ENGROSSED SENATE BILL 6318
State of Washington 52nd Legislature 1992 Regular Session
By Senators Niemi, West and Bailey
Read first time 01/24/92. Referred to Committee on Health & Long‑Term Care.
AN ACT Relating to refining the provisions for mental health reform; reenacting and amending RCW 71.24.035, 71.24.045, and 71.24.300; creating a new section; repealing RCW 72.06.010, 72.06.050, 72.06.060, and 72.06.070; and providing an effective date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1. It is the intent of this act to:
(1) Focus, restate, and emphasize the legislature's commitment to the mental health reform embodied in chapter 111, Laws of 1989 (SB 5400);
(2) Eliminate, or schedule for repeal, statutes that are no longer relevant to the regulation of the state's mental health program; and
(3) Reaffirm the state's commitment to provide incentives that reduce reliance on inappropriate state hospital or other inpatient care.
Sec. 2. RCW 71.24.035 and 1991 c 306 s 3, 1991 c 262 s 1, and 1991 c 29 s 1 are each reenacted and amended to read as follows:
(1) The department is designated as the state mental health authority.
(2) The secretary may provide for public, client, and licensed service provider participation in developing the state mental health program.
(3) The secretary shall provide for participation in developing the state mental health program for children and other underserved populations, by including representatives on any committee established to provide oversight to the state mental health program.
(4) The secretary shall be designated as the county authority if a county fails to meet state minimum standards or refuses to exercise responsibilities under RCW 71.24.045.
(5) The secretary shall:
a biennial state mental health program that incorporates county biennial needs
assessments and county mental health service plans and state services for
mentally ill adults and children. The secretary may also develop a six‑year
state mental health plan; (b))) Assure
that any county community mental health program provides access to treatment
for the county's residents in the following order of priority: (i) The acutely
mentally ill; (ii) chronically mentally ill adults and severely emotionally
disturbed children; and (iii) the seriously disturbed. Such programs shall
(A) Outpatient services;
(B) Emergency care services for twenty‑four hours per day;
(C) Day treatment for mentally ill persons which includes training in basic living and social skills, supported work, vocational rehabilitation, and day activities. Such services may include therapeutic treatment. In the case of a child, day treatment includes age‑appropriate basic living and social skills, educational and prevocational services, day activities, and therapeutic treatment;
(D) Screening for patients being considered for admission to state mental health facilities to determine the appropriateness of admission;
(E) Employment services, which may include supported employment, transitional work, placement in competitive employment, and other work‑related services, that result in mentally ill persons becoming engaged in meaningful and gainful full or part‑time work. Other sources of funding such as the division of vocational rehabilitation may be utilized by the secretary to maximize federal funding and provide for integration of services;
(F) Consultation and education services; and
(G) Community support services;
(b) Develop and promulgate rules establishing state minimum standards
for the delivery of mental health services including, but not limited to:
(i) Licensed service providers;
(ii) Regional support networks; and
(iii) Residential and inpatient services, evaluation and treatment services and facilities under chapter 71.05 RCW, resource management services, and community support services;
(c) Assure that the special needs of minorities, the elderly, disabled,
children, and low‑income persons are met within the priorities
established in this section;
(d) Establish a standard contract or contracts, consistent with state
minimum standards, which shall be used by the counties;
(e) Establish, to the extent possible, a standardized auditing procedure
which minimizes paperwork requirements of county authorities and licensed
(f) Develop and maintain an information system to be used by the state,
counties, and regional support networks when they are established which shall
include a tracking method which allows the department and regional support
networks to identify mental health clients' participation in any mental health
service or public program on an immediate basis. The information system shall
not include individual patient's case history files. Confidentiality of client
information and records shall be maintained as provided in this chapter and in
RCW 71.05.390, 71.05.400, 71.05.410, 71.05.420, 71.05.430, and 71.05.440. The state-operated
system shall be fully operational no later than January 1, 1993(( :
PROVIDED, HOWEVER, That when a regional support network is established, the
