Background:

Long-Term Mental Health Placement Facilities.

The Involuntary Treatment Act governs the commitment of persons for involuntary mental health treatment if they pose a likelihood of serious harm or are gravely disabled due to a mental disorder. Except in regional service areas with fully-integrated medical care, behavioral health organizations are responsible for the administration of community-based commitments and services under the Involuntary Treatment Act. Inpatient commitments for 90 or 180 days of treatment take place at one of two state hospitals operated by the Department of Social and Health Services. Long-term inpatient care beds at the state hospitals are divided among all of the regional service areas with a specific allocation to each based on patient days of care.

Certificate of Need.

The certificate of need process evaluates proposals by certain health care providers to expand health care activities and reviews the potential impact of the expansion on a community's need for the service. A certificate of need from the Department of Health (Department) is required prior to the construction, renovation, or sale of a health care facility; changes in bed capacity; an increase in the number of dialysis stations at a kidney disease treatment center; or the addition of specialized health services. Under the program, the Department reviews the project using specific criteria related to community need, quality of services, financial feasibility, and the impact on health care costs in the community. A facility or service that is subject to the certificate of need program must be approved prior to beginning operations.

Until June 30, 2019, certificate of need requirements have been suspended for hospitals that change the use of licensed beds to increase the number of beds used to provide psychiatric services. For acute care hospitals, the exemption applies to hospitals that are changing the use of licensed beds to psychiatric beds as well as adding new psychiatric beds. For psychiatric hospitals, the exemption applies to the addition of up to 30 new psychiatric beds. The exemption also applies to the construction of a new psychiatric facility that has no more than 16 beds, a portion of which are to be used for treating adults on 90- or 180-day involuntary commitment orders. The Department of Commerce administers grants to hospitals to add new psychiatric beds to their facilities. The certificate of need requirements were suspended in fiscal years 2016 and 2017 for hospitals adding beds through the grant program.

Developmental Disabilities Administration.

The Department of Social and Health Services Developmental Disability Administration (DDA) assists individuals with developmental disabilities and their families to obtain services and support based on individual preferences, capabilities, and needs. The DDA clients live in residential habilitation centers an institutional setting, as well as in the community.

Eligibility for DDA services hinges on whether the client has a qualified developmental disability, has a functional need, and meets certain income and asset standards.

The services provided to clients are designed to promote everyday activities, routines, and relationships common to most citizens, and they include employment services and community access services, which are provided pursuant to contracts with counties.

In December 2018 the Developmental Disabilities Ombuds published a report regarding adults with developmental disabilities in hospitals without any medical need. Many of these individuals were DDA clients who had been receiving residential services. The report included stories from hospital employees and hospitalized individuals. The report includes policy recommendations related to the hospitalization without medical need of individuals with developmental disabilities

Summary:

Intensive Behavioral Health Treatment Facilities.

The Department of Health (Department) is authorized to license or certify intensive behavioral health treatment facilities. An "intensive behavioral health treatment facility" is defined as a community-based specialized residential treatment facility for people with behavioral health conditions and impairments or behaviors that do not meet criteria for involuntary treatment and whose care needs cannot be met in other community-based placement settings, including people discharging from or being diverted from a state or local hospital. The Department must work with the Health Care Authority (Authority) and the Department of Social and Health Services (DSHS) to create credentialing standards for intensive behavioral health treatment facilities.

The Department's rules related to intensive behavioral health treatment facilities must:

define clinical eligibility criteria in alignment with the definition of the facilities;
require 24-hour supervision of residents;
establish staffing standards that include a clinical team and a high staff-to-patient ratio;
establish requirements for providing services to individuals with intellectual or developmental disabilities;
require access to regular psychosocial rehabilitation services, including skills training in activities of daily living, social interaction, behavior management, impulse control, and self-management of medications;
require staffing levels that meet the acuity of the residents;
define the ability to use limited egress;
limit the age of residents to persons who are at least 18 years old; and
establish resident rights that are similar to the rights of residents of other long-term care facilities.

The Secretary of the Department must consult with the DSHS, the Department of Commerce, the Long-Term Care Ombuds, and other relevant stakeholders to provide recommendations on providing resident rights and access to ombuds services to the residents of intensive behavioral health facilities. The report must be submitted to the Governor and the appropriate committees of the Legislature by December 1, 2019.

Mental Health Peer Respite Centers.

The Department is authorized to credential mental health peer respite centers. Mental health peer respite centers are peer-operated programs that serve individuals in need of voluntary, short-term noncrisis services that focus on recovery and wellness. The Department, in consultation with the Authority and the DSHS, must:

establish requirements for community behavioral health agencies to provide mental health peer respite center services;
require credentialed agencies to partner with the local crisis system;
establish staffing requirements;
limit services to a maximum of seven days in a month;
limit services to persons who are experiencing psychiatric distress, but do not meet criteria for involuntary hospitalization; and
limit services to persons who are at least 18 years old.

