AN ACT Relating to regional mental health residential care systems; amending RCW 71.24.025 and 71.24.045; adding a new section to chapter 71.24 RCW; and making an appropriation.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. A new section is added to chapter 71.24 RCW to read as follows:

(1) A county authority may make application to the secretary to establish a regional mental health residential care system designed to stabilize and maintain acutely and chronically mentally ill persons within the community.

(2) A regional mental health residential care system must cover a geographic area of at least forty thousand persons.

(3) For the period from January 1, 1986, to June 30, 1987, this chapter shall be implemented on a pilot project basis and in no more than three counties with at least one being a class AA county and at least one being a class A county located east of the crest of the Cascade mountain range.

County authorities choosing to participate in the pilot project shall submit to the department by October 1, 1985, an application and a plan for the initial phase of a regional mental health residential care system. The plan shall include:

(a) Administration of all current residential services as defined in RCW 71.24.025;

(b) Development and administration of new residential services specifically designed to reduce the incidence of emergency and acute care including involuntary detentions;

(d) Implementation of a management information system which includes client, service utilization, and budgetary information for all mental health services funded by state appropriation within its geographic region and which provides the means to meet the requirements of RCW 71.24.045(6). State funds used to cover the cost of the management information system shall not be limited by the provisions of RCW 71.24.045(7).

(4) Any county authority that has participated in the pilot project and chooses to continue administering a regional mental health residential care system for the 1987-89 and 1989-91 biennia shall submit, with their biennial plans required by RCW 71.24.045(1), a plan for implementation of the regional mental health residential care system, including administration of all residential care services as defined by RCW 71.24.025 and evaluation and treatment facilities as defined by RCW 71.05.020.

(5) Any county authority that has not participated in the 1986-87 pilot project and chooses to develop regional mental health residential care systems shall submit, with its 1987-89 and 1989-91 biennial plans required by RCW 71.24.045, an application that includes a plan for a regional mental health residential care system as outlined in subsection (3)(a) through (d) of this section to be implemented during that biennium. The county authority shall submit a plan for full implementation of a regional mental health residential care system in the 1991-93 biennium if the county chooses to continue administering the regional mental health residential care system. As a condition of implementation, the county authority shall agree to fully assume the authority for administering a regional mental health residential care system that includes all mental health services funded by state appropriation within its geographic region including residential services as defined by RCW 71.24.025 and evaluation and treatment facilities defined by RCW 71.05.020, except for one hundred eighty day commitments pursuant to RCW 71.05.310 which may be transferred for treatment to state hospitals. Subsequent plans for the regional mental health residential care system shall be submitted biennially.

(6) The department shall develop by July 1, 1987, rules and information for administration of regional mental health residential care systems in consultation with pilot project staff and county staff and based on the experience of the pilot project. This information shall be shared with counties and shall include a complete estimate of funds currently spent by the department of social and health services for any and all services within the scope of this section including, but not limited to, evaluation and treatment facilities, state hospitals, data systems, and management support and supervision.

(7) The department's 1987-89 and 1989-91 biennial budget requests for full implementation of this section in the pilot project counties shall reflect the biennial plans submitted in the counties' applications made pursuant to subsection (4) of this section. The secretary may submit a supplementary funding recommendation if the secretary chooses.

(8) In geographic areas in which the county authority does not choose to assume the role of the regional mental health residential care authority under this section, the department shall assume such authority beginning July 1, 1991. In such cases, the department shall comply with all planning requirements established by this chapter.

Sec. 2. Section 3, chapter 204, Laws of 1982 and RCW 71.24.025 are each amended to read as follows:

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Acutely mentally ill" means a condition which is limited to a short-term severe crisis episode of: (a) A mental disorder as defined in RCW 71.05.020(2); (b) being gravely disabled as defined in RCW 71.05.020(1); or (c) presenting a likelihood of serious harm as defined in RCW 71.05.020(3).

(2) "Available resources" means those funds which shall be appropriated under this chapter by the legislature during any biennium for the purpose of providing community mental health programs under RCW 71.24.045.

(3) "Licensed service provider" means an entity licensed by the department according to state minimum standards or individuals licensed under chapter 18.71, 18.83, or 18.88 RCW.