department shall have an operational interim tracking system for that network
that will be adequate for the regional support network to perform its required
duties under this chapter)) and a regional support network system shall
be fully operational by June 30, 1993;
(g) License service providers who meet state minimum standards;
(h) Certify regional support networks that meet state minimum standards;
(i) Periodically inspect certified regional support networks and
licensed service providers at reasonable times and in a reasonable manner; and
(j) Fix fees to be paid by evaluation and treatment centers to the
secretary for the required inspections;
(k) Monitor and audit counties, regional support networks, and licensed
service providers as needed to assure compliance with contractual agreements
authorized by this chapter;
Prior to September 1, 1989,)) (l) Adopt such rules as are necessary
to implement the department's responsibilities under this chapter pursuant to
chapter 34.05 RCW(( : PROVIDED, That such rules shall be submitted to the
appropriate committees of the legislature for review and comment prior to
adoption; and (n)
Beginning July 1, 1989, and continuing through July 1, 1993,));
(m) Track by region and county diagnosis, and to the extent information is available, eligibility for state funded nonmental health services, the use and cost of state hospital and local evaluation and treatment facilities for seventy‑two hour detention, fourteen, ninety, and one hundred eighty day commitments pursuant to chapter 71.05 RCW, voluntary care in state hospitals, and voluntary community inpatient care covered by the medical assistance program. Service use and cost reports shall be provided to regions and appropriate operating divisions of the department in a timely fashion at six‑month intervals; and
(n) Administer a fund that may be appropriated by the legislature from state hospital and regional support network funds to enhance contracts with regional support networks that agree to provide periods of stable community living according to RCW 71.24.300(5).
The secretary shall use available resources appropriated specifically for
community mental health programs only for ((
programs under RCW 71.24.045.
After July 1, 1995, or when regional support networks are established,
available resources may be used only for)) regional support networks.
(7) Each certified regional support network and licensed service provider shall file with the secretary, on request, such data, statistics, schedules, and information as the secretary reasonably requires. A certified regional support network or licensed service provider which, without good cause, fails to furnish any data, statistics, schedules, or information as requested, or files fraudulent reports thereof, may have its certification or license revoked or suspended.
(8) The secretary may suspend, revoke, limit, or restrict a certification or license, or refuse to grant a certification or license for failure to conform to the law, applicable rules and regulations, or applicable standards, or failure to meet the minimum standards established pursuant to this section.
(9) The superior court may restrain any regional support network or service provider from operating without certification or a license or any other violation of this section. The court may also review, pursuant to procedures contained in chapter 34.05 RCW, any denial, suspension, limitation, restriction, or revocation of certification or license, and grant other relief required to enforce the provisions of this chapter.
(10) Upon petition by the secretary, and after hearing held upon reasonable notice to the facility, the superior court may issue a warrant to an officer or employee of the secretary authorizing him or her to enter at reasonable times, and examine the records, books, and accounts of any regional support network or service provider refusing to consent to inspection or examination by the authority.
(11) The secretary shall adopt such rules as may be necessary to effectuate the intent and purposes of this chapter, which shall include but not be limited to certification and licensing and other action relevant to certifying regional support networks and licensing service providers.
(12) Notwithstanding the existence or pursuit of any other remedy, the secretary may, in the manner provided by law, upon the advice of the attorney general who shall represent the secretary in the proceedings, maintain an action in the name of the state for an injunction or other process against any person or governmental unit to restrain or prevent the establishment, conduct, or operation of a regional support network or service provider without certification or a license under this chapter.
(13) The standards for certification of evaluation and treatment facilities shall include standards relating to maintenance of good physical and mental health and other services to be afforded persons pursuant to this chapter and chapter 71.05 RCW, and shall otherwise assure the effectuation of the purposes and intent of this chapter and chapter 71.05 RCW.