Mental Health Drop-In Center Services.

The Authority is directed to establish a pilot program to provide mental health drop-in center services. The mental health drop-in center services are to provide a peer-focused recovery model during the daytime hours through a community-based, therapeutic, less restrictive alternative to hospitalization for acute psychiatric needs. The pilot program must assist clients in need of voluntary, short-term, noncrisis services that focus on recovery and wellness. The pilot program will occur between January 1, 2020, and July 1, 2022, in the largest city in a regional service area with at least nine counties. The Authority must submit a preliminary report to the Governor and the appropriate committees of the Legislature by December 1, 2020, that includes a survey of peer mental health programs. A final report must be submitted by December 1, 2021, on the results of the pilot program.

Community Long-Term Inpatient Care Capacity.

The Authority and behavioral health organizations must assess the capacity of community hospitals and evaluation and treatment facilities to become certified to provide long-term inpatient care. In addition, the Authority and behavioral health organizations must enter into contracts with those hospitals and evaluation and treatment facilities that choose to provide such services. Community hospitals and evaluation and treatment facilities are not required to become certified to provide long-term mental health placements.

By November 15, 2019, the Authority must confer with the Department, hospitals, and evaluation and treatment facilities to review laws and regulations and identify changes that may be necessary to address health care delivery and cost-effective treatment for adults on 90- or 180-day commitment orders. The Authority must report its findings to the Governor and the appropriate committees of the Legislature by December 15, 2019.

Certificate of Need.

The suspension of certificate of need requirements is extended from June 30, 2019, to June 30, 2021, for:

acute care hospitals that are changing the use of licensed beds to increase the number of beds to provide psychiatric services;
acute care hospitals that add new psychiatric beds;
psychiatric hospitals that add up to 30 new psychiatric beds; and
entities that construct a new psychiatric hospital that has no more than 16 beds and dedicate a portion of the beds to providing treatment to persons on a 90- or 180-day involuntary commitment order.

The suspension of certificate of need requirements for hospitals receiving grants from the Department of Commerce to add new psychiatric beds is continued for grants received in fiscal years 2018 and 2019.

Psychiatric hospitals are exempt from certificate of need requirements for the one-time addition of up to 60 psychiatric beds to be used for 90-day and 180-day civil commitment patients. The exemption applies to psychiatric hospitals that are awarded a grant by the Department of Commerce to increase behavioral health capacity in fiscal year 2019 and make a commitment to maintain a payer mix of at least 50 percent Medicare and Medicaid patient days for five years. The exemption expires June 30, 2021.

Enhanced Adult Residential Rates.

The DSHS is authorized to provide an enhanced adult residential rate to nursing homes that convert their bed use to provide assisted living or adult residential care. Nursing homes that permanently convert a portion of capacity to assisted living or adult residential care, including serving persons with behavioral health treatment needs, may receive a supplemental add-on residential care rate. The authority for the DSHS to provide a supplemental assisted living services rate to nursing homes that permanently convert beds from nursing home use to assisted living is eliminated.

Residential Intensive Behavioral Health and Developmental Disability Services.

The Authority and the DSHS must provide recommendations on short-term and long-term residential intensive behavioral health and developmental disabilities services for certain youth and adults who have, or may have, barriers related to discharging from inpatient behavioral health treatment. The report must be developed in consultation with the Department, the Department of Children, Youth, and Family, representatives from providers serving children's inpatient psychiatric needs in the three largest cities in Washington, representatives from behavioral health and developmental disability service providers, and representatives from developmental disability advocacy organizations. The recommendations must: (1) consider services to support the youth or adult, the family, and the residential service provider; (2) establish staffing and funding requirements that provide an appropriate level of treatment for residents in facilities; and (3) consider how to successfully transition youth to adult services without service disruption. The recommendations are due to the Governor's Office and the appropriate committees of the Legislature by July 1, 2020.

Developmental Disabilities Administration Clients Taken to a Hospital.

The DSHS must track and monitor the following items, within existing resources, and make the deidentified information available to the Developmental Disabilities Ombuds, the Legislature, the Washington State Hospital Association, and the public upon request:

certain information about clients receiving services from a provider that are taken to a hospital; and
certain information about clients that are taken to a hospital once the provider terminates services.

A provider must notify the DSHS when a client is taken to a hospital so that the DSHS may track and collect information. Providers include certified residential services and support programs under contract with the Developmental Disabilities Administration and state-operated living alternatives.

House	98
Senate	48	(Senate amended)
House	96	(House concurred)