Indicates Matter Stricken
Indicates New Matter

The Senate assembled at 11:00 A.M., the hour to which it stood adjourned and was called to order by the ACTING PRESIDENT, Senator COURSON.

To the Honorable Carroll A. Campbell, Jr., Governor of South Carolina, and Members of the General Assembly of South Carolina:

The South Carolina Legislative-Governor's Committee on Mental Health and Mental Retardation is pleased to offer their Report on the One Hundred and Eighth General Assembly of South Carolina for your consideration.

The Committee is divided into two distinct working subcommittees. Senator Bryan chairs the Mental Health Subcommittee. Senator Hayes, Representative Mattos, Representative Pat Harris, Ms. Naomi Dreher and Mr. James Harrison complete the membership of the Mental Health Subcommittee. Their hard work has resulted in legislation designed to better serve the mentally ill in South Carolina. Representative Carnell chairs the Mental Retardation Subcommittee. Senator Peeler, Senator Fielding, Representative Jean Harris, Representative Mattos, Ms. Nancy Banov and Mr. Jack Barnes complete the membership of the Mental Retardation Subcommittee. Their work has resulted in landmark changes for persons in South Carolina who have mental retardation.

The Committee has been involved in several special projects throughout this two year session, and has extensive plans for the next two year session.

We wish to thank all the many people who have shared their time with us for the sake of mentally ill and persons with mental retardation.

Respectfully submitted,
Rep. Patrick B. Harris,   Senator James E. Bryan
Chairman     Vice-Chairman
Senator Harvey Peeler   Senator John C. Hayes
Rep. Marion P. Carnell   Rep. James G. Mattos
Rep. Jean L. Harris   Mr. Jack W. Barnes
Mrs. Nancy L. Banov   Mrs. Naomi H. Dreher
Mr. James Harrison

The Committee was created in 1957 by Concurrent Resolution H. 1895 and was called the Committee to Study Public and Private Facilities for Mental Health and Mental Laws of South Carolina. Senate Resolution S.648 of 1958 and Senate Resolution S.76 of 1959 continued the Committee's existence for two years until Act 888 in 1960 created a permanent study committee. The Committee's name was changed to the Legislative-Governor's Committee on Mental Health and Mental Retardation by Act 617 of 1967. Act 38 of 1973 increased the size of the Committee from nine to twelve members and expanded the Committee's scope to include the study of "mental retardation and mental retardation institutions."

The Committee continues to operate pursuant to Act 38 of 1973 (Sections 2-39-10 and 2-39-20 of 1976 Code of Laws of South Carolina). This Act provides for a twelve-member committee: four Senate members appointed by the President of the Senate, four House members appointed by the Speaker of the House, and four Gubernatorial appointees.

The Committee is allocated $104,822 annually and is currently authorized for three positions.
The Department of Mental Health and the Department of Mental Retardation are allocated the 3rd and 9th largest budgets respectively. Together, these agencies receive 7% percent of the General Fund. The MH/MR Committee monitors the budget process as it effects these two agencies and the populations they serve.

H.4240 S.938 (Act No. 389)
Contraband.
Provides for offenses involving the use of alcoholic beverages, controlled substances, firearms, and dangerous weapons by a patient receiving inpatient services from the Alcohol and Drug Division of the Department of Mental Health. Amends Section 16-1-10 to include the felony offenses provided for in this act.

Sponsors:   H.4240 P. Harris, J. Harris, Carnell, Mattos.

S.938 Bryan, Peeler, Hayes, Fielding, Giese.

Status:   S.938 Signed by Governor 4-3-90.

H.4240 Tabled in House Judiciary Committee 3-6-90.

H.4245 S.936 (Act No. 419)
Competency to Stand Trial.
Provides for the determination of the capacity of a person to stand trial if he is unable to understand the charges against him or assist in his own defense as a result of a lack of mental capacity. Provides for court actions to be taken if mental illness or mental retardation is suspected by directing either mental health or mental retardation professionals to evaluation depending on the suspected problem.

Sponsors:   H.4245 P. Harris, J. Harris, Carnell, Mattos.

S.936 Bryan, Peeler, Hayes, Fielding.

Status:   S.936 Enrolled for ratification 4-16-90.

H.4245 Referred to House Judiciary 1-9-90.

H.4241 S.937 (Act No. 414)
Mental Retardation Boards Powers and Duties.
Amends the code of laws relating to the powers and duties of County Mental Retardation Boards, including the power to incur debt. The Department of Mental Retardation must approve all debt.

Sponsors:   H.4241 P. Harris, J. Harris, Carnell, Mattos.

S.937 Bryan, Peeler, Hayes, Fielding.

Status:     H.4241 Signed by Governor 4-10-90.

S.937 Referred to Senate Medical Affairs 1-9-90.

S.129 H.3136 (Act No. 38)
Report to Court on Examination of Alcohol and Drug Abuse Patients.
Provides for examination of a person involuntarily committed, reports on his condition included to the court, and a decision as to whether or not the person is likely to benefit from involuntary treatment.

Sponsors:   S.129 Bryan, Peeler, Hayes.

H.3136 P. Harris, J. Harris, Carnell.

Status:     S.129 Referred to Senate Judiciary 1-12-89.

H.3136 Signed by Governor 3-31-89.

S.1167 H.4509 (signed by Governor 5-30-90)
Mental Retardation and Related Disabilities Act.
Provides for a service system, requirements for licensure, and regulation of facilities and programs, and capital improvements for the Department of Mental Retardation.

Sponsors:   H.4509 P. Harris, J. Harris, Carnell, Mattos.

S.1167 Bryan, Peeler, Hayes, Fielding.

Status:   H.4509 Referred to Medical, Military, Public and Municipal Affairs 11-30-90.

S.130 H.3135 (Act No. 15)
Family Participation in Alcohol and Drug Abuse Treatment.
Provides for a family member to participate in the treatment process of a family member who has received emergency commitment to an alcohol and drug abuse facility, upon court order.

Sponsors:   S.130 Bryan, Peeler, Hayes.

H.3135 P. Harris, J. Harris, Carnell.

Status:   S.130 Signed by Governor 3-12-89.

H.3135 Tabled 2-16-89.

S.637 H.3765 (Act No. 145)
South Carolina Protection and Advocacy Board Membership.
Provides for up to four additional members, who serve as chairmen of federal or state created boards or county boards or councils involved with S.C. Protection and Advocacy. Advisory boards or councils may be elected by the board. Increases terms of members from three to four years. Deletes the requirement that the advice of the Senate must be obtained for appointment of the additional board members. Limits appointed members to two consecutive terms.

Sponsors:   S.637 Bryan, Hayes, Peeler, Fielding.

H.3765 P. Harris, Mattos, J. Harris, Carnell.

Status:   S.637 Signed by Governor 6-5-89.

H.3765 Tabled in Medical, Military, Public and Municipal Affairs Committee 3-21-89.

S.297 H.3414 (Act No. 95)
Continuum of Care for Emotionally Disturbed Children.
Provides for the Continuum of Care for Emotionally Disturbed Children by providing commission members, meetings, an advisory council, the children to be served, duties and functions, director and staff employment, reports to the General Assembly and the Governor, and administrative support. Also provides for the initial terms of the commission and advisory council.

Sponsors:   S.297 N. Smith, Moore, Hayes, Drummond, Mullinax, Martschink, and Giese.

H.3414 Beasley, Hayes, Fair, P. Harris, J. Harris, Carnell, Mattos.

Status:   S.297 Recommitted to Senate Medical Affairs Committee.

H.3414 Signed by Governor 5-22-89.

H.4271 S.1101 (Act No. 377)
Community Residential Care Facility Licenses and Team Advocacy.
Provides for suspension, revocation, or denial of a community residential care home license for failing to allow a team advocacy inspection.