The department, in consultation with affected parties, shall establish a
distribution formula that reflects county needs assessments based on the number
of persons who are acutely mentally ill, chronically mentally ill, severely
emotionally disturbed, and seriously disturbed as defined in chapter 71.24
RCW. The formula shall take into consideration the impact on counties of
demographic factors in counties which result in concentrations of priority
populations as defined in subsection (15) of this section. These factors shall
include the population concentrations resulting from commitments under the
involuntary treatment act, chapter 71.05 RCW, to state psychiatric hospitals,
as well as concentration in urban areas, at border crossings at state
boundaries, and other significant demographic and workload factors. Beginning
with the contracting period July 1, 1993, the funding formula for participating
regional support networks may include a factor related to use of state
The department shall submit a proposed distribution formula in accordance with
this section to the ways and means and health and long‑term care
committees of the senate and to the ways and means and human services
committees of the house of representatives by October 1, 1991. The formula
shall also include a projection of the funding allocations that will result for
each county, which specifies allocations according to priority populations,
including the allocation for services to children and other underserved
supersede duties assigned under subsection (5) (a) and (b) of this
section, and to)) assure a county‑based, integrated system of care
for acutely mentally ill adults and children, chronically mentally ill adults,
severely emotionally disturbed children, and seriously disturbed adults and
children who are determined by regional support networks at their sole
discretion to be at risk of becoming acutely or chronically mentally ill, or
severely emotionally disturbed, the secretary shall encourage the development
of regional support networks as follows:
December 1, 1989,)) The secretary shall recognize regional support
networks requested by counties or groups of counties.
counties wishing to be recognized as a regional support network on December 1,
1989, shall submit their intentions regarding participation in the regional
support networks by October 30, 1989, along with preliminary plans.))
Counties wishing to be recognized as a regional support network by January 1 of
any year (( thereafter)) shall submit their intentions by October 30 of
the previous year along with preliminary plans. The secretary shall assume all
duties assigned to the nonparticipating counties under chapters 71.05 and 71.24
RCW on July 1, 1995, or sooner if requested by the county. Such
responsibilities shall include those which would have been assigned to the
nonparticipating counties under regional support networks.
The implementation of regional support networks, or the secretary's assumption of all responsibilities under chapters 71.05 and 71.24 RCW, shall be included in all state and federal plans, contracts, or agreements affecting the state mental health program including at least those required by this chapter, the medicaid program, and P.L. 99‑660. Nothing in these plans, contracts, or agreements shall be inconsistent with the intent and requirements of this chapter.
By January 1, 1992,)) The secretary shall provide available
resources to regional support networks to operate freestanding evaluation and
treatment facilities or for regional support networks to contract with local
hospitals to assure access for regional support network patients. Any
savings achieved through reduction in the use of state or local hospital bed
days, or free standing evaluation and treatment facility bed days, shall be
retained by the regional support network, and may not be diverted to other
state programs or purposes.
(17) The secretary shall:
Disburse the first funds for the regional support networks ((
that are ready
to begin implementation by January 1, 1990, or)) within sixty days of
approval of the biennial contract. The department must either approve or
reject the biennial contract within sixty days of receipt.
Enter into biennial contracts with regional support networks to ((
implementation between January 1, 1990, and March 1, 1990, and)) complete
implementation by June 1995. The contracts shall be consistent with available
resources. No contract shall be approved that does not include progress toward
meeting the goals of this chapter by taking responsibility for: (i) Short‑term
commitments; (ii) residential care; ((and)) (iii) (( emergency)) crisis
response systems; and (iv) the return to the community of long-term state
hospital patients who no longer need state hospital level care.
(c) By July 1, 1993, allocate one hundred percent of available resources to regional support networks created by January 1, 1990, in a single grant. Regional support networks created by January 1, 1991, shall receive a single block grant by July 1, 1993; regional support networks created by January 1, 1992, shall receive a single block grant by July 1, 1994; and regional support networks created by January 1, 1993, shall receive a single block grant by July 1, 1995. The grants shall include funds currently provided for all residential services, all services pursuant to chapter 71.05 RCW, and all community support services and shall be distributed in accordance with a formula submitted to the legislature by January 1, 1993, in accordance with subsection (14) of this section.
