Date of Adoption: November 20, 2003.

     Purpose: The Mental Health Division is adopting new WAC 388-865-0217 and amending WAC 388-865-0150, to implement a state funded eligibility category, psychiatric indigent inpatient (PII) program, to provide emergent psychiatric inpatient services to qualified persons. This program replaces the psychiatric inpatient portion of the medically indigent program, which the legislature ended on June 30, 2003. When effective, the permanent rule will replace the emergency rule filed as WSR 03-19-009.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-865-0150.

     Statutory Authority for Adoption: RCW 71.05.560, 71.24.035, and 71.34.800.

     Other Authority: Chapter 25, Laws of 2003 1st sp.s.

      Adopted under notice filed as WSR 03-19-096 on September 15, 2003.

     Changes Other than Editing from Proposed to Adopted Version: The following changes were made in response to public comments:

     1. WAC 388-865-0217, subsection (3)(b) will become subsection (3)(c) and read "If a client's income and/or resources exceed the standard for medically needy (MN), as described in WAC 388-478-0070, the client must spend down the excess amount as described in 388-519-0100...." This change was made because there was a public comment that the resource rule references were unclear.

     2. WAC 388-865-0217, subsection (3)(c) will become subsection (3)(d) and read "A client who is voluntarily admitted must have incurred an emergency medical expense requirement (EMER) of two thousand dollars over a twelve-month period. A client who is detained under the Involuntary Treatment Act (ITA) is exempt from medical expense requirement (EMER)." This change was made in response to public comment that involuntary clients should be exempt from the EMER to be consistent with previous policy under the medically indigent program.

     3. Proposed WAC 388-865-0217, subsection (4) will be moved to subsection (3)(b) and the language will be revised to read as follows: "Consumers applying for the psychiatric indigent inpatient (PII) program are subject to the income and resource rules for TANF and TANF-related clients in chapter 388-450 and 388-470 WAC." This change was made because there was a public comment that the resource rule references were unclear.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 1, Repealed 0.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 0, 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 1, Amended 1, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

November 20, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     "Child" means a person who has not reached his/her eighteenth birthday. For persons eligible for the Medicaid program, child means a person who has not reached his/her twenty-first birthday.

     "Clinical services" means those direct age and culturally appropriate consumer services which either:

     (1) Assess a consumer's condition, abilities or problems;

     (2) Provide therapeutic interventions which are designed to ameliorate psychiatric symptoms and improve a consumer's functioning.

     "Consumer" means a person who has applied for, is eligible for or who has received mental health services. For a child, under the age of thirteen, or for a child age thirteen or older whose parents or legal guardians are involved in the treatment plan, the definition of consumer includes parents or legal guardians.

     "Consultation" means the clinical review and development of recommendations regarding the job responsibilities, activities, or decisions of, clinical staff, contracted employees, volunteers, or students by persons with appropriate knowledge and experience to make recommendations.

     "Cultural competence" means a set of congruent behaviors, attitudes, and policies that come together in a system or agency and enable that system or agency to work effectively in cross-cultural situations. A culturally competent system of care acknowledges and incorporates at all levels the importance of language and culture, assessment of cross-cultural relations, knowledge and acceptance of dynamics of cultural differences, expansion of cultural knowledge and adaptation of services to meet culturally unique needs.

     "Ethnic minority" or "racial/ethnic groups" means, for the purposes of this chapter, any of the following general population groups:

     (1) African American;

     (2) An American Indian or Alaskan native, which includes:

     (a) A person who is a member ((of)) or considered to be a member in a federally recognized tribe;

     (b) A person determined eligible to be found Indian by the secretary of interior, and

     (c) An Eskimo, Aleut, or other Alaskan native.

     (d) A Canadian Indian, meaning a person of a treaty tribe, Metis community, or nonstatus Indian community from Canada.

     (e) An unenrolled Indian meaning a person considered Indian by a federally or nonfederally recognized Indian tribe or off reservation Indian/Alaskan native community organization.

     (3) Asian/Pacific Islander; or

     (4) Hispanic.

     "Medical necessity" or "medically necessary" - A term for describing a requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions in the recipient that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause or physical deformity or malfunction, and there is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the person requesting service. For the purpose of this chapter "course of treatment" may include mere observation or, where appropriate, no treatment at all.

     "Mental health division" means the mental health division of the Washington state department of social and health services (DSHS). DSHS has designated the mental health division as the state mental health authority to administer the state and Medicaid funded mental health program authorized by chapters 71.05, 71.24, and 71.34 RCW.

     "Mental health professional" means:

     (1) A psychiatrist, psychologist, psychiatric nurse or social worker as defined in chapter 71.05 and 71.34 RCW;

     (2) A person with a masters degree or further advanced degree in counseling or one of the social sciences from an accredited college or university. Such person shall have, in addition, at least two years of experience in direct treatment of persons with mental illness or emotional disturbance, such experience gained under the supervision of a mental health professional;

     (3) A person who meets the waiver criteria of RCW 71.24.260, which was granted prior to 1986.

