SOCIAL AND HEALTH SERVICES
(Health and Rehabilitative Services Administration)
Preproposal statement of inquiry was filed as WSR 03-07-041.
Title of Rule: WAC 388-865-0500 series "inpatient evaluation and treatment facilities."
Purpose: The Mental Health Division is revising these rules to be consistent with rules being developed for residential treatment facilities by the Department of Health. Current rules, WAC 388-865-0501 through 388-856-0565 will be repealed. The subject matter of these rules is being revised and reorganized for clarity, and will be adopted as new rules in the WAC 388-865-0500 series.
Statutory Authority for Adoption: RCW 71.05.560 and 71.34.800.
Statute Being Implemented: Chapters 71.05 and 71.34 RCW.
Summary: These rules are being revised for clarity and to be consistent with the rules being developed for residential treatment facilities by the Department of Health. In addition, program standards specific to long-term inpatient treatment for children that had previously been in Department of Health chapter 246-323 WAC have been moved to the Mental Health Division.
Reasons Supporting Proposal: Treatment standards are more appropriate for regulation by the mental health program.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kathy Burns Peterson, P.O. Box 45320, Olympia, WA 98504, (360) 902-0843.
Name of Proponent: Department of Social and Health Services, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: These changes are intended to result in improved delivery of services to DSHS clients. See Purpose, Summary and Reasons Supporting Proposal above.
Proposal Changes the Following Existing Rules: See Purpose, Summary and Reasons Supporting Proposal above.
No small business economic impact statement has been prepared under chapter 19.85 RCW. These changes are improvements for clarity and do not have an economic impact to small businesses or small nonprofits compared to current rules for these facilities.
RCW 34.05.328 does not apply to this rule adoption. The department finds that this rule does not meet the definition of a significant legislative rule in RCW 34.05.328 (5)(c)(iii), and the provisions of this statute do not apply.
Hearing Location: Blake Office Building East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503, on October 21, 2003, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by October 17, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail firstname.lastname@example.org.
Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail email@example.com, by 5:00 p.m., October 21, 2003.
Date of Intended Adoption: Not sooner than October 22, 2003.
August 26, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3293.8
(1) The following facilities must be licensed by the department of health:
(a) General hospital;
(b) Psychiatric hospital; or
(c) Residential (nonhospital) inpatient facility such as adult residential rehabilitation centers and psychiatric institutions for children and youth.
(2) The following state psychiatric hospitals for adults or children are not licensed by the state, but certified by the Health Care Financing Administration and accredited by the Joint Commission on Accreditation of Healthcare Organizations:
(a) Eastern state hospital;
(b) Western state hospital; and
(c) Child study and treatment center.
(3) No correctional institution or facility, juvenile court detention facility, or jail may be used as an inpatient evaluation and treatment facility within the meaning of this chapter)) (1) These standards implement chapter RCW 71.05.560 and 71.34.800 to establish certification standards for twenty-four-hour-per-day mental health care provided within a general hospital, psychiatric hospital, inpatient evaluation and treatment facility, or child long-term inpatient treatment facility.
(2) Compliance with the regulations in this chapter does not constitute release from the requirements of applicable federal, state and local codes and ordinances. Where regulations in this chapter exceed other local codes and ordinances, the regulations in this chapter will apply.
(3) This chapter does not apply to state psychiatric hospitals as defined in chapter 72.23 RCW.
[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, § 388-865-0500, filed 5/31/01, effective 7/1/01.]
(1) Be licensed by the department of health as:
(a) A hospital as defined in chapter 70.41 RCW;
(b) A psychiatric hospital as defined in chapter 246-322 WAC;
(c) A mental health inpatient evaluation and treatment facility consistent with chapter 246-337 WAC; or
(d) A mental health child long-term inpatient treatment facility consistent with chapter 246-337 WAC.
(2) Be approved by the regional support network, or the mental health division in the case of mental health child long-term inpatient treatment facilities; and
(3) Successfully complete a provisional and annual on-site review by the mental health division to determine facility compliance with the minimum standards of this section and chapters 71.05 and 71.34 RCW.
(1) Deeming will be in accordance with the established agreement between the mental health division and the accrediting agency, to include the minimum standards of this section and chapters 71.05 and 71.34 RCW.
(2) The mental health division retains all responsibilities relating to applications of new providers, complaint investigations, suspensions and revocations.
(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. In the case of a child, the facility must submit the written request directly to the mental health division.
(2) The facility receiving the single bed certification must meet all requirements of this section unless specifically waived by the mental health division.
(3) The request for single bed certification must describe why the consumer meets at least one of the following criteria:
(a) The consumer requires services that are not available at a facility certified under this chapter or a state psychiatric hospital; or
(b) 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.