January 1, 1990, allocate available resources to regional support networks for
community support services, resource management services, and residential
services excluding evaluation and treatment facilities provided pursuant to
chapter 71.05 RCW in a single grant using the distribution formula established
in subsection (14) of this section. (e)
By March 1, 1990, or)) By August 1, 1992, report
to the senate committees on health and long-term care and ways and means and
the house committees on human services and appropriations options and
recommendations for using allowable medicaid payment systems and other methods
to support regionally managed mental health care.
(e) Within sixty days of approval of the contract continuing through July 1, 1993, provide grants as specifically appropriated by the legislature to regional support networks for evaluation and treatment facilities for persons detained or committed for periods up to seventeen days according to chapter 71.05 RCW. For regional support networks created by January 1, 1993, provide grants as specifically appropriated by the legislature to regional support networks for evaluation and treatment facilities for persons detained or committed for periods up to seventeen days according to chapter 71.05 RCW through July 1, 1995.
(f) Notify regional support networks of their allocation of available resources at least sixty days prior to the start of a new biennial contract period.
(g) Deny funding allocations to regional support networks based solely upon formal findings of noncompliance with the terms of the regional support network's contract with the department. Written notice and at least thirty days for corrective action must precede any such action. In such cases, regional support networks shall have full rights to appeal under chapter 34.05 RCW.
(h) Identify in its departmental biennial operating and capital budget requests the funds requested by regional support networks to implement their responsibilities under this chapter.
(i) Contract to provide or, if requested, make grants to counties to provide technical assistance to county authorities or groups of county authorities to develop regional support networks.
The department of social and health services, in cooperation with the state
congressional delegation, shall actively seek waivers of federal requirements
and such modifications of federal regulations as are necessary to allow (a)
federal medicaid reimbursement for services provided by free‑standing
evaluation and treatment facilities certified under chapter 71.05 RCW and
(b) regional support networks to retain savings that accrue from their ability
to avoid the use of medicaid or state general fund reimbursed local hospital or
state hospital bed days. The department shall ((
its efforts to the health and long-term care (( and corrections))
committee of the senate and the human services committee of the house of
representatives by January 1993.
The secretary shall establish a task force to examine the recruitment,
training, and compensation of qualified mental health professionals in the
community, which shall include the advantages and disadvantages of establishing
a training academy, loan forgiveness program, or educational stipends offered
in exchange for commitments of employment in mental health. The task force
shall report back to the appropriate committees of the legislature by January
1, 1990)) The department shall cooperate with other departments of state
government and its political subdivisions in the following manner:
(a) By disseminating educational information relating to the prevention, diagnosis, early intervention, and treatment of mental illness.
(b) Upon request therefor, by advising public officers, organizations and agencies interested in the mental health of the people of the state.
(20) The department and the several state hospitals for the mentally ill shall cooperate with local mental health programs by providing necessary information, recommendations relating to proper after care for patients paroled or discharged from such institutions and shall also supply the services of psychiatrists, psychologists and other persons specialized in mental illness as they are available.