Sponsors:   H.4271 P. Harris, J. Harris, Mattos, Carnell, Wilder, Baxley.

S.1101 Bryan, Hayes, Fielding, Peeler, Giese.

Status:   H.4271 Signed by Governor 3-19-90.

S.1101 Referred to Senate Medical Affairs 1-17-90.

H.4234 S.941 (Act No.376)
Department of Health and Environmental Control Release of Information.
Provides that inspection information, collected by Department of Health and Environmental office of Licensure, on community residential care facilities is to be given out to the public upon request. This aligns South Carolina with federal law.

Sponsors:   H.4234 P. Harris, J. Harris, Mattos, Carnell.

S.941 Bryan, Hayes, Fielding, Peeler, Giese.

Status:   H.4234 Signed by Governor 3-19-90.

S.941 Was recommitted to Senate Judiciary 2-8-90.

H.4255 S.1037 (Act No.351)
Team Advocacy Immunity.
Provides for immunity for team advocacy volunteers and employees of the South Carolina Protection and Advocacy when acting in good faith.

Sponsors:   H.4255 P. Harris, J. Harris, Mattos, Carnell.

S.1037 Bryan, Hayes, Peeler, Fielding.

Status:   S.1037 Signed by Governor 3-19-90.

H.4255 Adjourned debate in House Judiciary subcommittee.

H.4492
A concurrent resolution to recognize the community as the primary locus for service to the mentally ill.

Sponsors:   H.4492 P. Harris, J. Harris, Mattos, Carnell.

Status:   Adopted by House and Senate 2-1-90.

H.4235 S.939 (Act No. 345)
Obsolete Language.
This bill was requested by the Department of Mental Health and reflects clean-up of their governing code. The deleted sections are obsolete. They are either time specific, permanent provisions of the Appropriations Bill, or elsewhere in the Code of Laws.

Sponsors:   H.4235 P. Harris, J. Harris, Mattos, Carnell.

S.939 Bryan, Peeler, Hayes, Fielding.

Status:   H.4235 Signed by Governor 2-28-90.

S.939 Recommitted to Senate Judiciary 2-7-90.

H.4236 S.940 (Act No.381)
Team Advocacy.
Requires South Carolina Protection and Advocacy to conduct team advocacy inspections and defines the inspections. The bill further requires South Carolina Protection and Advocacy to issue a report in regard to the inspections and disseminate the report to the MH/MR Committee, Department of Health and Environmental Control, and Department of Mental Health.

Sponsors:   H.4236 P. Harris, J. Harris, Mattos, Carnell.

S.940 Bryan, Peeler, Hayes, Fielding, Giese.

Status:   H.4236 Signed by Governor 3-19-90

S.940 Referred to Senate Medical Affairs 1-9-90.

H.3760 S.572 (Act No.383)
Probable Cause to Continue Emergency Detention of a Patient.
Provides that within forty-eight hours of receipt of application and certification the court must review all evidence in order to determine if there is probable cause to detain the patient. If probable cause is not found, the patient will be released. If probable cause is found, the court may order the continued detention of the patient.

Sponsor:   H.3760 P. Harris, J. Harris, Mattos, Carnell.

S.572 Bryan, Hayes, Peeler, Fielding.

Status:   H.3760 Signed by Governor 3-19-90.

S.572 Referred to Senate Medical Affairs 3-23-90.

H.4242 S.935
Creation of Local Mental Retardation Boards.
Provides for a standardization of the manner in which local mental retardation boards may be created after July 1, 1990. Also, provides for the continuance of local mental retardation boards established before this date.

Sponsors:   H.4242 P. Harris, J. Harris, Mattos, Carnell.

S.935 Bryan, Hayes, Peeler, Fielding, Giese.

Status:   H.4242 Referred to Medical, Military, Public and Municipal Affairs 1-9-90.

S.935 Referred to Medical Affairs 1-9-90.

H.3180 S.127
Rights of Clients of the Department of Mental Health and Mental Retardation.
Provides for a policy of least restrictive environment to maximize quality of life by requiring clients to be treated with dignity and given the rights any citizen of South Carolina is entitled.

Sponsors:   H.3180 P. Harris, J. Harris, Carnell.

S.127 Bryan, Peeler, Hayes, Giese.

Status:   H.3180 Referred to Judiciary Committee 1-12-90.

S.127 Referred to Senate Medical Affairs 1-12-90.

H.3137 S.256
Procedures for Children in Need of Mental Health Treatment.
Provides for the insurance of children's basic rights in treatment centers. Encompasses least restrictive setting.

Sponsors:   H.3137 P. Harris, J. Harris, Carnell.

S.256 Bryan, Hayes, Rose, Giese.

Status:   H.3137 Referred to Medical, Military, Public and Municipal Affairs 1-1-90.

S.256 Referred to Medical Affairs 1-25-90.

H.3922 S.694
Tax Credit Legislation for Parents and Guardians of Persons with Severe Mental Retardation.
Provides for tax credits of 25% of all expenditures, not exceeding $1000.00, paid by the parent or legal guardian of a person with severe mental retardation, who lives at home, who is dependent on his parent or guardian for at least half of his financial support.

Sponsors:   H.3922 P. Harris, J. Harris, Carnell, Mattos.

S.694 Bryan, Peeler, Hayes, Fielding.

Status:   H.3922 Referred to Ways and Means 4-3-90.

S.694 Referred to Senate Finance 4-19-90.

S.1167 Enrolled for Ratification 5-11-90.

H.3132 (Act No.412)
Retirement Beneficiary.
Allows a retiree under the South Carolina Retirement System to name more than one beneficiary, one of whom can be a trust for a handicapped person.

Sponsor:   Barfield

Status:   Signed by Governor 4-11-90.

S.282
Transportation of a Patient to the Department of Mental Health.
Provides for the department to transport persons requiring immediate care instead of an officer of the peace providing transportation.

Sponsor:   Peeler.

Status:   Referred to Senate Medical Affairs 1-31-90.

S.406
Mental Retardation Death Penalty
Prohibits the execution of mentally retarded persons convicted of murder. Provides for punishment.

Sponsors:   Waddell, Bryan, Giese, Fielding, Shealy.

Status:   Referred to Senate Judiciary 2-21-90.

H.4244 (Act No. 467)
Joint Committee on Disabilities.
Creates a joint committee to study the problems of persons with disabilities.

Sponsors:   H.4244 Wilder, Baxley, and Corning.

Status:   H.4244 Passed.

H.3894
Involuntary Commitment Hearings.
Provides for all involuntary commitment hearings involving patients at Crafts-Farrow Hospital be held on the hospital premises.

Sponsor:   Wright.

Status:   Referred to House Medical, Military, Public and Municipal Affairs 4-13-89. Tabled on 1-9-90.

H.3800
Nursing Home and Community Residential Care Facility Updated Language.
Defines nursing home administrators, community residential care facility, community residential care facility administrator. Provides for licensure of community residential care facility administrators. Provides for criminal records check for applicants for licensure. Provides assistance to the Department of Health and Environmental Control regarding the licensing and inspection of community residential care facilities by revising the membership of the committees. Repeals Section 44-7-310 relating to public disclosure of information received by the Office of Health Licensing.

Sponsors:   Hearn, Wilder, Baxley.

Status:   Sent to Senate and referred to Senate Medical Affairs 1-11-90. Reported out of Committee on 5-17-90.

H.4653 (Act No.506)
Standards for Examinations of Physicians.
Amends the code relating to the standards for the examination of physicians. Provides for an examination for the special purpose examination and for circumstances under which the requirement applies.

Sponsor:   Rogers.

Status:   Enrolled for Ratification 4-12-90.