(4) The mental health division director or the director's designee makes the decision and gives written notification to the requesting regional support network 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) The mental health division 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 determines that the violation places consumers in imminent jeopardy, immediate revocation of this exception can occur.
(6) Neither consumers nor facilities have fair hearing rights as defined under chapter 388-02 WAC regarding single bed certification decisions by mental health division staff.
(2) For children: At the discretion of the mental health division, a facility that is certified as a 'mental health inpatient evaluation and treatment facility' may be granted an exception to provide treatment to a child on a one hundred and eighty-day inpatient involuntary treatment order only until the child is discharged from his/her order to the community, or until a bed is available for that child in a child long-term inpatient treatment facility (CLIP). The child cannot be assigned by the CLIP placement team in accordance with RCW 71.34.100 to any facility other than a CLIP facility.
(3) The exception certification may be requested by the facility, the director of the mental health division or his/her designee, or the regional support network for the facility's geographic area.
(4) The facility receiving the long-term exception certification for ninety- or one hundred eighty-day patients must meet all requirements found in WAC 388-865-0500.
(5) The exception certification must be signed by the director of the mental health division. The exception certification may impose additional requirements, such as types of consumers allowed and not allowed at the facility, reporting requirements, requirements that the facility immediately report suspected or alleged incidents of abuse, or any other requirements that the director of the mental health division determines are necessary for the best interests of residents.
(6) The mental health division may make unannounced site visits at any time to verify that the terms of the exception certification are being met. Failure to comply with any term of the exception certification may result in corrective action. If the mental health division determines that the violation places residents in imminent jeopardy, immediate revocation of the certification can occur.
(7) Neither consumers nor facilities have fair hearing rights as defined under chapter 388-02 WAC regarding the decision to grant or not to grant exception certification.
(1) A description of the program, including age of consumers to be served, length of stay and services to be provided.
(2) An organizational structure including clear lines of authority for management and clinical supervision.
(3) Designation of a physician or other mental health professional as the professional person in charge of clinical services at that facility.
(4) A quality management plan to monitor, collect data and develop improvements to meet the requirements of this chapter.
(5) A policy management structure that establishes:
(a) Procedures for maintaining and protecting resident medical/clinical records consistent with chapter 70.02 WAC, "Medical Records Health Care Information Access and Disclosure Act" and Health Insurance Patient Privacy Act (HIPAA); RCW 71.05.390; 71.05.395; and WAC 388-865-0115;
(b) Procedures for maintaining adequate fiscal accounting records consistent with Generally Accepted Accounting Principles (GAAP);
(c) Procedures for management of human resources to ensure that residents receive treatment or care by adequate numbers of staff who are qualified and competent to carry out their assigned responsibilities;
(d) Procedures for admitting consumers needing inpatient evaluation and treatment services seven days a week, twenty-four hours a day;
(e) Procedures to assure transportation for persons who are not approved for admission to his or her residence or other appropriate place;
(f) Procedures to detain arrested persons who are not approved for admission for up to eight hours in order to enable law enforcement to return to the facility and take the person back into custody;
(g) Procedures to assure access to necessary medical treatment, emergency life-sustaining treatment, and medication;
(h) Procedures to assure the protection of consumer and family rights as described in this chapter and chapters 71.05 and 71.34 RCW;
(i) Procedures to inventory and safeguard the personal property of the consumer being detained, including a process to limit inspection of the inventory list by responsible relatives or other persons designated by the detained consumer;
(j) Procedures to assure that a mental health professional and licensed physician are available for consultation and communication with both the consumer and the direct patient care staff twenty-four hours a day, seven days a week;
(k) Procedures to provide warning to an identified person and law enforcement when an adult has made a threat against an identified victim;
(l) Procedures to ensure that consumers detained for up to fourteen additional days of treatment are evaluated by the professional staff of the facility in order to be prepared to testify that the consumer's condition is caused by a mental disorder and either results in likelihood of serious harm or the consumer being gravely disabled.
(2) The facility must document that each resident has received evaluations to determine the nature of the disorder and the treatment necessary, including:
(a) A health assessment of the consumer's physical condition to determine if the consumer needs to be transferred to an appropriate hospital for treatment;
(b) Examination and medical evaluation within twenty-four hours by a licensed physician, advanced registered nurse practitioner, or physician assistant-certified;
(c) Psychosocial evaluation by a mental health professional;
(d) Development of an initial treatment plan;
(e) Consideration of less restrictive alternative treatment at the time of admission; and
(f) The admission diagnosis and what information the determination was based upon.