Sec. 3. RCW 71.24.045 and 1991 c 363 s 147 and 1991 c 306 s 5 are each reenacted and amended to read as follows:
The county authority shall:
biennial needs assessments beginning January 1, 1983, and mental health service
plans which incorporate all services provided for by the county authority
consistent with state minimum standards and which provide access to treatment
for the county's residents including children and other underserved populations
who are acutely mentally ill, chronically mentally ill, severely emotionally
disturbed, or seriously disturbed. The county program shall provide: (a)
Outpatient services; (b)
Emergency care services for twenty‑four hours per day; (c)
Day treatment for mentally ill persons which includes training in basic living
and social skills, supported work, vocational rehabilitation, and day
activities. Such services may include therapeutic treatment. In the case of a
child, day treatment includes age‑appropriate basic living and social
skills, educational and prevocational services, day activities, and therapeutic
Screening for patients being considered for admission to state mental health
facilities to determine appropriateness of admission; (e)
Employment services, which may include supported employment, transitional work,
placement in competitive employment, and other work‑related services,
that result in mentally ill persons becoming engaged in meaningful and gainful
full or part‑time work; (f)
Consultation and education services; (g)
Residential and inpatient services, if the county chooses to provide such
optional services; and (h)
Community support services. The
county shall develop the biennial needs assessment based on clients to be
served, services to be provided, and the cost of those services, and may
include input from the public, clients, and licensed service providers. Each
county authority may appoint a county mental health advisory board which shall
review and provide comments on plans and policies developed by the county
authority under this chapter. The composition of the board shall be broadly
representative of the demographic character of the county and the mentally ill
persons served therein. Length of terms of board members shall be determined
by the county authority; (2))) Contract
as needed with licensed service providers. The county authority may, in the
absence of a licensed service provider entity, become a licensed service
provider entity pursuant to minimum standards required for licensing by the
department for the purpose of providing services not available from licensed
(2) Operate as a licensed service provider if it deems that doing so is
more efficient and cost effective than contracting for services. When doing
so, the county authority shall comply with rules promulgated by the secretary
that shall provide measurements to determine when a county provided service is
more efficient and cost effective;
(3) Monitor and perform biennial fiscal audits of licensed service
providers who have contracted with the county to provide services required by
this chapter. The monitoring and audits shall be performed by means of a
formal process which insures that the licensed service providers and
professionals designated in this subsection meet the terms of their contracts,
including the minimum standards of service delivery as established by the
(4) Assure that the special needs of minorities, the elderly, disabled,
children, and low‑income persons are met within the priorities
established in this chapter;
(5) Maintain patient tracking information in a central location as
required for resource management services;
(6) Use not more than two percent of state‑appropriated community
mental health funds, which shall not include federal funds, to administer
community mental health programs under RCW 71.24.155: PROVIDED, That county
authorities serving a county or combination of counties whose population is one
hundred twenty‑five thousand or more may be entitled to sufficient state‑appropriated
community mental health funds to employ up to one full‑time employee or
the equivalent thereof in addition to the two percent limit established in this
subsection when such employee is providing staff services to a county mental
health advisory board;
(7) Coordinate services for individuals who have received services
through the community mental health system and who become patients at a state
Sec. 4. RCW 71.24.300 and 1991 c 295 s 3, 1991 c 262 s 2, and 1991 c 29 s 3 are each reenacted and amended to read as follows:
A county authority or a group of county authorities whose combined population is no less than forty thousand may enter into a joint operating agreement to form a regional support network. The roles and responsibilities of county authorities shall be determined by the terms of that agreement and the provisions of law. The state mental health authority may not determine the roles and responsibilities of county authorities as to each other under regional support networks by rule, except to assure that all duties required of regional support networks are assigned and that a single authority has final responsibility for all available resources and performance under the regional support network's contract with the secretary.
(1) Regional support networks shall within three months of recognition submit an overall six‑year operating and capital plan, timeline, and budget and submit progress reports and an updated two‑year plan biennially thereafter, to assume within available resources all of the following duties by July 1, 1995, instead of those presently assigned to counties under RCW 71.24.045(1):
(a) Administer and provide for the availability of all resource management services, residential services, and community support services.
(b) Administer and provide for the availability of all investigation, transportation, court‑related, and other services provided by the state or counties pursuant to chapter 71.05 RCW.
(c) By July 1, 1993, provide within the boundaries of each regional support network evaluation and treatment services for at least eighty‑five percent of persons detained or committed for periods up to seventeen days according to chapter 71.05 RCW. Regional support networks with populations of less than one hundred fifty thousand may contract to purchase evaluation and treatment services from other networks. For regional support networks that are created after June 30, 1991, the requirements of (c) of this subsection must be met by July 1, 1995.
(d) By July 1, 1993, administer a portion of funds appropriated by the legislature to house mentally ill persons in state institutions from counties within the boundaries of any regional support network, with the exception of mentally ill offenders, and provide for the care of all persons needing evaluation and treatment services for periods up to seventeen days according to chapter 71.05 RCW in appropriate residential services, which may include state institutions. The regional support networks shall reimburse the state for use of state institutions at a rate equal to that assumed by the legislature when appropriating funds for such care at state institutions during the biennium when reimbursement occurs. The duty of a state hospital to accept persons for evaluation and treatment under chapter 71.05 RCW is limited by the responsibilities assigned to regional support networks under this section. For regional support networks that are created after June 30, 1991, the requirements of (d) of this subsection must be met by July 1, 1995.