H.3029
Mental Health Center Fund Raising.
Provides that Mental Health Centers may solicit contributions and raise funds for the benefit, operation and maintenance of the local facility.

Sponsor:   McAbee.

Status:   Tabled in Medical, Military, Public & Municiple Affairs Committee 3-9-89.

H.4222 S.930
Joint Day Care Centers.
A joint resolution to direct the department of Mental Health to study the feasibility of joint day care centers to care for children and persons suffering from Alzheimer's Disease.

Sponsors:   H.4222 P. Harris, Blackwell, Waldrop

S.930 McLeod, Lourie, N. Smith, Passailaigue, Mullinax, Hinson.

Status:   H.4222 Referred to Medical, Military, Public & Municiple Affairs Committee 1-9-90.

S.930   Referred to Medical Affairs 1-9-90.

H.4797
Mental Health Center Fund Raising.
Provides that Mental Health Centers may solicit contributions and raise funds for the operation and maintenance of the local facility.

Sponsors:   J.C. Johnson, McAbee, Carnell.

Status:   Referred to Medical, Military, Public & Municipal Affairs Committee 3-7-90. Tabled on 4-18-90.

H.5035
Law Enforcement Detainment of Persons Needing Mental Health Care.
Provides that law enforcement officials may temporarily detain persons suspected of needing mental health care until a medical examination can be conducted.

Sponsor:   Fair.

Status:   Referred to Medical, Military, Public and Municipal Affairs Committee 4-12-90.

Team Advocacy

The MH/MR Committee and the South Carolina Protection and Advocacy System co-sponsored a 1985 training session by the New York State Commission on Quality of Care. Committee members, members of the South Carolina Alliance for the Mentally Ill, members of the South Carolina Mental Health Association, and South Carolina Protection and Advocacy staff were trained to review basic living conditions for institutionalized patients. The New York "team advocacy system" was adapted to South Carolina institutions and has now been expanded into community residential care homes.

The MH/MR Committee was allocated an additional $31,000 to contract with S.C. Protection and Advocacy to conduct team advocacy inspections. The goal of team advocacy is to work with the Department of Mental Health and the residential care homes to improve living conditions of patients.

The current contract is attached in Appendix A. We are currently in the process of negotiating contract renewal.

Continuum of Care Study

The MH/MR Committee worked with the Children's Committee during the 1989 Session to study and make recommendations in regard to the Continuum of Care. The study and hearings by the two Committees resulted in a new board for the Continuum.

The MH/MR Committee held two public hearings on mental retardation. The first public hearing was held in June 1989 in Charleston. The second hearing was held in Greenwood in August 1989. Listed below are issues identified by the public as concerns and requests of the Committee:

1.   Waiting list for services
2.   Mentally retarded clients who are patients at the Department of Mental Health
3.   Homes for mentally retarded who are also physically handicapped
4.   Team advocacy inspections for mental retardation facilities
5.   Respite care for families of persons with mental retardation
6.   Geriatric wing at Coastal Center
7.   Higher staff/client ratio at mental retardation facilities
8.   Early intervention centers for children with mental retardation
9.   Extended school day for children with mental retardation
10.   Extended school year for children with mental retardation
11.   Lower school class sizes for handicapped children
12.   More special education teachers and speech therapists
13.   Juvenile delinquents in mental retardation facilities
14.   Coordination of state prevention plan
15.   Integration of state mentally retarded into the day care system
16.   Coordination of employment efforts for persons with mental retardation
17.   Transportation problems
18.   Expansion of Department of Vocational Rehabilitation efforts for the mentally retarded
19.   Services for the dually diagnosed
20.   Parent counseling
21.   Medical professionals training and continuing education in working with the mentally retarded
22.   State Department of Vocational Education not doing anything for the retarded
23.   Competitive salaries for private providers
24.   Limited terms for Mental Retardation Board members
25.   Knowledgable Mental Retardation Board members
26.   Limited number of Mental Retardation Board members
27.   Funding and placement of Autism Program
28.   Transition planning from school to work
29.   Insurance coverage for the mentally retarded
30.   Citizen advocacy training
31.   Equity in funding (day services vs. residential) at the Department of Mental Retardation
32.   Accountable delivery of professional services
33.   Equal distribution of services across the State
34.   Cost contained delivery of services
35.   Third party reimbursements to all etiologies

The MH/MR Committee also held a public hearing on mental health issues. The hearing was held in Columbia in August 1989. Below are the issues identified by the public as concerns and requests of the Committee:

1.   Separate line item in the Appropriations Bill for organization of a self-help group
2.   Legislation that would make the Department of Mental Health mission clearer
3.   Contraband legislation for alcohol and drug abuse
4.   Obsolete language legislation for the mental health code
5.   Review and implementation of Oregon's system for prioritization of mental health service funding
6.   Revamping of the mental health code
7.   Pay raises for doctors and nurses at the Department of Mental Health
8.   Revamp state personnel regulations
9.   Hold the Department of Mental Health accountable in budget expenditures
10.   Create through legislation an independent quality care review board for incidents occurring at the Department of Mental Health
11.   Legislation mandating discharge planning
12.   Study other mental health successes in other states
13.   Study of the Charleston delivery system on screening
14.   Full funding of Harris Hospital
15.   Better funding for the Department of Mental Health
16.   Access of clozapine for Department of Mental Health patients
17.   Legislation for community residential care facilities
18.   Change the name of the Committee and the Department of Mental Health to reflect mental illness instead of mental health
19.   Prohibit the Department of Mental Health from transferring monies from program to program
20.   Other state funding of mental health over the last five years
21.   Legislation setting up a self sufficiency trust fund

Mental Health Insurance Coverage Study and Public Hearing
(Appendix B)

The MH/MR Committee studied the issue of insurance coverage for the mentally ill. The report enclosed in Appendix B provided the Committee with a number of options that include mandated mental health insurance coverage, optional insurance coverage, defining certain mental illnesses as physical in nature, and lawsuits. The Mental Health Subcommittee held a public hearing in November 1989 in regard to mental health insurance coverage. They recommended the Committee conduct a cost analysis of each option for insurance. The Committee will conduct cost analysis for each option during the interim.

Elderly Population at the Department of Mental Health (Appendix C)

The Committee studied the problems experienced by the Department of Mental Health with non-mentally ill elderly patients. The report enclosed in Appendix C presented clear evidence that the Department of Mental Health has resolved a number of the problems experienced with the elderly in the past.

Outside Activities

The MH/MR Committee members and staff serve on various advisory councils and committees. The following are activities the Committee is involved in:

Continuum of Care Advisory Council
Team Advocacy Advisory Committee
Transition Task Force - Developmental Disabilities Council
Transition Leadership Council
Advocates Network
Protection and Advocacy for the Mentally Ill Council
Protection and Advocacy for Individuals with Retardation Council
Walk for the Mentally Ill
Involved with Christmas fund raiser, Legislative-Charity Basketball Game
S.C. Probate Judges Association

Tour of Facilities

During the course of the public hearings on issues related to mental retardation, Committee members and staff toured many of the Department of Mental Retardation programs.

Coastal Center
Whitten Center
two community training homes
one group home
one apartment living arrangement
Delicious Delights Bakery
Emerald Center in Greenwood
two work programs
Greenwood Genetic Center

The Committee believes these tours were vital to their understanding of mental retardation issues.

Committee staff will arrange tours for any member of the General Assembly upon request.

The Committee has a busy schedule planned for the interim. The Mental Health Subcommittee will work on the children's commitment law and patient rights. They will do a cost analysis on mental health insurance coverage and study the possibility of a separate line item in the Appropriations Bill for consumers. They will also work on legislation for a self sufficiency trust fund and and an independent review board for incidents at the Department of Mental Health.