     (4) A person who had an approved waiver to perform the duties of a mental health profession that was requested by the regional support network and granted by the mental health division prior to July 1, 2001; or

     (5) A person who has been granted a time-limited exception of the minimum requirements of a mental health professional by the mental health division consistent with WAC 388-865-265.

     "Mental health specialist" means:

     (1) A "child mental health specialist" is defined as a mental health professional with the following education and experience:

     (a) A minimum of one hundred actual hours (not quarter or semester hours) of special training in child development and the treatment of children and youth with serious emotional disturbance and their families; and

     (b) The equivalent of one year of full-time experience in the treatment of seriously emotionally disturbed children and youth and their families under the supervision of a child mental health specialist.

     (2) A "geriatric mental health specialist" is defined as a mental health professional who has the following education and experience:

     (a) A minimum of one hundred actual hours (not quarter or semester hours) of specialized training devoted to the mental health problems and treatment of persons sixty years of age or older; and

     (b) The equivalent of one year of full-time experience in the treatment of persons sixty years of age or older, under the supervision of a geriatric mental health specialist.

     (3) An "ethnic minority mental health specialist" is defined as a mental health professional who has demonstrated cultural competence attained through major commitment, ongoing training, experience and/or specialization in serving ethnic minorities, including evidence of one year of service specializing in serving the ethnic minority group under the supervision of an ethnic minority mental health specialist; and

     (a) Evidence of support from the ethnic minority community attesting to the person's commitment to that community; or

     (b) A minimum of one hundred actual hours (not quarter or semester hours) of specialized training devoted to ethnic minority issues and treatment of ethnic minority consumers.

     (4) A "disability mental health specialist" is defined as a mental health professional with special expertise in working with an identified disability group. For purposes of this chapter only, "disabled" means an individual with a disability other than a mental illness, including a developmental disability, serious physical handicap, or sensory impairment.

     (a) If the consumer is deaf, the specialist must be a mental health professional with:

     (i) Knowledge about the deaf culture and psychosocial problems faced by people who are deaf; and

     (ii) Ability to communicate fluently in the preferred language system of the consumer.

     (b) The specialist for consumers with developmental disabilities must be a mental health professional who:

     (i) Has at least one year's experience working with people with developmental disabilities; or

     (ii) Is a developmental disabilities professional as defined in RCW 71.05.020.

     "Older person" means an adult who is sixty years of age or older.

     "Service recipient" means for the purposes of a mental health prepaid health plan, a consumer eligible for the Title XIX Medicaid program.

     "Substantial hardship" means that a consumer will not be billed for emergency involuntary treatment if he or she meets the eligibility standards of the ((medically)) psychiatric indigent inpatient program that is administered by the DSHS ((medical assistance)) economic services administration.

     "Supervision" means monitoring of the administrative, clinical, or clerical work performance of staff, students, volunteers, or contracted employees by persons with the authority to give direction and require change.

     "Underserved" means consumers who are:

     (1) Minorities;

     (2) Children;

     (3) Older adults;

     (4) Disabled; or

     (5) Low-income persons.

[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, § 388-865-0150, filed 5/31/01, effective 7/1/01.]

     (2) The psychiatric indigent inpatient (PII) program pays only for involuntary and emergent voluntary inpatient psychiatric care in community hospitals within the state of Washington. Psychiatric indigent inpatient (PII) does not cover ancillary charges for physician, transportation, pharmacy or other costs associated with an inpatient psychiatric hospitalization.

     (3) To be eligible for the psychiatric indigent inpatient (PII) program, a client is subject to the following conditions and limitations:

     (a) The client must have an involuntary or voluntary inpatient psychiatric admission authorized by a regional support network (RSN) in the month of application or within the three months immediately preceding the month of application.

     (b) Consumers applying for the psychiatric indigent inpatient (PII) program are subject to the income and resource rules for TANF and TANF-related clients in chapter 388-450 and chapter 388-470 WAC.

     (c) If a client's income and/or resources exceed the standard for medically needy (MN), as described in WAC 388-478-0070, the client must spend down the excess amount as described in WAC 388-519-0100 for the client to be eligible for the psychiatric indigent inpatient (PII) program.

     (d) A client who is voluntarily admitted must have incurred an emergency medical expense requirement (EMER) of two thousand dollars over a twelve-month period. A client who is detained under the Involuntary Treatment Act (ITA) is exempt from the emergency medical expense requirement (EMER).

     (i) Qualifying emergency medical expense requirement (EMER) expenses are psychiatric inpatient services in a community hospital.

     (ii) The emergency medical expense requirement (EMER) period lasts for twelve calendar months, beginning on the first day of the month of certification for psychiatric indigent inpatient (PII) and continuing through the last day of the twelfth month.

     (e) A client is limited to a single three-month period of psychiatric indigent inpatient (PII) eligibility per twelve-month emergency medical expense requirement (EMER) period.

     (4) Clients are not eligible for the psychiatric indigent inpatient (PII) program if they:

     (a) Are eligible for, or receiving, any other cash or medical program; or

     (b) Entered the Washington state specifically to obtain medical care; or

     (c) Are inmates of a federal or state prison.

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