(e) Administer and provide for the availability of all other mental health services, which shall include patient counseling, day treatment, consultation, education services, employment services as defined in RCW 71.24.035, and mental health services to children as provided in this chapter.
(f) Establish standards and procedures for reviewing individual service plans and determining when that person may be discharged from resource management services.
(2) Regional support networks shall assume all duties assigned to county authorities by this chapter and chapter 71.05 RCW.
(3) A regional support network may request that any state‑owned land, building, facility, or other capital asset which was ever purchased, deeded, given, or placed in trust for the care of the mentally ill and which is within the boundaries of a regional support network be made available to support the operations of the regional support network. State agencies managing such capital assets shall give first priority to requests for their use pursuant to this chapter.
(4) Each regional support network shall appoint a mental health advisory board which shall review and provide comments on plans and policies developed under this chapter. The composition of the board shall be broadly representative of the demographic character of the region and the mentally ill persons served therein. Length of terms of board members shall be determined by the regional support network.
(5) Regional support networks shall assume all duties specified in their plans and joint operating agreements through biennial contractual agreements with the secretary. Such contracts may include agreements to provide periods of stable community living and work or other day activities for specific chronically mentally ill persons who have completed commitments at state hospitals on ninety‑day or one hundred eighty‑day civil commitments or who have been residents at state hospitals for no less than one hundred eighty days within the previous year. Periods of stable community living may involve acute care in local evaluation and treatment facilities but may not involve use of state hospitals.
Counties or groups of counties participating in a regional support network are
not subject to RCW 71.24.045(7). The office of financial management shall
consider information gathered in studies required in this chapter and
information about the experience of other states to propose a mental health
services administrative cost lid to the ((
1991)) 1993 legislature
which shall include administrative costs of licensed service providers, the
state psychiatric hospitals and the department.
first regional support network contract may include a pilot project to:
Establish standards and procedures for (a) making referrals for comprehensive
medical examinations and treatment programs for those whose mental illness is
caused or exacerbated by organic disease, and (b) training staff in recognizing
the relationship between mental illness and organic disease. (8))) By
November 1, 1991, and as part of each biennial plan thereafter, each regional
support network shall establish and submit to the state, procedures and
agreements to assure access to sufficient additional local evaluation and
treatment facilities to meet the requirements of this chapter while reducing
short‑term admissions to state hospitals. These shall be commitments to
construct and operate, or contract for the operation of, freestanding
evaluation and treatment facilities or agreements with local evaluation and
treatment facilities which shall include (a) required admission and treatment
for short‑term inpatient care for any person enrolled in community
support or residential services, (b) discharge planning procedures, (c)
limitations on admissions or transfers to state hospitals, (d) adequate
psychiatric supervision, (e) prospective payment methods, and (f) contractual
assurances regarding referrals to local evaluation and treatment facilities
from regional support networks.
(8) Regional support networks may receive technical assistance from the
housing trust fund and may identify and submit projects for housing and housing
support services to the housing trust fund established under chapter 43.185
RCW. Projects identified or submitted under this subsection must be fully
integrated with the regional support network six‑year operating and
capital plan, timeline, and budget required by subsection (1) of this section.
NEW SECTION. Sec. 5. The following acts or parts of acts are each repealed:
(1) RCW 72.06.010 and 1970 ex.s. c 18 s 59 & 1959 c 28 s 72.06.010;
(2) RCW 72.06.050 and 1977 ex.s. c 80 s 46 & 1959 c 28 s 72.06.050;
(3) RCW 72.06.060 and 1979 c 141 s 185, 1977 ex.s. c 80 s 47, & 1959 c 28 s 72.06.060; and
(4) RCW 72.06.070 and 1959 c 28 s 72.06.070.