(3) A consumer who has been delivered to the facility by a peace officer for evaluation must be evaluated by a mental health professional within the following timeframes:
(a) Three hours of an adult consumer's arrival;
(b) Twelve hours of arrival for a child in an inpatient evaluation and treatment facility; or
(c) At any time for a child in a child long-term inpatient treatment facility.
(4) If the licensed physician and mental health professional determine that the needs of an adult consumer would be better served by placement in a chemical dependency treatment facility then the consumer must be referred to an approved treatment program defined under chapter 70.96A RCW.
(1) Diagnostic and therapeutic services prescribed by the attending clinical staff.
(2) A plan for treatment developed collaboratively with the consumer. This may include participation of a multi-disciplinary team or mental health specialists as defined in WAC 388-865-0150, or collaboration with members of the consumer's support system as identified by the consumer.
(3) Copies of advance directives, powers of attorney or letters of guardianship provided by the consumer.
(4) A plan for discharge including a plan for follow-up where appropriate.
(5) Documentation of the course of treatment.
(6) That a mental health professional has contact with each involuntary consumer at least daily (current WAC 388-865-0525(7)) for the purpose of:
(c) Release from involuntary commitment to accept treatment on a voluntary basis;
(d) Discharge from the facility to accept voluntary treatment upon referral.
(7) For consumers who are being evaluated as dangerous mentally ill offenders under RCW 72.09.370(7), the professional person in charge of the evaluation and treatment facility must consider filing a petition for a ninety day less restrictive alternative in lieu of a petition for a fourteen-day commitment.
(1) A current job description.
(2) A current Washington state department of health license or certificate or registration as may be required for his/her position.
(3) Washington state patrol background checks for employees in contact with consumers consistent with RCW 43.43.830.
(4) Clinical supervisors must meet the qualifications of mental health professionals or specialists as defined in WAC 388-865-0150.
(5) An annual performance evaluation.
(6) Development of an individualized annual training plan, to include at least:
(a) The skills he or she needs for his/her job description and the population served;
(b) Least restrictive alternative options available in the community and how to access them;
(c) Methods of resident care;
(d) Management of assaultive and self-destructive behaviors, including proper and safe use of seclusion and/or restraint procedures; and
(e) The requirements of chapter 71.05 and 71.34 RCW, this chapter, and protocols developed by the mental health division.
(7) If contract staff are providing direct services, the facility must ensure compliance with the training requirements outlined in (6) above.
(1) Immediate release, unless involuntary commitment proceedings are initiated.
(2) Wear your own clothes and to keep and use personal possessions, except when deprivation is essential to protect your safety or that of another person.
(3) Keep and be allowed to spend a reasonable sum of your own money for canteen expenses and small purchases.
(4) Adequate care and individualized treatment.
(5) Have all information and records compiled, obtained, or maintained in the course of receiving services kept confidential.
(6) Have access to individual storage space for your private use.
(7) Have visitors at reasonable times.
(8) Have reasonable access to a telephone, both to make and receive confidential calls.
(9) Have ready access to letter writing materials, including stamps, and to send and receive uncensored correspondence through the mails.
(10) Not to consent to the administration of anti-psychotic medications beyond the hearing conducted pursuant to RCW 71.05.320(2) or the performance of electroconvulsant therapy or surgery, except emergency life-saving surgery, unless ordered by a court of competent jurisdiction pursuant to the following standards and procedures: RCW 71.05.200 (1)(e); 71.05.215; and 71.05.370(7).
(11) To dispose of property and sign contracts unless you have been adjudicated as incompetent in a court proceeding directed to that particular issue.
(12) Not to have psychosurgery performed under any circumstances."
(1) Remain silent and any statement you make may be used against you.
(2) Access to attorneys, courts and other legal redress, including the name and address of the attorney the mental health professional has designated for you.
(3) Immediately be informed of your right to speak with an attorney and a review of the legality of your detention including representation at the probable cause hearing.
(4) Have access to a certified language interpreter in the primary language understood by you.
(5) Have a responsible member of your immediate family if possible, guardian or conservator, if any, and such person as designated by you be given written notice of your inpatient status, and your rights as an involuntary consumer.
(6) A medical and psychosocial evaluation within twenty-four hours of admission to determine whether continued detention in the facility is necessary.
(7) A judicial hearing before a superior court if you are not released within seventy-two hours (excluding Saturday, Sunday, and holidays), to decide if continued detention within the facility is necessary.
(8) Not forfeit any legal right or suffer any legal disability as a consequence of any actions taken or orders made, other than as specifically provided.
(9) Not to be denied treatment by spiritual means through prayer in accordance with the tenets and practices of a church or religious denomination.