The Committee has also appointed an independent panel of professionals to make recommendations to the full MH/MR Committee on changes to the mental health code. These changes will hopefully address concerns and requests expressed at the public hearing on mental health issues. They will also address legislative issues raised in the Legislative Audit Council Report on the Department of Mental Health.

The Mental Retardation Subcommittee will address patient rights for persons with mental retardation. They will also continue to address the recommendations raised by the public hearings and the eighteen month study conducted by the MH/MR Committee.

Committee members and staff visit facilities and community programs/homes of both the Department of Mental Health and the Department of Mental Retardation. Some of the visits are arranged tours and others are unannounced. These visits result in first hand knowledge of how the Department of Mental Health and the Department of Mental Retardation operate their programs. The Committee has also been very active in handling constituent problems of General Assembly members relating to mental health and mental retardation. There have also been numerous speaking engagements by members and staff across the State dealing with these problems.

The Committee receives several publications beneficial to both staff and members. Hospital and Community Psychiatry, State Health Reports - Mental Health, Alcoholism and Drug Abuse, Community Health Journal, New Directions, Legislative News and Views, Mental Health Reports, Bell Ringer, The Catalyst, The S.C. P&A Advocate, American Journal of Mental Deficiency, and Capitol Capsule are available upon request.

The South Carolina Protection and Advocacy System for the Handicapped, Inc. (SCP&A) hereby enters into an agreement with the Joint Legislative Governor's Committee on Mental Health and Mental Retardation (MH/MR Committee) to continue the Team Advocacy Project.

MH/MR Committee agrees to provide funds as appropriated by the South Carolina General Assembly to the SCP&A for the Team Advocacy Project (Project) in quarterly installments in July, October, January and April and to allow the Project to operate under the auspices of the MH/MR Committee.

SCP&A agrees to take responsibility for overseeing the administration of the Project, including the hiring of a Project Coordinator, and designating a SCP&A staff person to supervise the Project and act as the contact person to the MH/MR Committee. The SCP&A staff person will prepare an annual budget for the Project and provide periodic progress reports to the MH/MR Committee which will include quarterly reports of financial expenditures, a final financial report due no later than forty-five (45) days after the end of the fiscal year (June 30), and an annual report of Project activities due no later than sixty (60) day after the end of the fiscal year (June 30). SCP&A will submit an annual plan and a budget for the Project for approval by the MH/MR Committee before June 30 and agrees to spend the funds in accordance with the plan and budget unless a request for amendment is approved by the MH/MR Committee prior to the requested amendment is made.

This agreement shall be effective on July 1, 1990, and shall remain in effect unless terminated by the MH/MR Committee at the end of a fiscal year.

Louise R. Ravenel,   Patrick B. Harris, Chm.
Executive Director   Jt. Leg. Governors Comm.
South Carolina Protection   on Mental Health and
& Advocacy System for the   Mental Retardation
Handicapped

The TEAM ADVOCACY PROJECT, under the supervision of the South Carolina Protection and Advocacy System for the Handicapped, Inc., agrees to implement the following activities during the 1990-91 fiscal year:
1.   Inspect, at a minimum, five (5) Department of Mental Health facilities, at least one of which will be conducted at Morris Village and which includes the initial surprise inspection and the follow-up;
2.   Inspect, at a minimum, nine (9) Community Residential Care Facilities, which includes the initial surprise inspection and the follow-up;
3.   Hold at least one press conference to report on the findings from the inspections completed by the date of the conference, including a summary of recurring deficiencies found during the inspections;
4.   Review and revise the volunteer training to incorporate information about the roles and responsibilities of the Joint Legislative Governor's Committee on Mental Health and Mental Retardation, Department of Mental Health, and South Carolina Association of Residential Care Providers and include staff members of the Committee and Department and a home owner of the Association when possible to present said information to the volunteers and conduct additional training sessions for volunteers as needed; however, no person employed by the Department or community
residential care facility, may be a member of an inspection team;
5.   Have the Project Coordinator attend such functions as related to the Project, such as meetings of the Mental Health Commission and its pertinent subcommittees, Quality Care Review Board meetings relating to matters inspected by the Project, groups and organizations requesting information about the Project, and meetings of the Joint Legislative Governor's Committee on Mental Health and Mental Retardation as requested;
6.   Provide the Joint Legislative Governor's Committee on Mental Health and Mental Retardation with reports on all inspections, quarterly financial reports, an annual financial report, and an annual report on Project activities;
7.   Hold, at a minimum, quarterly meetings of the Team Advocacy Project advisory committee which is made up of a representative of the MH/MR Committee, Alliance for the Mentally Ill, Mental Health Association, Self Help Association Regarding Emotions, and SCP&A;
8.   Conduct such other activities as directed by the MH/MR Committee and SCP&A, including, but not limited to, (1) the development of a brochure outlining the roles and responsibilities of the volunteers and community residential care facilities administrators with regard to Team Advocacy, and (2) the development of a survey instrument to assess the services provided through the Community Mental Health Centers of the Department of Mental Health; and
9.   Follow the procedures outlined below:
a.   With regard to the DMH facility inspection reports, provide the final report to the following: Joint Legislative-Governor's Committee on Mental Health and Mental Retardation, Commissioner of the Department of Mental Health, and SCP&A;
b.   With regard to the Community Residential Care Facilities inspection reports, provide the final report to the following: Joint Legislative-Governor's Committee on Mental Health and Mental Retardation, owner of the CRCF, Commissioner of the Department of Mental Health, Commissioner of the Department of Health and Environmental Control, and SCP&A;
c.   Upon receipt of the response, which is due thirty days from the date the inspection report was mailed, the response will be sent as outlined above;
d.   No sooner than sixty (60) days from the date the reports were originally sent as outlined in a. and b. above, a follow-up inspection will be scheduled, regardless of whether a response has been received or not, and follow-up inspection reports provided as outlined above; and
e.   Prior to the inspection being conducted, Team members will again be cautioned about the need to keep the information about the report confidential and be asked to sign an additional statement of confidentiality.

The MH/MR Committee agrees to provide copies of the reports to individuals or agencies requesting copies, to encourage Community Residential Care Facility administrators to respond to the reports, to report facilities which refuse admittance to Team Advocacy volunteers to the Department of Health and Environmental Control, and to arbitrate any disputes which arise between the Team Advocacy Project/SCP&A and the facilities being inspected which SCP&A is unable to resolve independently.

The plan outlined above is agreed to on the date shown below by the South Carolina Protection and Advocacy System for the Handicapped, Inc. and the Joint Legislative Governor's Committee on Mental Health and Mental Retardation.

Louise R. Ravenel,   Patrick B. Harris, Chm.
Executive Director   Jt. Leg. Governors Comm.
South Carolina Protection   on Mental Health and
& Advocacy System for the   Mental Retardation
Handicapped

May 1, 1990   May 1, 1990

Expense   MH/MR   In-kind   Total

Committee

Personnel:       $26,901
Project Coord.*   $21,062
Bookkeeper   750
Project Supv.   1,200
Fringe Benefits   3,889

Travel (Coord/vol)   2,050     2,050

Publications**     620   620

Operating Expenses:       4,465
Supplies
Including Postage   1,500
Telephone, include.
base/Long dist.   549   541
Rent***   _______   1,875

TOTALS   $31,000   $3,036   $34,036

*         Present annual salary - $20,600; projected raise of 3% October 1, 1990 to $21,218.
**     Donations from Mental Health Association and Alliance for the Mentally Ill to develop brochure to publicize the Team Advocacy Project and attract additional volunteers.
***   Does not include secretarial support, use of equipment, insurance or other support services.

Patients who are diagnosed with mental disorders and their families are faced with many problems, including social stigma, costly care and treatment and inadequate insurance coverage. The Committee has voted to study the problems associated with health insurance coverage for the mentally ill and their families.

