WSR 15-01-193 EMERGENCY RULES DEPARTMENT OF SOCIAL AND HEALTH SERVICES (Behavioral Health and Service Integration Administration) [Filed December 24, 2014, 8:44 a.m., effective December 26, 2015] Effective Date of Rule: December 26, 2015.
Purpose: The department is amending WAC 388-865-0526 as a result of the Washington supreme court decision in In re the Detention of D.W., et. al., No. 90110-4. This section contains the department's rules for single bed certification which allow for the inpatient treatment of adults and children in facilities that are not certified as inpatient evaluation and treatment facilities. The amendment: (1) Allows residential treatment facilities, psychiatric hospitals, hospitals with a psychiatric unit, and hospitals that can provide timely and appropriate mental health treatment to be recognized for single bed certification; (2) requires that any facility which is the site of a proposed single bed certification to confirm that it is willing to provide treatment services; (3) articulates standards that facilities must meet while operating under a single bed certification; and (4) clarifies that the regional support networks retain responsibility for ensuring that the rights of patients are protected while in single bed certifications.
Citation of Existing Rules Affected by this Order: Amending WAC 388-865-0526.
Statutory Authority for Adoption: RCW 71.05.560, 71.24.035, and 71.34.380.
Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.
Reasons for this Finding: The Washington supreme court agreed to stay its decision until December 26, 2014, upon assurances from the department that more inpatient bed capacity would be found. The emergency rule allows for certain appropriate consumers to be certified to facilities that they previously would not have been able to, thus creating new bed opportunities and preventing the inappropriate release of consumers who need involuntary mental health treatment. This emergency rule supersedes the emergency rule filed as WSR 14-20-007 on September 18, 2014. The department filed a CR-101 under WSR 14-22-016 on October 23, 2014, for the permanent rule.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: December 17, 2014.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION (Amending WSR 09-02-030, filed 12/30/08, effective 1/30/09)
WAC 388-865-0526 Single bed certification.
At the discretion of the ((mental health division)) department, an exception may be granted to allow timely and appropriate mental health treatment to an adult on a seventy-two hour detention or fourteen-day commitment in a facility that is not certified under WAC 388-865-0500; or for a maximum of thirty days to allow a community facility to provide treatment to an adult on a ninety- or one hundred eighty-day inpatient involuntary commitment order. For involuntarily detained or committed children, the exception may be granted to allow timely and appropriate mental health treatment in a facility not certified under WAC 388-865-0500 until the child's discharge from that setting to the community, or until they transfer to a bed in a children's long-term inpatient program (CLIP).
(1) The regional support network or its designee must submit a written request for a single bed certification to the ((mental health division prior to the commencement of the order)) department. In the case of a child, the facility must submit the written request ((directly)) to the ((mental health division)) department. The request must be submitted and approved prior to the commencement of the detention. If the ((DSHS secretary)) department has assumed the duties assigned to a nonparticipating regional support network, ((a single bed certification may be requested by a mental health division designee contracted to provide inpatient authorization or designated crisis response services)) an entity designated by the department will perform the functions described in this section.
(2) ((The facility receiving the single bed certification must meet all requirements of this section unless specifically waived by the mental health division.))
((3)) A single bed certification may be issued when the following requirements are met in each instance where such certification is sought for an individual:
(a) The facility that is the site of the proposed single bed certification confirms that it is willing and able to provide directly, or by direct arrangement with other public or private agencies, timely and appropriate mental health treatment to the consumer suffering from a mental disorder for whom the single bed certification is sought; and
(b) The request for single bed certification ((must describe)) describes why the consumer meets at least one of the following criteria:
(((a))) (i) The consumer requires medical services that are not available at a facility certified under this chapter or a state psychiatric hospital; ((or))
(((b))) (ii) The consumer is expected to be ready for discharge from inpatient services within the next thirty days and being at a community facility would facilitate continuity of care, consistent with the consumer's individual treatment needs((.));
(iii) The consumer can receive appropriate mental health treatment in a residential treatment facility, as defined under chapter 246-337 WAC, and the single bed certification will be only to that facility; or
(iv) The consumer can receive appropriate mental health treatment in a hospital with a psychiatric unit, a hospital that is willing and able to provide timely and appropriate mental health treatment, or a psychiatric hospital, and the single bed certification will apply only to that facility.
(3) In order to provide timely and appropriate mental health treatment, the facility receiving the single bed certification, or the public or private agency the facility has a direct arrangement with to provide mental health treatment, must:
(a) Implement standards for administration that include written procedures to assure that a mental health professional, as defined in RCW 71.05.020 or WAC 388-865-0150, and licensed physicians are available for consultation and communication with both the consumer and the direct patient care staff;
(b) Use a plan of care/treatment. The medical or clinical record must contain documentation of:
(i) An individualized mental health treatment plan that was developed, when possible, collaboratively with the consumer. If the consumer is unwilling or unable to participate in development of the plan, documentation must be made in the record. Development of this plan may include participation of a multidisciplinary team, a mental health professional, as defined in RCW 71.05.020 or WAC 388-865-0150, or collaboration with members of the consumer's support system as identified by the consumer.
(ii) A mental health professional, as defined in RCW 71.05.020 or WAC 388-865-0150, will have contact with each involuntarily detained consumer at least daily for the purpose of:
(A) Observation and evaluation; and
(B) Release from involuntary commitment to accept treatment on a voluntary basis.
(c) Have standards for administration and monitoring of medication, including psychiatric medications. Consumers have a right to make an informed decision regarding the use of antipsychotic medication consistent with RCW 71.05.215.
(4) The ((mental health division director or the director's designee)) department makes the decision and gives written notification to the requesting entity in the form of a single bed certification. The single bed certification must not contradict a specific provision of federal law or state statute.
(5) A consumer who receives services under a single bed certification under this section must be transferred to an evaluation and treatment facility if on a seventy-two hour detention or fourteen-day commitment, or to a state hospital if on a ninety- or one hundred eighty-day inpatient commitment, as soon as the attending physician considers the consumer medically stable and a bed becomes available, unless the treating facility consents to continue treatment and continued treatment in the current setting is consistent with the best clinical interests of the consumer.
(6) The ((mental health division)) department may make site visits at any time to verify that the terms of the single bed certification are being met. Failure to comply with any term of this exception may result in corrective action. If the ((mental health division)) department determines that the violation places consumers in imminent jeopardy, immediate revocation of this exception can occur.
(((6))) (7) The regional support network retains the responsibility for ensuring due process required by RCW 71.24.300 (6)(b).
(8) Neither consumers nor facilities have fair hearing rights as defined under chapter 388-02 WAC regarding single bed certification decisions by ((mental health division)) department staff.
Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings. |