(10) Refuse psychiatric medication, except medications ordered by the court under WAC 388-865-0570 but not any other medication previously prescribed by an authorized prescriber.
(11) Refuse treatment, but not emergency lifesaving treatment unless otherwise specified in a written advance directive provided to the facility.
(12) Be given a copy of WAC 388-865-0585 outlining limitations on the right to possess a firearm."
(1) The clinical record must document:
(a) The physician's attempt to obtain informed consent;
(b) The consumer was asked if he or she wishes to decline treatment during the twenty-four hour period, and the answer must be in writing and signed when possible.
(c) The reasons why any antipsychotic medication is administered over the consumer's objection or lack of consent.
(2) The physician may administer antipsychotic medications over a consumer's objections or lack of consent only when:
(a) An emergency exists, provided there is a review of this decision by a second physician within twenty-four hours. An emergency exists if:
(i) The consumer presents an imminent likelihood of serious harm to self or others;
(ii) Medically acceptable alternatives to administration of antipsychotic medications are not available or are unlikely to be successful; and
(iii) In the opinion of the physician, the consumer's condition constitutes an emergency requiring that treatment be instituted before obtaining an additional concurring opinion by a second physician.
(b) There is an additional concurring opinion by a second physician for treatment up to thirty days;
(c) For continued treatment beyond thirty days through the hearing on any one hundred eighty-day petition filed under RCW 71.05.370(7), provided the facility medical director or director's medical designee reviews the decision to medicate a consumer. Thereafter, antipsychotic medication may be administered involuntarily only upon order of the court. The review must occur at least every sixty days.
(3) The examining physician must sign all one hundred eighty-day petitions for antipsychotic medications files under the authority of RCW 71.05.370(7);
(4) Consumers committed for one hundred eighty days who refuse or lack the capacity to consent to antipsychotic medications have the right to a court hearing under RCW 71.05.370(7) prior to the involuntary administration of antipsychotic medications;
(5) In an emergency, antipsychotic medications may be administered prior to the court hearing provided that an examining physician files a petition for an antipsychotic medication order the next judicial day;
(6) All involuntary medication orders must be consistent with the provisions of RCW 71.05.370 (7)(a) and (b), whether ordered by a physician or the court.
(1) Examination and evaluation by a children's mental health specialist within twenty-four hours of admission.
(2) Provisions for evaluation of children brought to the facility for evaluation by their parents.
(3) Procedures to notify child protective services if the facility has reasonable cause to believe that abuse, neglect, financial exploitation or abandonment of a child has occurred.
(4) For a child thirteen years or older who is brought to an inpatient evaluation and treatment facility or hospital for immediate mental health services, the professional person in charge of the facility must evaluate the child's mental condition, determine a mental disorder, need for inpatient treatment, and willingness to obtain voluntary treatment. The facility may detain or arrange for the detention of the child up to twelve hours for evaluation by a county designated mental health professional to commence detention proceedings.
(5) Admission of children thirteen years or older admitted without parental consent must have concurrence of the professional person in charge of the facility and written review and documentation no less than every one hundred eighty days.
(6) Notice must be provided to parents when a child is voluntarily admitted to inpatient treatment without parental consent within twenty four hours of admission in accordance with the requirements of RCW 71.34.044.
(7) Children who have been admitted on a voluntary basis may give notice to leave at any time in any form the intent of the child can be discerned. The child must be discharged within two judicial days of receipt of the notice of intent to leave.
(8) Children who have been admitted on the basis of a county designated mental health professional petition for detention must be evaluated by the facility providing seventy two hour evaluation and treatment to determine the child's condition and either admit or release the child. If the child is not approved for admission, the facility must make recommendations and referral for further care and treatment as necessary.
(9) Examination and evaluation of a child 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 parents; and
(c) Advising the child of rights in accordance with chapter 71.34 RCW.
(10) Petition for fourteen-day commitment in accordance with the requirements of RCW 71.34.070.
(11) Commitment hearing requirements and release from further inpatient treatment which may be subject to reasonable conditions if appropriate in accordance with RCW 71.34.080.
(12) Discharge and conditional release of a child in accordance with RCW 71.34.120.
(13) Rights of children undergoing treatment and posting of such rights must be in accordance with RCW 71.34.160, 71.34.162.and 71.34.290.
(14) Release of a child who is not accepted for admission or who is released by an inpatient evaluation and treatment facility in accordance with RCW 71.34.170.
(15) Information concerning treatment of children and all information obtained through treatment under this chapter may be disclosed only in accordance with RCW 71.34.200.
