The Health Care Authority provides medical care services to eligible low-income state residents and their families, primarily through the Medicaid program.  Coverage for medical services is primarily provided through managed care systems.  Managed care is a prepaid, comprehensive system for delivering a complete medical benefits package that is available for eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women.  Since January 1, 2020, all behavioral health services and medical care services have been fully integrated in a managed care health system for most Medicaid clients.
 
While most Medicaid clients receive behavioral health services through a managed care health system, behavioral health administrative services organizations administer certain behavioral health services that are not covered by the managed care health system within a specific regional service area.  There are 10 behavioral health administrative services organizations in Washington.  The services provided by a behavioral health administrative services organization include maintaining continuously available crisis response services, administering services related to the involuntary commitment of adults and minors, coordinating planning for persons transitioning from long-term commitments, maintaining an adequate network of evaluation and treatment services, and providing services to non-Medicaid clients in accordance with contract criteria.  In addition, each behavioral health administrative services organization must provide for an independent, separately funded behavioral health ombuds office that maximizes the use of consumer advocates.

Behavioral health ombuds offices that are supported by each behavioral health administrative services organization to serve a particular region are discontinued and replaced with the State Office of Behavioral Health Consumer Advocacy (SOBHCA).  By July 1, 2022, the Department of Commerce must establish the SOBHCA to provide policy direction to and to contract with a private nonprofit organization (contracting advocacy organization) to provide behavioral health consumer advocacy services, as directed by the SOBHCA.  The Department of Commerce must encourage persons with lived experience with behavioral health conditions or who are family members of a person with a behavioral health condition to apply to be the contracting advocacy organization.  The stated intent of the Legislature is that regional behavioral health ombuds programs be integrated into the statewide program, that regional ombuds be assessed and certified by the contracting advocacy organization as behavioral health consumer advocates, and that the SOBHCA provide regional ombuds programs with any additional training that certified behavioral health consumer advocates may need to carry out their responsibilities.  
 
The SOBHCA and the contracting advocacy organization are assigned several responsibilities in relation to patients, residents, and clients of behavioral health providers or facilities.  A "behavioral health provider or facility" is defined to include:

• behavioral health providers, to the extent that they provide behavioral health services, such as physicians, osteopathic physicians, physician assistants, osteopathic physician assistants, advanced registered nurse practitioners, registered nurses, psychologists, substance use disorder professionals, mental health counselors, social workers, and marriage and family therapists;
• licensed or certified behavioral health agencies;
• certain long-term care facilities in which adults or children with behavioral health conditions reside;
• state hospitals; and
• facilities or agencies that receive funds from the state to provide residential or treatment services to adults or children with a behavioral health condition.

 
The SOBHCA must adopt rules to establish standards for the contracting advocacy organization to use when certifying behavioral health consumer advocates, establish procedures for appropriate access by behavioral health consumer advocates to behavioral health providers or facilities, and establish procedures related to the confidentiality of records.  Prior to beginning operations, the Department of Commerce must accept recommendations from the behavioral health community for options for renaming the SOBHCA and the certified behavioral health consumer advocates in a way that shows respect for the community, and the names must be changed accordingly. 
 
The SOBHCA must work with the Department of Social and Health Services on issues specific to state hospitals.  The issues relate to specialized training for behavioral health consumer advocates working with forensic and criminal justice involved populations at the state hospitals, access for behavioral health consumer advocates to state hospital patients and their families or guardians, collaboration between the SOBHCA and state employees who serve in an ombuds or advocate role at state hospitals, and structures for reporting to the Governor's Office about systemic issues discovered in state hospitals.  The work must be completed by July 1, 2023, and before any behavioral health consumer advocates are dispatched to a state hospital.  The SOBHCA must make efforts to encourage individuals with lived experience related to state hospitals to become trained as behavioral health consumer advocates at state hospitals.
 
The contracting advocacy organization must:

• certify and coordinate the activities of behavioral health consumer advocates throughout the state, according to standards established by the SOBHCA;
• provide training regarding access by behavioral health consumer advocates to behavioral health providers or facilities, according to standards established by the SOBHCA;
• establish a toll-free phone number, website, and other technology to facilitate access to the contracting advocacy organization's services for patients, residents, and clients of behavioral health providers or facilities;
• establish a uniform reporting system to perform functions related to complaints, conditions, and service quality provided by behavioral health providers or facilities;
• establish procedures to protect the confidentiality of the records of patients, residents, clients, providers, and complainants;
• monitor the development and implementation of laws and policies related to the provision of behavioral health services and advocate for consumers;
• develop and deliver educational programs and information to patients, residents, and clients of behavioral health providers or facilities and their family on topics such as mental health advance directives, wellness recovery action plans, crisis services and contacts, family advocacy, and involuntary treatment; and
• report to the Legislature and public agencies regarding the quality of services, complaints, problems for individuals receiving services from behavioral health providers or facilities, and any recommendations for improving services for behavioral health consumers.