(4) "Chronically mentally ill person" means a person who has a mental disorder and meets at least one of the following criteria:

(a) Has undergone two or more episodes of hospital care for a mental disorder within the preceding two years;

(b) Has experienced a continuous psychiatric hospitalization or residential treatment exceeding six months' duration within the preceding year; or

(c) Has been unable to engage in any substantial gainful activity by reason of any mental disorder which has lasted for a continuous period of not less than twelve months. "Substantial gainful activity" shall be defined by the department by rule consistent with Public Law 92-603, as amended.

(5) "Community mental health program" means all mental health services established by a county authority.

(6) "County authority" means the board of county commissioners, county council, or county executive having authority to establish a community mental health program, or two or more of the county authorities specified in this subsection which have entered into an agreement to provide a community mental health program.

(7) "Department" means the department of social and health services.

(8) "Mental health services" means community services pursuant to RCW 71.24.035(4)(b) and other services provided by the state for the mentally ill.

(9) "Mentally ill persons" and "the mentally ill" mean persons and conditions defined in subsections (1), (4), and (11) of this section.

(10) "Residential services" means a ((~~facility or distinct part thereof which provides food, clothing, and shelter, and may include day treatment services as defined in RCW 71.24.045~~)) a program that provides or assures room and board and a range of services based on the level of functioning, including daily living supervision and support and training, for acutely mentally ill, chronically mentally ill, or seriously disturbed persons as defined in this section. ((~~Such facilities~~)) The programs include, but are not limited to, congregate care facilities ((~~providing mental health client services as stipulated by contract with the department beginning January 1, 1982~~)), adult residential care facilities, community support programs, adult foster care, and semi-independent living programs. These programs shall constitute a continuum of care designed to maximize an individual's level of independence.

(11) "Seriously disturbed person" means a person who:

(a) Is gravely disabled or presents a likelihood of serious harm to himself or others as a result of a mental disorder as defined in chapter 71.05 RCW;

(b) Has been on conditional release status at some time during the preceding two years from an evaluation and treatment facility or a state mental health hospital;

(d) Exhibits suicidal preoccupation or attempts; or

(e) Is a minor child diagnosed by a mental health professional, as defined in RCW 71.05.020, as experiencing a mental disorder which is clearly interfering with the child's functioning in family or school or with peers or is clearly interfering with the child's personality development and learning.

(12) "Secretary" means the secretary of social and health services.

(13) "State minimum standards" means: (a) Minimum requirements for management and delivery of mental health services as established by departmental rules and necessary to implement this chapter, including but not limited to county administration, licensing service providers, information, accountability, contracts, and services; and (b) minimum service requirements for licensed service providers for the provision of mental health services as established by departmental rules pursuant to chapter 34.04 RCW as necessary to implement this chapter, including, but not limited to: Qualifications for staff providing services directly to mentally ill persons; the intended result of each service for those priority groups identified in RCW 71.24.035(4)(b); and the rights and responsibilities of persons receiving mental health services pursuant to this chapter.

(14) "Region" means a county or group of counties.

Sec. 3. Section 5, chapter 204, Laws of 1982 and RCW 71.24.045 are each amended to read as follows:

The county authority shall:

(1) Submit 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 who are acutely mentally ill, chronically mentally ill, 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;

(d) Screening for patients being considered for admission to state mental health facilities to determine appropriateness of admission;

(e) Consultation and education services;

(f) Residential and inpatient services, if the county chooses to provide such optional services; and

(g) Community support services for acutely and chronically mentally ill persons which include: (i) Discharge planning for clients leaving state mental hospitals and other acute care inpatient facilities; (ii) sufficient contacts with clients, families, or significant others to provide for an effective program of community maintenance; and (iii) medication monitoring.

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 service providers;

(3) 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. Whenever a county authority chooses to operate as a licensed service provider, the secretary shall act as the county authority for that service.

(4) 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 management and service delivery as established by the department;

(5) Assure that the special needs of minorities, children, the elderly, disabled, and low-income persons are met within the priorities established in RCW 71.24.035(4)(b);

(6) Maintain patient tracking information in a central location for the chronically mentally ill;

(7) Use not more than two percent of state-appropriated community mental health funds, which shall not include continuing federal ((~~funds~~)) operations grants, 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 equal to or greater than that of a county of the first class 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; and

(8) Coordinate services for individuals who have received services through the community mental health system and who become patients at a state mental hospital.

NEW SECTION. Sec. 4. There is appropriated from the general fund to the department of social and health services for the biennium ending June 30, 1987, the sum of .......... dollars, or so much thereof as may be necessary, to carry out the purposes of this act.