Many states have mandated minimum benefits and other states have legislation pending, but are awaiting the results of Supreme Court decisions, and other litigation to assist in their decisions. During the last decade there has been a significant increase in interest and availability of insurance coverage by third-party payers, but the supply of necessary coverage has not adequately reached the demand. Numerous studies have been conducted relative to the impact of mandated insurance coverage for mental disorders which have resulted in conflicting conclusions. The insurance industry and the mental health community contradict each other's studies, claiming skewed statistics, flawed research and biased data interpretations.

Consideration must be given to federal regulations, for example, ERISA (Employment Retirement Income Security Act of 1974). ERISA regulates employment benefit plans directly, whereas state mandated laws regulate employee benefit plans indirectly by regulating the insurance coverage or the plan that is purchased to fund life or health benefits. ERISA and state laws work together: 1) if a public or private employer self-insures a health care plan, the plan is subject to ERISA regulation and state regulation of the the plan is preempted; 2) if the plan is insured it is subject to state mandates. The coexistence of ERISA and state regulations and their effect on insurance coverage have been the target of recent litigation around the country. The states have the right to regulate insurance. The US Supreme Court recently upheld the rights of the states by holding that ERISA did NOT preempt a Massachusetts state law that mandated employers purchase group health insurance or plans to provide certain minimum health benefits.

I.   Mandated Mental Health Insurance Coverage CONS: (Insurance Industry)

A. Consumer Choice in the Free-Market System

1.   Deny employers and employees the right to choose the benefits they want.
2.   Regressive Tax: Since all employees pay for a portion of their coverage, if the coverage is mandated, and unnecessary financial burden will be imposed on low income employees.
3.   HMO's and self-insurers will have an unfair advantage over the industry because they are not subject to state mandates.
4.   Increase the number of self-insurers to avoid federal and state mandates.
5.   Discourage industry from locating and remaining in the state. Industry pays for almost 40% of their employees labor costs on benefits.
6.   The number of uninsured employees will increase because small businesses cannot afford excessive benefits.

B. Possible Increases in Costs and Utilization
1.   Costs will rise unless adequate provider incentives are added to control costs.
2.   Because demand for services is dependant on price of the services, utilization will increase dramatically because mental health services will become more accessible.
3.   A mandate will freeze into place a benefit and impose an administrative burden on the legislature and the industry. (e.g.: If the insurer wishes to change benefits to conform with new technology or health care delivery, then they have to ask for
legislation to repeal the current statutes that mandate benefits.)

C. Should Legislatures Decide Insurance Issues?
1.   Industry claims they should make the decisions on the most cost-effective and appropriate of mental health benefits on a plan-by-plan system.
2.   The Industry should maintain the right to decide what types of services are to be covered, and the option to offer the coverage in the policies they deem necessary.
3.   The Industry claims that mental health mandates prove to be more costly than other types of health care coverage. (Maryland study)
4.   Opponents challenge that mandating one set of benefits which expands the market for a particular group of care providers (and consumers) sets a dangerous precedent for the next special interest group to pressure legislatures to further expand mandated health insurance coverage, thus increasing costs and utilization for business and consumers alike.
II.   MANDATE THAT INSURANCE COMPANIES MUST OFFER OPTIONAL MENTAL HEALTH COVERAGE PLANS
PROS:
A.   Allows businesses and individuals the option of having mental health coverage.

B.   A viable compromise chosen by several state legislatures.
CONS:

A.   Allows insurance companies to over price the optional coverage, thus decreasing its affordability.

B.   Allows insurance companies to decide what types of mental health coverage to offer.
----------------------------------------------------
III.   DEFINE SCHIZOPHRENIA AND MAJOR AFFECTIVE DISORDERS AS PHYSICAL DISORDERS IN THE SOUTH CAROLINA CODE OF LAWS, 1976.
PROS:

A.   Allow current insurance coverage of the diseases same as heart disease or cancer.
CONS:

A.   Increase costs and utilization of current health coverage.
---------------------------------------------------
IV.   Allow the courts to decide on health insurance coverage for the mentally ill.
(see attachments)

The Arkansas Court of Appeals affirmed a lower court's decision that found that a health policy issued by Blue Cross and Blue Shield had to cover, as a physical condition, the hospitalization of the insured's daughter for bipolar affective disorder (depression). Arkansas Blue Cross and Blue Shield, Inc. v. Doe. 733 S.W.2d 429 (Arkansas Court of Appeals, 1987)

John Doe and his daughter Jane were insured under a group health insurance policy. Under its terms, the policy provided liberal benefits for hospitalization and treatment of physical disorders, but only limited coverage for psychiatric or nervous conditions. After the daughter was hospitalized and treated for a bipolar affective disorder, the father submitted the expenses. Only limited benefits were paid, however, because the insurance company contended that the condition was mental, not physical.

At the lower court hearing, the treating psychiatrist testified that while the symptoms indicated a mental illness, the cause was an illness of the brain stemming from a chemical imbalance that was responsive to medication. Thus, while the illness manifested some behavioral disturbances, the causes of those manifestations were biological. This view was supported by other expert witnesses.

There also was testimony that the classification of illnesses by symptoms was primitive and that psychiatrists were moving away from that method. But the insurance company's expert witness testified that bipolar affective disorder was normally classified as a mental disorder by insurance companies, hospitals and clinics. The lower court concluded that the child's condition was physical.

The appeals court found credible evidence to support the lower court's conclusion that classifying illnesses by symptom, rather than cause, was falling into disfavor, and the number of experts viewed bipolar affective disorder as an illness with biological, not mental, basis.

The appeals court also ruled that the trial court did not err in excluding testimony from the insurance company's actuarial manager. Finally, the fact that the insured was a licensed attorney did not prevent him from attorney's fees as a successful litigant.

(National Association of State Mental Health Program Directors, Legal Issues April, 1988)

A Missouri appeals court reversed and remanded a lower court's order that denied the petition of a conservator who was trying to recover medical expenses for his ward's neurological disorder. Crum-Vandlandingham v. Blue Cross Health Services. 34 S.W.2d 266 (Missouri Court of Appeals)

As stipulated by the parties, June Crum became a member of a group health plan offered through her deceased husband's company. Four years later, she contracted a progressively disabling neurological disorder that required in-home private nursing care. By that time, however, she turned 65 and qualified for Medicare, so her coverage was converted to Medicare supplementary program pursuant to the master contract. With the help of her attorneys, she was reinstated to the group health plan, but remained enrolled in the Medicare supplementary program with the company picking up the premiums directly. The supplementary plan provide 20% of the expenses in excess of Medicare payments and has a $10,000 lifetime maximum amount. The Blue Cross plan has a million dollar maximum.

Blue Cross refused to pay for June Crum's medical expenses, viewing her as entitled only to the supplementary benefits of the Medicare program since she was converted at the age of 65. However, the claimant maintained that there was an ambiguity as to whether the $10,000 or $1,000,000 limit applied, and that any ambiguity had to be resolved in favor of the insured. The trial court ruled for the insurance company.

On appeal, the court noted that the brochure accompanying the policy stated that the $1,000,0000 protection would not be dropped due to advancing age, while the master contract had no provision or language about continuing protection. Thus, the brochure was part of the insurance contract, creating obvious ambiguity that had to be resolved in favor of the insured. Thus, there was $1,000,000 limit for serious illness.

The appeals court also held that under the precedent of Lutsky v. Blue Cross Hospital Service, Inc. 69995 S.W.2d 870, (Mo. Sup. Ct. 1985), 10MPDLR 42, a limit below $1,000,000 could not be imposed against benefits available for an illness having its inception while the original program was in effect. Otherwise, the lifetime limit would be "illusory to the point of being positively deceptive". Even though Crum's coverage was converted, she never terminated her membership or withdrew from the overall program. The act of conversion "appears to have affected only future illnesses". The matter was remanded to the lower court, which was instructed to hold Blue Cross liable for the expenses.