 
In addition, the contracting advocacy organization must establish a statewide advisory council.  The council's members must include individuals with a history of mental illness, individuals with a history of substance use disorder, family members of individuals with behavioral health needs, representatives of an organization representing consumers of behavioral health services, representatives of behavioral health providers or facilities, peer specialists, medical clinicians and nonmedical providers serving individuals with behavioral health needs, a representative of a behavioral health administrative services organization, a representative from a labor union representing workers who work in settings serving individuals with behavioral health conditions, and other community representatives.  A majority of the council's members must be people with lived experience.  The council must select a name for the contracting advocacy organization to use for the advocacy program. 
 
The contracting advocacy organization, with the approval of the SOBHCA, must develop a process to train and certify all behavioral health consumer advocates.  Certified behavioral health consumer advocates must have training or experience in behavioral health and related social services programs; the legal system; advocacy and supporting self-advocacy; dispute or problem resolution techniques; and patient, resident, and client rights.  Safeguards are established to avoid situations in which a certified behavioral health consumer advocate may have a conflict of interest between their duties and their employment or financial holdings.
 
Certified behavioral health consumer advocates are responsible for:

• identifying, investigating, and resolving complaints made by, or on behalf of, patients, residents, and clients of behavioral health providers or facilities involving administrative action, inaction, or decisions that may adversely affect the health, safety, welfare, and rights of these individuals;
• assisting and advocating on behalf of patients, residents, and clients of behavioral health providers or facilities before government agencies and seeking administrative and legal remedies on their behalf;
• informing patients, residents clients, family members, guardians, resident representatives, and others of the rights of patients and residents;
• making recommendations through the SOBHCA and the contracting advocacy organization for improving the quality of services provided to patients, residents, and clients of behavioral health providers or facilities; and
• involving family members, friends, and other designated individuals in the complaint resolution process.

 
There must be a behavioral health consumer advocate office within the boundaries of the region served by each behavioral health administrative services organization.  Medicaid managed care organizations must contract with the contracting advocacy organization for the provision of behavioral health consumer advocacy services and must reimburse the SOBHCA for behavioral health consumer advocacy services provided to their enrollees. 
 
The contracting advocacy organization must develop procedures, approved by the SOBHCA, for certified behavioral health consumer advocates to refer complaints to appropriate state or local agencies, in accordance with a mutually established working agreement.  The contracting advocacy organization must develop working agreements to coordinate services with the protection and advocacy agency, the Long-Term Care Ombuds, the Developmental Disabilities Ombuds, the Corrections Ombuds, and the Children and Family Ombuds.  The contracting advocacy organization must also develop working agreements with each managed care organization, each behavioral health administrative services organization, each state psychiatric hospital, and all relevant state and local agencies.  Working agreements must set the roles of the contracting advocacy organization and the agencies, as well as the processes and procedures to assure timely and seamless information sharing. 
 
Behavioral health providers or facilities must post a notice providing the contracting advocacy organization's toll-free phone number and website.  The notice must also include the name, address, and phone number of the appropriate local behavioral health consumer advocate and a brief description of the available services.  The information must also be provided to the patient, residents, and clients of behavioral health providers or facilities, as well as their family members and legal guardians, if appropriate, upon admission to a behavioral health facility.  Every behavioral health provider or facility must provide access to a free telephone for the purpose of contacting the contracting advocacy organization.  Behavioral health providers or facilities must allow appropriate access to certified behavioral health consumer advocates.

Employees, volunteers, patients, residents, and clients of behavioral health providers or facilities are protected from discriminatory, disciplinary, or retaliatory action for good-faith communications made to a certified behavioral health consumer advocate, and the communications are deemed privileged and confidential.  Certified behavioral health consumer advocates are not liable for the good-faith performance of their responsibilities.  Records and files of the SOBHCA, the contracting advocacy organization, and certified behavioral health consumer advocates related to complaints and investigations and the identities of complainants, witnesses, patients, residents, and clients are confidential, except as provided by court order.  Representatives of the contracting advocacy organization are exempt from testifying in court on confidential matters, unless the client, resident, or patient is the subject of the court proceeding.