WSR 12-18-070

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed September 4, 2012, 11:28 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 12-14-027.

Title of Rule and Other Identifying Information: Amending WAC 388-865-0430 Clinical record and 388-865-0575 Special considerations for serving children; and new WAC 388-865-0576 Minor children ages thirteen through seventeen -- Admission, treatment, and discharge without parental consent -- Evaluation and treatment facility and 388-865-0578 Minor children seventeen years of age and younger -- Admission, evaluation, and treatment without the minor's consent -- Evaluation and treatment facility.

Hearing Location(s): Office Building 2, Lookout Room, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html), on October 9, 2012, at 10:00 a.m.

Date of Intended Adoption: Not earlier than October 10, 2012.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m., October 9, 2012.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by September 25, 2012, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at jennisha.johnson@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These rules meet the requirements of SSB 5187, chapter 302, Laws of 2011, that requires, in part, an inpatient psychiatric facility that provides services to minors to inform, both verbally and in writing, a parent or guardian of a minor who is seeking treatment for that minor, of all statutorily available treatment options, including the option for parent-initiated treatment.

Reasons Supporting Proposal: These rules allow the department to be in compliance with SSB 5187 by requiring facilities to adopt policies and protocols regarding mental health treatment for minors.

Statutory Authority for Adoption: RCW 71.05.560, 71.24.035, 71.34.375, 71.34.500, 71.34.510, 71.34.520, 71.34.610, 71.34.620, 71.34.630, 71.34.640, 71.34.650, 71.34.750, and SSB 5187.

Statute Being Implemented: RCW 71.05.560, 71.24.035, 71.34.375, 71.34.500, 71.34.510, 71.34.520, 71.34.610, 71.34.620, 71.34.630, 71.34.640, 71.34.650, and 71.34.750.

Rule is not necessitated by federal law, federal or state court decision.

Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: The department is developing these rules in collaboration with the department of health.

Name of Proponent: Department of social and health services, governmental.

Name of Agency Personnel Responsible for Drafting: Kathy Sayre, P.O. Box 45330, Olympia, WA 98504-5330, (360) 725-1342; Implementation and Enforcement: Pete Marburger, P.O. Box 45330, Olympia, WA 98504-5330, (360) 725-1513.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The preparation of a small business economic impact statement is not required, as no new costs will be imposed on small businesses or nonprofits.

A cost-benefit analysis is not required under RCW 34.05.328. These rules are exempt under RCW 34.05.328 (5)(b)(v) as they are explicitly and specifically dictated by statute.

August 28, 2012

Katherine I. Vasquez

Rules Coordinator

4372.2
AMENDATORY SECTION(Amending WSR 10-09-061, filed 4/19/10, effective 5/20/10)

WAC 388-865-0430   Clinical record.   ((The)) A licensed community mental health agency must have and maintain a clinical record for each individual served in a manner consistent with WAC 388-865-0435, 388-865-0436, or any successors. The clinical record must contain:

(1) An intake evaluation((;)).

(2) Evidence that the consumer rights statement was provided to the individual, or their parent or other legal representative ((if)) when applicable((;)).

(3) Documentation that the provider requested a copy of and inserted into the clinical record if provided, any of the following:

(a) Mental health advance directives;

(b) Medical advance directives;

(c) Powers of attorney;

(d) Letters of guardianship, parenting plans and/or court order for custody;

(e) Least restrictive alternative order(s);

(f) Discharge summaries and/or evaluations stemming from outpatient or inpatient mental health services received within the last five years, when available.

(4) Any crisis plan that has been developed((;)).

(5) The individual service plan and all revisions to the plan((;)).

(6) Documentation that services are provided by or under the clinical supervision of a mental health professional((;)).

(7) Documentation of any clinical consultation or oversight provided by a mental health specialist((;)).

(8) Documentation of:

(a) All service encounters;

(b) Objective progress toward established goals as outlined in the treatment plan; and

(c) How any major changes in the individual's circumstances were addressed.

(9) Documentation that any mandatory reporting of abuse, neglect, or exploitation consistent with chapters 26.44 and 74.34 RCW has occurred((;)).

