SAMHSA Public Health Act) is eligible for home-based services. SED can include a range of serious emotional, behavioral, or mental health disorders. The definitions above consider a number of factors, including the nature and duration of a child’s condition and the extent to which it substantially interferes with his or her functioning in a variety of contexts, including home, school and community. Children and adolescents with developmental disabilities, autism spectrum or substance abuse disorders are also eligible for home-based services, provided they have a co-occurring serious emotional disturbance. How can schools assist parents in accessing home-based services? Children and families may be referred for home-based services in a number of ways, depending on how much is already known about the child’s condition. Medicaid-eligible children can receive preventative behavioral health screening from their primary care clinician during routine well-child visits, or at other times by parent request. When a positive screen occurs, parents and providers can decide whether to manage symptoms within the practice or to seek further outside assessment. If a child is identified as having a behavioral health condition, she or he should be referred to a mental health professional for a full assessment. Schools and school health care professionals, state and local agencies, child care providers, and other professionals who serve children may refer a child for behavioral health screening or evaluation by a mental health specialist. Children who have already been diagnosed with a form of SED can be referred directly to a network of regional Community Service Agencies (CSAs), to be developed by the Commonwealth. The local CSA will offer intensive care coordination and a comprehensive home-based assessment, based on the child’s medical need. CSA referrals might come from hospitals, clinicians, crisis teams, parents, or school personnel. How can schools collaborate successfully with families who receive home-based services? At the request of a parent or guardian, school districts may be invited to participate in the treatment planning process. This participation may include helping to inform the goals and objectives of the single treatment plan, and working together to integrate those goals into the school environment, and individual education plan, as appropriate. The highly coordinated treatment planning process can provide schools with a single source for ongoing and updated treatment information, while the intensive care manager offers a single point of contact for conveying concerns directly to the treatment team. Conversely, the child’s care manager, who is responsible for coordinating all behavioral health services, can participate in the development of the IEP or other school-based educational plan, in order to ensure that educational goals are carried over and consistently implemented in all environments. How can these new services complement and support the work done by schools? Common goals and a shared mission make schools and home-based service providers natural allies. Both seek to serve children in the least restrictive environment. Both hope to cultivate a child’s ability to succeed and function independently in all aspects of life. Once available, home-based services are expected to treat and support children in the settings where they live and socialize and learn. In making specific service recommendations, treatment teams can and should consider children’s needs before, during, and after the school day, in order to maximize his or her overall functioning and availability for learning. Home-based services can be provided in school settings, in addition to after school or other community settings, to promote generalization of important social, emotional and independent living skills. Home-based behavioral health therapists and other professionals can consult with teachers and classroom aides to identify and reinforce strategies for supporting students in school, and responding to challenging situations. This partnership can also promote consistency in addressing the child’s behavioral health needs across a variety of educational, social and community settings. For example, mobile crisis teams will be available to respond to school settings. When a child is participating in intensive care coordination, this crisis response could be a pre-determined strategy for effective intervention and stabilization, minimizing the use of suspensions or other punitive actions that might impede, rather than enhance, the child’s success in school. The goal of these teams, and the longer term crisis stabilization service, is to help children and families manage, diffuse and reduce crises in the community, avoiding potentially traumatic and unnecessary emergency room or in patient stays, and resulting interruptions in a child’s education. How can schools and families stay informed about this new mental health service system? Information on the Rosie D. remedy and its implementation is available from a number of sources. MassHealth customer service representatives will be receiving training on the system improvements above, including methods for accessing home-based behavioral health services. Updated information regarding the availability of screening, assessments, and intensive home-based services will be circulated by MassHealth through relevant member notices, handbooks, provider bulletins, contracts and government websites. Special trainings and referral information is being developed by the Commonwealth for use by schools and child care agencies. The Center for Public Representation’s education and outreach campaign is partnering with stakeholder groups and organizations across the Commonwealth to disseminate relevant training materials and to discuss these system changes as they unfold. Information regarding the Court’s decisions can be found at: www.centerforpublicrep.org . Additional information that focuses on this initiative and its ongoing implementation will soon be available at the Center’s new website: www.RosieD.org. |
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While the health needs of Massachusetts’ students have grown increasingly complex, many thousands of students receive no, or inadequate, school health services. At the same time, Governor Romney has proposed elimination of the School Health Program in his FY’05 Budget. By discontinuing this successful program, school nurses will be laid off and thousands of children will no longer have access to needed nursing services which, in turn, will impact their ability to attend school. |
Good morning. |
My name is Anthony Delmonaco. I am 10 years old, and I live in Pembroke, Massachusetts. I go to Bryantville Elementary school. A few months back I heard that Governor Romney was going to cut back on school nurses. It made me very upset and mad. I was yelling, and my mom told me getting mad isn’t going to help and that if it means a lot to me that I need to write a letter. So I wrote my letter and sent it out to the papers. I didn’t think that anyone would print it because I was a kid. But I was wrong. People did listen to me, and people from all over read my letter. I even got a call from Baltimore Maryland. They asked if they could reprint my letter and I said yes. I like my school nurse. She is also my friend. I have known her since the first grade. I have asthma. Mrs. Regan has taught me how to use my inhaler. Some other things she has helped me with – I broke my leg last year. Mrs Regan said my cast was too tight, and she was right. I had to go back to Children's, and they gave me a new one. Just a few months ago I had my eyes tested, and I didn’t pass. My glasses were only 4 months old. I can see much better now. |
Massachusetts State Government has a new web site (www.02133.org) which is designed to help citizens make sense of the latest news You can access who is on what legislative committee by visiting Massachusetts Committees of the General Court. You can also use this site to follow bills and to identify your local Representative and Senator.
![]() ![]() The following sample letter is intended to serve as a guide for nurses to keep politically active. Please feel free to keep it on your desk or by your telephone for quick reference when needed.
Dear Representative or Senator: (Name)
I am one of over 1800 school nurses in Massachusetts who is concerned with the safety and health care of the children
in Massachusetts. Children attending schools today are faced not only with the usual common infectious diseases; they
face the threat of other major health problems not always well understood by teachers, parents, and the communities.
Special needs children integrating into the classrooms of every town have significant health and nursing needs.
The administration of medication and monitoring their effects, coupled with the needs of children from dysfunctional families, further complicate the picture of school health.
Please watch for upcoming legislation for expansion of Chapter 71, Section 3, M.G.L. or bill #. We urge you to support an act/or Bill # of providing a minimum of one school nurse for every public and non- public school building in the Commonwealth.
Thank you for your attention to this important issue.
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