§ 16R — Interagency review team for complex cases

Section 16R. (a) There shall be an interagency review team to collaborate on complex cases where there is a need for urgent action to address the lack of consensus or resolution between state agencies about current service needs or placement of an individual who: (i) is under the age of 22; (ii) is disabled or has complex behavioral health or special needs; and (iii) qualifies or may qualify for services from 1 or more state agencies, or special education services through the individual's school district.(b) The team shall consist of: the secretary of health and human services or a designee, who shall serve as co-chair; the commissioner of elementary and secondary education or a designee, who shall serve as co-chair; the assistant secretary of MassHealth or a designee; the commissioner of mental health or a designee; the commissioner of children and families or a designee; the commissioner of developmental services or a designee; the commissioner of youth services or a designee; the commissioner of early education and care or a designee; the secretary of the executive office of education or a designee; a representative from the office of the child advocate; and a representative from the school district or districts responsible for any aspect of an individual's education. The co-chairs may agree to convene a subset of the above-listed team members according to the circumstances of the individual's case; provided however, that a representative from the office of the child advocate shall be present at all team meetings.(c)(1) An individual may be referred to the team by the individual themselves if the individual is age 16 years or older, a state agency including a representative from the agency's ombudsman's office, the juvenile court, a hospital or emergency service provider, a school district, an attorney representing the individual or the individual's parent or guardian, a physician or behavioral health care provider authorized to act on behalf of a parent or guardian who is seeking access to services for the individual or the individual's parent or guardian.(2) Not later than 5 business days after referral of an individual to the team, the co-chairs shall convene the team; provided, however, that for referrals involving an individual waiting in a hospital emergency department or medical bed, or at home for not less than 5 days to be placed in an appropriate therapeutic setting or to be provided with appropriate evaluations and services, the co-chairs shall convene the team not later than 1 business day after receiving the referral. The team may order expedited eligibility determinations by a state agency or an extended evaluation at a special education residential school in order for the team to make determinations about the individual's current service needs if deemed necessary after the receipt of the referral and a review of relevant materials, including educational records and evaluations and review of any report issued from the area or regional level of state agencies involved.(3) Upon receipt and review of all necessary and updated information regarding the individual's service needs and eligibility decisions, the team shall determine the services currently in place, additional services that are needed to meet the current needs of the individual, which agencies shall provide said services, including location or placement where appropriate and ongoing case management services, and which agencies have fiscal responsibilities to pay for such services. The team shall complete its review within 30 business days; provided, however, that for referrals involving an individual waiting in a hospital emergency department or medical bed, or at home for not less than 5 days to be placed in an appropriate therapeutic setting or to be provided with appropriate evaluations and services, the team shall complete its review within 5 business days. The co-chairs may authorize the expenditure of funds pursuant to section 2TTTTT of chapter 29 to effectuate the purposes of this section. If the team does not come to resolution regarding which agency or agencies have fiscal responsibility, the co-chairs shall assume joint fiscal responsibility to avoid any delay in an individual receiving needed services. The co-chairs may authorize the expenditure of funds pursuant to said section 2TTTTT of said chapter 29 to cover the costs of needed services for an individual until a resolution regarding agency fiscal responsibility is reached.(d) If the individual or their parent or guardian disputes the decision of the team, the individual or their parent or guardian may file an appeal with the division of administrative law appeals, established under section 4H of chapter 7, which shall conduct an adjudicatory proceeding and order any necessary relief consistent with state or federal law; provided, however, that nothing in this section shall be construed to entitle an individual to services that the individual would otherwise be ineligible for under applicable agency statutes or regulations.(e) Notwithstanding chapters 66A, 112 and 119 or any other state or federal law related to the confidentiality of personal data, the team, the secretary of health and human services and the division of administrative law appeals shall have access to and may discuss materials related to the case while the case is under review; provided, that the individual or their parent or guardian shall consent in writing; and provided further, that such materials shall not be considered public records and that those having access shall agree in writing to keep the materials confidential.(f) The secretary of health and human services with the commissioner of elementary and secondary education shall promulgate regulations to effectuate the purposes of this section. The regulations shall include, but not be limited to: (i) the respective roles of the secretary of health and human services and the commissioner of elementary and secondary education for facilitating the work of the team; (ii) processes, including expedited processes, and timelines for required notifications between state agencies, the team and individuals who may be eligible for assistance or their parent or a person legally authorized to act on their behalf; (iii) record sharing processes, including requirements for obtaining consumer or parental consent; (iv) data gathering and reporting requirements; (v) protocols to ensure that individuals, parents and guardians are aware of the interagency review available in accordance with this section, and are provided with regular updates from the team and afforded opportunities to provide input and make decisions throughout the review process; and (vi) the interagency services reserve fund established in section 2TTTTT of chapter 29, including allowable uses of resources from said fund, processes for requesting and documenting requests, authorizations and denials and issuance of resources from said fund.(g) The secretary of health and human services shall publish an annual report not later than October 1 summarizing the cases reviewed by the team in the previous year, the length of time spent at each stage and the final resolution; provided, however, that the report shall not include any personally identifiable information of an individual. The report shall be provided to the child advocate and the clerks of the senate and the house of representatives.(h) Nothing in this section shall limit the rights of parents, guardians or children under chapter 71B, the federal Individuals with Disabilities Education Act, 20 U.S.C. 1400 et seq. or section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794 et seq. No decision or action taken under this section by the team shall be considered prejudicial by the Bureau of Special Education Appeals, the Division of Administrative Law Appeals or the MassHealth Board of Hearings.