October 26, 1989
Ms. Wendy E. Arndt
Director Of Research
Legislative-Governor's Committee
On Mental Health and Mental
Retardation
209 Blatt Building
Post Office Box 11867
Columbia, South Carolina 29211

Dear Ms. Arndt:

Some months ago, Representative Harris contacted Joe Barnett here at the Department of Insurance requesting an assessment from this Department on the problem of health insurance coverage for people with mental illness. The letter from Representative Harris has been given to me with the request that I respond.

In this past session, the General Assembly passed legislation creating the South Carolina Health Insurance Pool. Individuals who are unable to purchase health insurance coverage because of existing medical conditions will be eligible to purchase coverage through the Pool. Individuals with mental illnesses who are deemed uninsurable in the insurance marketplace will be able to apply to the Pool for a health insurance policy. And, individuals who are currently insured but who are paying a premium in excess of that charged by the Pool will be eligible for Pool coverage. It is hoped that this mechanism will provide much-needed coverage to those individual, including mentally ill individuals, who have found it impossible to obtain health insurance from a licensed insurer.

There are, however, many insurance companies who will not refuse to write individuals with mental illnesses or nervous disorders, but whose policies exclude coverage or limit benefits for those conditions. With regard to individual health insurance policies, South Carolina law, by regulation, allows the exclusion of coverage for the treatment of mental or nervous disorders. Our law is based on a model law prepared by the National Association of Insurance Commissioners. With regard to group policies, coverage for mental or nervous disorders is typically provided, but on a limited basis.

I trust this information has been of some assistance. If I can supply anything further, please let me know.

Yours very truly,
Susanne K. Murphy
Deputy Chief Insurance Commissioner

The Department of Mental Health is required by law to care for the elderly, veterans and alcohol and substance abusers. This report is limited to information on the elderly population.

The Commission on Aging has estimated that about 3% of South Carolinians over age 65 live in nursing homes. Nationally, about 18% of the aging in the community are functionally impaired and need home health services. The National Mental Health Association claims that almost 60% of the nursing home residents have a primary or secondary diagnosis of mental illness. These diagnoses include:
-   chronic mental illness without physical disorders
-   chronic mental illness with physical condition
-   patients with a combination of dementia accompanied by physical disorders

Historical Perspective:

According to the Department of Mental Health, the agency has served the state as a Department of Institutions. The structure of the commitment law permitted the commitment of people who could not live with their families or reside in their communities because agencies, facilities or services were unavailable or unaffordable. A person could be committed if he were unable to care for himself. (DMH letter 8-28-89)

The Department feels that their mandate of mental health treatment has been lost in recent years.
1976 Code of Laws of South Carolina:

44-9-50 Divisions of Department; deputy commissioners.

The Department of Mental Health may be divided into divisions as may be authorized by the State Commissioner of Mental Health and approved by the Commission. ... One of these divisions shall be a Division for Long-Term Care which shall have primary responsibility for care and treatment of elderly persons who are mentally and physically handicapped to the extent that their needs are not met in other facilities either public or private.

1)   Crafts-Farrow State Hospital - Psychiatric

Facility for Geriatric Patients

Total Number of Beds -   511

Number of Medicaid

Certified Beds -   227

Number of Patients FY89 -   886

(Over 65 Years of Age)

Average Length of

Stay (over age 65) -   141.2 days

Number Medicaid

Eligible Patients -   30

Cost of Care

Per Patient/Per Day -   $119.22

Medicaid Revenue 89 -   $1,799,734

Medicare Revenue 89 -   $462,618

Other Revenue 89 -   $1,612,302

Crafts-Farrow State Hospital patients are primarily committed by families and general hospitals; the patients must be at least fifty-five years old.

The Patrick B. Harris Psychiatric Hospital was built in Anderson to accommodate the upstate region and to divert elderly admissions from Crafts-Farrow State Hospital; however, the Department of Mental Health has closed the geriatric unit at Harris Hospital.

2)   Tucker Human Resource Center - Certified

Nursing Home

Total Number of Beds -   90

Number of Medicaid

Certified Beds -   590

Number of Patients FY89 -   644

(Over 65 Years of Age)

Average Length of

Stay (over age 65) -   877.6 days

Number Medicaid

Eligible Patients -   282

Cost of Care

Per Patient/Per Day -   $87.06

Medicaid Revenue 89 -   $4,535,008

Medicare Revenue 89 -   $ 38,601

Other Revenue 89 -   $3,976,189

The Tucker Human Resource Center accepts admissions from other Mental Health inpatient hospitals and from Crafts-Farrow (for patients needing nursing care).

The Department of Mental Health has recently closed two wards of Fewell Pavilion (88 beds) and are in the process of closing a third 44-bed ward. As of October 20, Tucker Center was operating 478 beds. The Department is trying to remove all non-medicaid patients. Paying patients only pay $35/day for care at Tucker Center, when actual costs are $87/day, and the paying patient funds go to the paying patient fee account, not to operational funds for Tucker Center.

1)   Dowdy-Gardner Nursing Care Center - Certified

Nursing Home for geriatric patient who need active treatment for psychiatric care. (over 65 years of age)

Total Number of Beds -   518

Number of Medicaid

Certified Beds -   518

Number of Patients FY89 -   630

(Over 65 Years of Age)

Average Length of

Stay (over age 65) -   716.4 days

Number Medicaid

Eligible Patients -   244 (plus 33 retarded under 65 years)

Cost of Care

Per Patient/Per Day -   $ 87.47

Medicaid Revenue 89 -   $9,929,279

Medicare Revenue 89 -   $ 0

Other Revenue 89 -   $2,254,130

Patients at Dowdy-Gardner Nursing Center come from other DMH inpatient hospitals and from Crafts-Farrow for those needing psychiatric care and nursing care.

(In FY 89, 194 elderly patients were served in other facilities at the Department of Mental Health. Their average length of stay was 31.4 days.)

Recent Changes Which Have Decreased Inappropriate Admissions Of The Elderly To The Department Of Mental Health:
Mental Health Policy Changes:
1)   Tucker Center no longer accepts admissions from the community.
-All Tucker admissions have to come from within the Department.
2)   Dowdy-Gardner no longer accepts admissions from the community.
-All Dowdy-Gardner admissions have to come from within the Department.
3)   All admissions of elderly patients have to be made to Crafts-Farrow State Hospital... which means those who have a major psychiatric illness as their primary diagnosis.
4)   Changes in the Community Mental Health Services have helped alleviate the problems of inappropriate admissions.
-Task Force on the Elderly developed a State Plan to "Provide Mental Health Services for the Elderly". The plan included community based services for the elderly (see Task Force Plan).

Federal Legislation:
1)   Nursing Home Reform Act (Omnibus Reconciliation Act, 1987)
-Requires nursing home applicants be screened for mental illness to determine whether the patient needs active psychiatric treatment in a mental health setting.
2)   "Anti-Dumping" Regulation of the Federal Health Care Finance Administration
-$50,000 fines for physicians or hospitals who discharge Medicaid and Medicare patients prematurely because the allowable days for reimbursement have run out.

State Legislation
-1987 passage of H2102, Provided that all admissions to Crafts-Farrow had to have the results of a recent medical examination (within the previous 2 years) prior to admission. The medical exams were necessary to rule out any physical condition that could mimic a mental illness (drug reaction, etc.).
-Allowing 1,500 new Medicaid funded nursing home beds in the state.