(16) Availability of court records and files in accordance with RCW 71.34.210.
(17) Mental health services information must only be released in accordance with RCW 71.34.225.
Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
WAC 388-865-0580 Child long-term inpatient treatment facilities. Child long-term inpatient treatment facilities must develop a written plan for assuring that services provided are appropriate to the developmental needs of children and youth, including:
(1) If there is not a child psychiatrist on the staff, there must be a child psychiatrist available for consultation.
(2) There must be a psychologist with documented evidence of skill and experience in working with children and youth available either on the clinical staff or by consultation, responsible for planning and reviewing psychological services and for developing a written set of guidelines for psychological services.
(3) There must be a registered nurse, with training and experience in working with psychiatrically impaired children and youth, on staff as a full-time or part-time employee who must be responsible for all nursing functions.
(4) There must be a social worker with experience in working with children and youth on staff as a full-time or part-time employee who must be responsible for social work functions and the integration f these functions into the individualized treatment plan.
(5) There must be an educational/vocational assessment of each resident with appropriate educational/vocational programs developed and implemented or assured on the basis of that assessment.
(6) There must be an occupational therapist available who has experience in working with psychiatrically impaired children and youth responsible for occupational therapy functions and the integration of these functions into treatment.
(7) There must be a recreational therapist available who has had experience in working with psychiatrically impaired children and youth responsible for the recreational therapy functions and the integration of these functions into treatment.
(8) Disciplinary policies and practices must be stated in writing:
(a) Discipline must be fair, reasonable, consistent and related to the behavior of the resident. Discipline, when needed, must be consistent with the individualized treatment plan.
(b) Abusive, cruel, hazardous, frightening or humiliating disciplinary practices must not be used. Seclusion and restraints must not be used as punitive measures. Corporal punishment must not be used.
(c) Disciplinary measures must be documented in the medical record.
(9) Residents must be protected from assault, abuse and neglect. Suspected or alleged incidents of nonaccidental injury, sexual abuse, assault, cruelty or neglect to a child must be reported to a law enforcement agency or to the department of social and health services and comply with chapter 26.44 RCW.
(10) Orientation material must be made available to facility personnel, clinical staff and/or consultants informing practitioners of their reporting responsibilities and requirements. Appropriate local police and department phone numbers must be available to personnel and staff.
(11) When suspected or alleged abuse is reported, the medical record must reflect the fact that an oral or written report has been made to the child protective services of DSHS or to a law enforcement agency. This note must include the date and time that the report was made, the agency to which it was made and the signature of the person making the report. Contents of the report need not be included in the medical record.
Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
WAC 388-865-0585 Petition for the right to possess a firearm. An adult is entitled to the restoration of the right to firearm possession when he or she no longer requires treatment or medication for a condition related to the involuntary commitment. This is described in RCW 9.41.047 (3)(a).
(1) an adult who wants his or her right to possess a firearm restored may petition the court that ordered involuntary treatment or the superior court of the county in which he or she lives for a restoration of the right to possess firearms. At a minimum, the petition must include:
(a) The fact, date, and place of involuntary treatment;
(b) The fact, date, and release from involuntary treatment;
(c) A certified copy of the most recent order of commitment with the findings and conclusions of law.
(2) The person must show the court that he/she no longer requires treatment or medication for the condition related to the commitment.
(3) If the court requests relevant information about the commitment or release to make a decision, the mental health professionals who participated in the evaluation and treatment must give the court that information.
The following sections of the Washington Administrative Code are repealed:
|WAC 388-865-0501||Certification based on deemed status.|
|WAC 388-865-0502||Single bed certification.|
|WAC 388-865-0504||Exception to rule -- Long-term certification.|
|WAC 388-865-0505||Evaluation and treatment facility certification -- Minimum standards.|
|WAC 388-865-0510||Standards for administration.|
|WAC 388-865-0515||Admission and intake evaluation.|
|WAC 388-865-0530||Competency requirements for staff.|
|WAC 388-865-0535||The process for gaining certification and renewal of certification.|
|WAC 388-865-0540||Fees for evaluation and treatment facility certification.|
|WAC 388-865-0545||Use of seclusion and restraint procedures -- Adults.|
|WAC 388-865-0546||Use of seclusion and restraint procedures -- Children.|
|WAC 388-865-0550||Rights of all consumers who receive community inpatient services.|
|WAC 388-865-0555||Rights of consumers receiving involuntary inpatient services.|
|WAC 388-865-0557||Rights related to antipsychotic medication.|
|WAC 388-865-0560||Rights of consumers who receive emergency and inpatient services voluntarily.|
|WAC 388-865-0565||Petition for the right to possess a firearm.|