(10) Documentation that the department of corrections was notified by the provider when an individual on a less restrictive alternative or department of corrections order for mental health treatment informs the provider that the individual is under supervision by the department of corrections. Notification can be either written or oral. If oral notification, it must be confirmed by a written notice, including e-mail and fax. The disclosure to department of corrections does not require the person's consent.

(a) If the individual has been given relief from disclosure by the committing court, the individual must provide a copy of the court order to the treating community mental health agency (CMHA).

(b) There must be documentation that an evaluation by a designated mental health professional (DMHP) was requested in the following circumstance:

(i) The mental health provider becomes aware of a violation of the court-ordered treatment of an individual when the violation concerns public safety; and

(ii) The individual's treatment is a less restrictive alternative and the individual is being supervised by the department of corrections.

(11) Either documentation of informed consent to treatment by the individual or parent or other legal representative or if treatment is court ordered, a copy of the detention or involuntary treatment order((;)).

(12) Documentation that the individual, or their parent or other legal representative if applicable, are informed about the benefits and possible side effects of any medications prescribed for the individual in language that is understandable((;)).

(13) Documentation of confidential information that has been released without the consent of the individual under the provisions in RCW 70.02.050, 71.05.390, 71.05.630, and the Health Insurance Portability and Accountability Act (HIPAA)((;)).

(14) For individuals receiving community support services, the following information must be requested from the individual and the responses documented:

(a) The name of any current primary medical care provider;

(b) Any current physical health concerns;

(c) Current medications and any related concerns;

(d) History of any substance use/abuse and treatment;

(e) Any disabilities or special needs;

(f) Any previously accessed inpatient or outpatient services and/or medications to treat a mental health condition; and

(g) Information about past or current trauma and abuse.

(15) A description of the individual's strengths and resources((; and)).

(16) A description of the individual's self-identified culture.

(17) If the individual is a minor and, if applicable:

(a) Documentation that the minor's parent(s) brought the minor to the agency to be evaluated by a mental health specialist.

(b) Written authorization that allows the bringing of the minor to the agency to be evaluated by a mental health specialist.

(c) Documentation that the minor was evaluated by a mental health specialist and a determination of whether or not the minor has a mental disorder that requires outpatient treatment.

[Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), and 71.34.380. 10-09-061, 388-865-0430, filed 4/19/10, effective 5/20/10. Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, 388-865-0430, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.445 and 71.05.390 as amended by 2004 c 166. 05-14-082, 388-865-0430, filed 6/30/05, effective 7/31/05. Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, 388-865-0430, filed 5/31/01, effective 7/1/01.]


AMENDATORY SECTION(Amending WSR 06-17-114, filed 8/18/06, effective 9/18/06)

WAC 388-865-0575   Special considerations for serving minor children.   Inpatient evaluation and treatment facilities serving minor children seventeen years of age and younger must develop and implement policies and procedures to address special considerations for serving children((, including)). These special considerations must include:

(1) Procedures to ensure that adults ((must be)) are separated from ((children)) minors who are not yet thirteen years of age((;)).

(2) ((Children)) Procedures to ensure that a minor who ((have had their thirteenth birthday, but are under the age of eighteen, may be)) is at least age thirteen but not yet age eighteen is served with adults only if the ((child's)) minor's clinical record contains ((a professional judgment saying that placement in an adult facility will not be harmful to the child or adult)):

(a) Documentation that justifies such placement; and

(b) A professional judgment that placement in an inpatient evaluation and treatment facility that serves adults will not be harmful to the minor or to the adult.

(3) Procedures to ensure examination and evaluation of a minor by a children's mental health specialist occurs within twenty-four hours of admission.

(4) Procedures to ensure a facility that operates inpatient psychiatric beds for minors and is licensed by the department of health under chapter 71.12 RCW, meets the following notification requirements if a minor's parent(s) brings the child to the facility for the purpose of mental health treatment or evaluation. The facility must:

(a) Provide a written and verbal notice to the minor's parent(s) of:

(i) All current statutorily available treatment options available to the minor including, but not limited to, those provided in chapter 71.34 RCW; and

(ii) A description of the procedures the facility will follow to utilize the treatment options.

(b) Obtain and place in the clinical file, a signed acknowledgment from the minor's parent(s) that the notice required under (a) of this subsection was received.

(5) Procedures that address provisions for ((evaluation of children)) evaluating a minor brought to the facility for evaluation by ((their parents)) a parent(s).