Other Changes That Have Decreased The Number Of Inappropriate Admissions:
-Community Long Term Care and Home Health Services have helped decrease the number of inappropriate admissions to the Department of Mental Health.
-Home Health Services provides intermittent skilled and restorative care for homebound patients. Services include skilled nursing, home health aide, physical, speech and occupational therapy, dietary counseling and Medical social
services. DHEC administers Home Health Services and these services are available in all counties of the State.
-Personal Care Aid Services Program (DHEC) PCASP was implemented in April 1985 to ensure the statewide availability of personal care services to elderly and disabled adults eligible for community-based services sponsored by the Community Long Term Care Program. Persons must be at the intermediate or skilled level of care and financially eligible for medicaid sponsored nursing home benefits to receive assistance from the CLTC program.

The Task Force has set up their plan in four segments with specific targets in each segment.
I.     Define, design and implement a set of core services for the elderly.

A.   Needs Assessment Report - Drafted August 1989.

B.   The Mental Health Staff is reviewing a draft policy report which defines criteria for medically stable as a prerequisite for admission to DMH facilities, criteria for psychiatric stability as a prerequisite for discharge from psychiatric facilities and a procedure to monitor these.

C.   By December 31, a report will be sent to the Quality Assurance division on clinical and program standards for mental health treatment to the elderly.

D.   The task force has "on hold" a draft defining DMH's role as ancillary and supportive in providing community and institution based long term care and the scope of its responsibilities.

E.   No action has been taken to develop and revise laws that prohibit the admission of physically ill, infirm or handicapped individual into psychiatric hospitals when no serious psychiatric disorder exists. They plan to address this issue in 1990.

F.   The task force developed an operational budget for each Community Area Mental Health Center that provided one to three geriatric specialists teams. These teams provide evaluations, prescriptive recommendations, consultations, and follow-ups to providers throughout the service areas. The task force sent this budget to each CMHC and encouraged them to make this a part of their budget request in FY90. The request (totalling $750,000) was a low priority item and was not funded for FY90. However, $2.9 million was submitted to the budget planning office for the FY91. The $2.9 million would provide 36 teams and 80.5 FTE's which would serve all CMHC's.

G.   No action has been taken to implement the array of services defined in the plan. This target date is 1992.

H.   By 1992, the proportion of service to the elderly shall reflect the demographic characteristics and social indicators of need in all areas of the state and in the consumption of institution services.
II.     Define and implement a system of collaborative and supportive relationships with providers and caregivers.

A.   Self-help groups for families who care for mentally ill or demented elderly. These groups would provide consultation, support and assistance for the caregivers. Several CHMC's have encouraged the development of such groups, and the target date was set for 1989, but no state level work has begun to establish self-help groups.

B.   By 1990, interagency agreements should be established on state and local levels to provide appropriate services for the elderly.

-An agreement has been signed with the Commission on Aging.
-An agreement has been started with the Department of Social Services.
-An agreement was developed with the Health and Human Services Finance Commission for the "alternative disposition plan" under OBRA, 1987 (Nursing Home Reform Act) and other provisions of the Act.
-No other agreements have been reached.

C.   No action has been taken to establish and provide an educational program for the families and caregivers the etiology of dementias, psychological effects and mental health implications of the aging process, stress management and other techniques. The target date is 1990.

D.   By 1991, the task force, in collaboration with other providers and self-help caregivers, will develop appropriate respite care options for families who care for mentally ill elderly.
III.   Develop a clinical work force knowledgeable about mental health and aging throughout the mental health service delivery system and make their knowledge and skills available to natural caregivers and other health and human service providers.

A.   In 1988, the task force defined the clinical knowledge skills and competencies for clinical staff at survey and basic advanced levels.

B.   Discussions are in progress with the Staff Development Office to design a staff development inservice training and continuing education strategy and curriculum.

C.   By 1992, training packages will be developed to provide geriatric education training to natural caregivers and other health and human service providers (the date was originally set for 1990).

D.   1993 is the target for implementation of a system to assure maintenance of staff skills in working with geriatric populations.

E.   1993 is the target for implementing a system of high quality curriculum development and training.
IV.     The environment of service delivery sites shall promote accessibility and be barrier free.

A.   By 1989, unique needs of the elderly were to have been established. This project requires cooperaton of DMH, DHEC, Aging, AARP and others. No work has been done on this goal.

B.   By 1990, environmental standards will be field tested, revised, compliance costs and options determined and target dates for compliance established.

C.   No report on a system for monitoring compliance with standards has been implemented.

Possible Conclusions and Recommendations:

Change the SC Mental Health Code to eliminate the provision that the Department is responsible to care for the elderly, and direct another state agency to administer the care. This would be a costly and time-consuming project.

Amend the Mental Health Code to enforce the Department's compliance with the code, and take care of the elderly who are mentally or physically ill, those who have Alzheimer's and those suffering from senility.

Direct the Department to speed-up the task force study and implement Community Mental Health Services that have proved to divert inappropriate admissions.

Make no changes presently, and await the results of the task force study (1993) and for the full effects of the federal and state policy changes, as well as internal DMH policy changes that have begun to decrease the number of inappropriate admissions.

Direct the Department to utilize their Medicaid capability at Tucker Center by transferring Medicaid eligible patients from Crafts-Farrow or other facilities, and open the 88 Medicaid beds that were closed, study the possibility of using Tucker as a teaching facility for nursing home care (thereby receiving educational and medical grants) and re-open the geriatric ward of Harris Hospital.

(On motion of Senator BRYAN, with unanimous consent, ordered printed in the Journal)

To The Honorable Carroll A. Campbell, Jr., Governor of South Carolina, and Members of the South Carolina General Assembly:

The Committee to Study All Aspects of Public Transportation in Both Rural and Urban Areas of the State was established in 1974 to more closely examine the transportation problems in the State and make recommendations for improvements. The South Carolina Legislature recognized that in order for the elderly and the underprivileged to take advantage of the opportunities available to them, adequate and easily accessible transportation is required.

The demand for public transportation is expected to increase. If riders are required to pay the increase, they may be discouraged from using the public transportation provided. A greater financial commitment is required at the federal, state and local levels if the existing systems are to continue to operate. The duplication and lack of coordination in the present transportation services result in inefficient use of available resources and diminish the potential of increasing the level of service without increasing the cost to provide the service.

The committee held two public hearings and one meeting. In 1989, the study committee approved the Statewide Five-Year Public Transportation Development Plan submitted by the Public Transportation Division of the South Carolina Department of Highways and Public Transportation. This plan summarizes an assessment of public transportation in South Carolina and includes an evaluation of the performance of existing transportation services, and recommendations for future services, policies and funding requirements. It represents the work of representatives of the State's transportation industry, business community, human service agencies, State, city, and county officials, the State Legislature, private citizens and the Department's professional staff.

The Committee to Study all Aspects of Public Transportation in Both Rural and Urban Areas of the State has benefited greatly from the expertise of certain dedicated individuals. Mr. Jerome Noble, Director of the Public Transportation Division of the South Carolina Department of Highways and Public Transportation, has been an invaluable asset. In addition, Ms. Karen Grant, Senior Planner for the Public Transportation Division of the South Carolina Department of Highways and Public Transportation, has been an enthusiastic and knowledgeable participant at meetings, always stressing the need for adequate public transportation in South Carolina.

Additional information may be obtained from the study committee's office:

Joint Meeting of the Public Transportation Study Committee and the Senate Transportation Committee

The committees met for the purpose of receiving the South Carolina Five-Year Public Transportation Development Plan as presented by the Public Transportation Division of the South Carolina Department of Highways and Public Transportation. Recommendations resulting from the study were the need for a reliable and dedicated sources of funding; public transportation performance standards; new Regional Transportation Authority development; mandated coordination; improving coordinating mechanisms; and the need for an elderly transportation needs study.

The South Carolina Five-Year Public Transportation Development Plan was adopted by both the Public Transportation Committee and the Senate Transportation Committee.