(((5))) (6) Procedures to notify child protective services any time the facility has reasonable cause to believe that abuse, neglect, financial exploitation or abandonment of a ((child)) minor has occurred.

(((6) For a child)) (7) Procedures to ensure a minor thirteen years or older who is brought to an inpatient evaluation and treatment facility or hospital for immediate mental health services((,)) is evaluated by the professional person in charge of the facility. The professional person must evaluate the ((child's)) minor's mental condition((,)) and determine a mental disorder, the need for inpatient treatment, and the minor's willingness to obtain voluntary treatment. The facility may detain or arrange for the detention of the ((child)) minor up to twelve hours for evaluation by a designated mental health professional to commence detention proceedings.

(((7) Admission of children)) (8) Procedures to ensure that the admission of a minor thirteen years of age or older admitted without parental consent ((must have)) has the concurrence of the professional person in charge of the facility and written review and documentation no less than every one hundred eighty days.

(((8) Notice must be)) (9) Procedures to ensure that notice is provided to the parent(s) when a minor child is voluntarily admitted to inpatient treatment without parental consent within twenty-four hours of admission in accordance with the requirements of RCW 71.34.510.

(((9) Children)) (10) Procedures to ensure a minor who ((have)) has been admitted on the basis of a designated mental health professional petition for detention ((must be)) is evaluated by the facility providing seventy-two hour evaluation and treatment to determine the ((child's)) minor's condition and either admit or release the ((child)) minor. If the ((child)) minor is not approved for admission, the facility must make recommendations and referral for further care and treatment as necessary.

(((10))) (11) Procedures for the examination and evaluation of a ((child)) minor approved for inpatient admission to include:

(a) The needs to be served by placement in a chemical dependency facility;

(b) Restricting the right to associate or communicate with a parent(s); and

(c) Advising the ((child)) minor of rights in accordance with chapter 71.34 RCW.

(((11))) (12) Procedures to petition for fourteen-day commitment that are in accordance with ((the requirements of)) RCW 71.34.730.

(((12))) (13) Procedures for commitment hearing requirements and release from further inpatient treatment which may be subject to reasonable conditions, if appropriate, that are in accordance with RCW 71.34.740.

(((13))) (14) Procedures for discharge and conditional release of a ((child)) minor in accordance with RCW 71.34.770, provided that the professional person in charge gives the court written notice of the release within three days of the release. If the ((child)) minor is on a one hundred eighty-day commitment, the children's long-term inpatient program (CLIP) administrator must also be notified.

(((14))) (15) Procedures to ensure rights of ((children)) a minor undergoing treatment and posting of such rights ((must be)) are in accordance with RCW 71.34.355, 71.34.620, and 71.34.370.

(((15))) (16) Procedures for the release of a ((child)) minor who is not accepted for admission or who is released by an inpatient evaluation and treatment facility that are in accordance with RCW 71.34.365.

(((16) Information concerning)) (17) Procedures to ensure treatment of ((children)) a minor and all information obtained through treatment under this chapter ((may be)) are disclosed only in accordance with RCW 71.34.340.

(((17) Availability of)) (18) Procedures to make court records and files available that are in accordance with RCW 71.34.335.

(((18))) Procedures to release mental health services information ((must)) only ((be released)) in accordance with RCW 71.34.345 and other applicable state and federal statutes.

[Statutory Authority: RCW 71.24.035, 71.05.560, and chapters 71.24 and 71.05 RCW. 06-17-114, 388-865-0575, filed 8/18/06, effective 9/18/06. Statutory Authority: RCW 71.05.560, 71.34.800, and chapters 71.05 and 71.34 RCW. 04-07-014, 388-865-0575, filed 3/4/04, effective 4/4/04.]


NEW SECTION
WAC 388-865-0576   Minor children ages thirteen through seventeen--Admission, treatment, and discharge without parental consent--Evaluation and treatment facility.   (1) Under RCW 71.34.500, an evaluation and treatment facility may admit a minor child who is at least thirteen years of age and not older than seventeen years of age without the consent of the minor's parent(s) when:

(a) In the judgment of the professional person in charge of the facility, there is reason to believe that the minor is in need of inpatient treatment because of a mental disorder;

(b) The facility provides the type of evaluation and treatment needed by the minor;

(c) It is not feasible to treat the minor in a less restrictive setting or in the minor's home; and

(d) The minor gives written consent for the voluntary inpatient treatment.

(2) The evaluation and treatment facility must provide notice to the minor's parent(s) when the minor is voluntarily admitted. The notice must be in a form most likely to reach the minor's parent(s) within twenty-four hours of the minor's voluntary admission and advise the parent(s):

(a) That the minor has been admitted to inpatient treatment;

(b) Of the location and telephone number of the facility;

(c) Of the name of the professional staff member designated to provide the minor's treatment and discuss the minor's need for inpatient treatment; and

(d) Of the medical necessity for the minor's admission.

(3) The evaluation and treatment facility must:

(a) Review and document the minor's need for continued inpatient treatment at least every one hundred eighty days; and

(b) Obtain a renewal of the minor's written consent for the voluntary inpatient treatment at least every twelve calendar months.

(4) A minor admitted to an evaluation and treatment facility under RCW 71.34.500 may give notice of intent to leave at any time. The notice must be in writing, signed by the minor, and clearly state the minor intends to leave the facility.

(a) The facility staff member receiving the notice must:

(i) Immediately date it;

(ii) Record its existence in the minor's clinical record; and

(iii) Send a copy to the:

(A) Minor's attorney, if the minor has one;

(B) County-designated mental health professional; and

(C) Minor's parent(s).

(b) The facility must ensure a facility professional staff member discharges the minor from the facility by the second judicial day following receipt of the minor's notice of intent to leave.

(5) The evaluation and treatment facility must obtain parental consent, or authorization from a person who may consent on behalf of the minor under RCW 7.70.065, before admitting a minor child twelve years of age or younger.

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NEW SECTION
WAC 388-865-0578   Minor children seventeen years of age and younger--Admission, evaluation, and treatment without the minor's consent--Evaluation and treatment facility.   (1) Under RCW 71.34.600, an evaluation and treatment facility may admit, evaluate, and treat a minor child seventeen years of age or younger without the consent of the minor if the minor's parent(s) brings the minor to the facility.

(2) The evaluation and treatment facility must ensure a trained professional person (defined in RCW 71.05.020) evaluates the minor within twenty-four hours of the time the minor was brought to the facility.

(3) If the professional person determines the condition of the minor requires additional time for evaluation, the additional time must not be longer than seventy-two hours.

(4) If the evaluation and treatment facility holds the minor for treatment, the treatment must be limited to medically necessary treatment that the professional person has determined is needed to stabilize the minor's condition in order to complete the evaluation.

(5) The evaluation and treatment facility must:

(a) Notify the department within twenty-four hours of completing the minor's evaluation if the minor is held for inpatient treatment.

(b) Notify the minor being held for inpatient treatment of the right under RCW 71.34.620 to petition the superior court for release from the facility. The minor must be informed of this right before the department completes a review of the minor's admission and inpatient treatment (see subsection (7) of this section). If the minor is not released as a result of a petition for judicial review, the facility must release the minor no later than thirty days following the later of:

(i) The date of the department's determination under RCW 71.34.610; or

(ii) The date the petition is filed, unless a mental health professional initiates proceedings under Title 71 RCW.

(6) The minor's clinical record must show documentation that the department and the minor were notified as required under (a) and (b) of this subsection.

(7) One of the following must occur when the department conducts a review under RCW 71.34.610.

(a) If the department determines it is no longer medically necessary for the minor to receive inpatient treatment, the department notifies the minor's parent(s) and the facility. The facility must release the minor to the minor's parent(s) within twenty-four hours of receiving notice from the department.

(b) If the professional person in charge of the facility and the minor's parent(s) believe that it is medically necessary for the minor to remain in inpatient treatment, the facility must release the minor to the parent(s) on the second judicial day following the department's determination in order to allow the parent(s) time to file an at-risk youth petition under chapter 13.21A RCW.

(c) If the department determines it is medically necessary for the minor to receive outpatient treatment and if the minor declines to obtain such treatment, the refusal is grounds for the minor's parent(s) to file an at-risk youth petition under chapter 13.21A RCW.

(8) The evaluation and treatment facility must not discharge a minor admitted under RCW 71.34.600 based solely on the minor's request.

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