The committee conducted this first public hearing to review Charleston's public transportation needs and South Carolina's future public transportation plans. In particular, the committee wanted to look at the problems Charleston was encountering in their attempt to establish a Regional Transportation Authority.

Presentations were heard from City of Charleston officials, South Carolina Electric and Gas, the Charleston Trident Chamber of Commerce, and the South Carolina Department of Highways and Public Transportation.

As a result of the testimony heard, the committee recommended that legislation be drafted deleting the requirement for ratification of an agreement by the qualified electors within the proposed service area and prohibiting a service area from imposing a tax or changing the level of tax imposed unless a majority of the qualified electors within the area voting on the question approve.

The committee conducted this public hearing to review the public transportation needs of the Appalachian region. Presentations were heard from the Greenville Transit Authority; City of Greenville and Anderson officials; Duke Power; and the American Public Transit Association.

Members of the Greenville Transit Authority Board expressed their frustration with the lack of available funds for public transportation. The committee agreed that a dedicated funding source must be found. Subsequently, the committee recommended that legislation be drafted that would allow 25% of the interest earned on the State Highway Fund be allocated for public transportation purposes.

The committee recommended and supported several important pieces of legislation relating to the more effective and efficient operation of public transportation services in South Carolina.

The first bill (R308, S. 522) relating to Regional Transportation Authorities, provided that member governments, regardless of population, must have at least one member on the governing board of an authority. This bill addressed the fear that small member governments would lose their vote on RTA governing boards. This legislation ensured that all member governments would have at least one vote.

The second bill (S. 851) relating to the activation and dissolution of a regional transportation authority, would have deleted the requirement for ratification of an agreement by the qualified electors within the proposed service area and prohibited a service area from imposing a tax or changing the level of tax imposed unless a majority of the qualified electors within the area voting on the question approve. This bill did not become law and will be supported next year by the committee.

The third bill (S. 1058) relating to addition funding for public transportation, provided that 25% of the interest earned on the State Highway Fund be used for public transportation purposes. This bill did not become law and will be supported next year by the committee.

The rural poor, the minorities, and the elderly are the groups least able to pay for mass transit yet they have the greatest need for such services. The need for effective rural transportation must be recognized by all South Carolinians as one of the major obstructions to the full development of the State's human resources. South Carolina needs a comprehensive public transportation system which is dedicated to the delivery of efficient transportation and supportive of the human service programs.

Respectfully submitted,
Isadore E. Lourie, Chairman   Robert N. McLellan
Theo W. Mitchell   Jennings G. McAbee
Robert L. Helmly   Juanita M. White
For the Senate   For the House

Stuart Barnwell
F. Don Durham
Rev. Alex White
For the Governor

(On motion of Senator LOURIE, with unanimous consent, ordered printed in the Journal)

The following Joint Resolutions were read the third time and having received three readings in both Houses, it was ordered that the titles thereof be changed to that of Acts and same enrolled for Ratification:

H. 5011 -- Education and Public Works Committee: A JOINT RESOLUTION TO APPROVE REGULATIONS OF THE UNIVERSITY OF SOUTH CAROLINA, RELATING TO TRAFFIC, PARKING, AND REGISTRATION OF MOTOR VEHICLES, COLUMBIA CAMPUS, DESIGNATED AS REGULATION DOCUMENT NUMBER 1202, PURSUANT TO THE PROVISIONS OF ARTICLE 1, CHAPTER 23, TITLE 1 OF THE 1976 CODE.

(By prior motion of Senator SETZLER, with unanimous consent)

H. 5012 -- Education and Public Works Committee: A JOINT RESOLUTION TO APPROVE REGULATIONS OF THE UNIVERSITY OF SOUTH CAROLINA, RELATING TO INCREASE SPEED LIMIT AT THE UNIVERSITY OF SOUTH CAROLINA - SPARTANBURG CAMPUS, DESIGNATED AS REGULATION DOCUMENT NUMBER 1201, PURSUANT TO THE PROVISIONS OF ARTICLE 1, CHAPTER 23, TITLE 1 OF THE 1976 CODE.

(By prior motion of Senator SETZLER, with unanimous consent)

The following House Bills were read the third time, passed and ordered returned to the House with amendments:

H. 4038 -- Reps. Sharpe, Corbett, Hallman, Manly, Sturkie, Waites and Wilkes: A BILL TO AMEND CHAPTER 5, TITLE 49, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE GROUNDWATER USE ACT, SO AS TO REVISE AND PROVIDE FOR ADDITIONAL DEFINITIONS IN REGARD TO THIS ACT, TO FURTHER PROVIDE FOR FACTORS WHICH THE WATER RESOURCES COMMISSION SHALL CONSIDER IN DETERMINING AND DECLARING CAPACITY USE AREAS IN THE STATE, TO REVISE THE PROCEDURES REQUIRED TO BE FOLLOWED IN DECLARING A CAPACITY USE AREA, TO FURTHER PROVIDE FOR THE PROMULGATION OF THE REGULATIONS TO BE APPLIED IN A CAPACITY USE AREA, TO REVISE THE CONDITIONS UNDER WHICH, PROCEDURES UNDER WHICH, AND DURATION OF GROUNDWATER USE PERMITS WHICH MAY BE ISSUED IN THE CAPACITY USE AREA, TO AUTHORIZE THE COMMISSION TO COOPERATE WITH OTHER STATE AGENCIES AND AGENCIES OF THE FEDERAL GOVERNMENT IN THE ADMINISTRATION OF THE PROVISIONS OF THIS ACT, TO AUTHORIZE THE IMPOSITION BY THE COMMISSION OF CERTAIN CIVIL PENALTIES FOR THE VIOLATION OF THIS ACT, AND TO PROHIBIT CERTAIN FLOWING WELLS AND TO PROVIDE EXCEPTIONS.

(By prior motion of Senator WILLIAMS, with unanimous consent)

H. 4870 -- Rep. Moss: A BILL TO AMEND SECTION 20-7-954, AS AMENDED, CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO THE REQUIREMENT THAT GENETIC TESTS MUST BE CONDUCTED TO DETERMINE PATERNITY, SO AS TO DELETE LANGUAGE WHICH WOULD AUTHORIZE THE INDIVIDUAL INVOLVED IN THE TESTING NOT TO COOPERATE FOR GOOD CAUSE BECAUSE OF OTHER REASONS NOT ESTABLISHED IN THE SOCIAL SECURITY ACT.

(By prior motion of Senator STILWELL, with unanimous consent)

The following Bills having been read the second time were passed and ordered to a third reading:

S. 1632 -- Senators Lee, Russell and Horace C. Smith: A BILL TO DEVOLVE THE POWERS AND DUTIES OF THE SPARTANBURG COUNTY LEGISLATIVE DELEGATION RELATIVE TO THE VOLUNTEER FIRE DEPARTMENTS OF SPARTANBURG COUNTY ON THE SPARTANBURG COUNTY COUNCIL.

(By prior motion of Senator LEE)

H. 4987 -- Rep. Corning: A BILL TO AUTHORIZE A SHERIFF TO EMPLOY A DEPUTY AND PAY HIS COMPENSATION FROM FUNDS RECEIVED FROM A RESIDENTIAL HOMEOWNER'S ASSOCIATION, AND TO PROVIDE FOR THE PATROL DUTIES OF THE DEPUTY SHERIFF EMPLOYED AND COMPENSATED IN THIS MANNER.

(By prior motion of Senator GIESE, with unanimous consent)

On motion of Senator WADDELL the Senate agreed that when the Senate adjourns, it stand adjourned to meet Monday, June 4, 1990 at 2:00 P.M., which motion was adopted.

At 11:17 A.M., on motion of Senator SETZLER, the Senate adjourned to meet next Monday at 2:00 P.M.

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