Original Notice.

     Preproposal statement of inquiry was filed as WSR 04-08-122.

     Title of Rule and Other Identifying Information: Adding new sections and amending other related rules as appropriate in chapter 388-865 WAC to include provisions for consumer peer support services.

     Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on May 10, 2005, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than May 11, 2005.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., May 10, 2005.

     Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by May 6, 2005, TTY (360) 664-6178 or (360) 664-6097.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These rules implement the state's Medicaid 1915(b) waiver under the Social Security Act and state plan amendment to establish a peer support modality for Community Mental Health Agency (CMHA) services.

     Reasons Supporting Proposal: Implementation of these rules is necessary to maintain compliance with the Medicaid 1915(b) waiver and state plan amendment. The rule establishes standards for licensing CMHA peer support services and certifying peer counselors.

     Statutory Authority for Adoption: RCW 71.24.035 (5)(c) and 71.24.037.

     Statute Being Implemented: RCW 71.24.035 (5)(c) and 71.24.037.

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

     Name of Proponent: Department of Social and Health Services, governmental.

     Name of Agency Personnel Responsible for Drafting and Implementation: Karie Castleberry, Olympia, Washington, (360) 902-0799; and Enforcement: Kellean Foster, Olympia, Washington, (360) 902-0795.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. Affected regional support networks are government entities and are not small businesses.

     A cost-benefit analysis is not required under RCW 34.05.328. The proposed rule does not meet the definition of a significant rule under RCW 34.05.328.

March 31, 2005

Andy Fernando, Manager

Rules and Policies Assistance Unit

     (1) In order to be certified as a peer counselor, all applicants must meet the following requirements:

     (a) Be a self-identified consumer of mental health services, as defined;

     (b) Maintain registration as a counselor under chapter 18.19 RCW;

     (c) Complete specialized training provided or contracted by the mental health division; and

     (d) Successfully pass an examination administered by the mental health division or an authorized contractor.

     (2) The training requirement specified in (2)(c) of this subsection is waived for consumers who were trained prior to October 1, 2004 by trainers approved by the mental health division, provided that all of the other requirements are met by January 31, 2005.

     (3) A consumer whose request for certification is denied has the right to contest this decision by submitting a written request to the mental health division within twenty-eight calendar days of the date of notification:

     (a) The request should include the consumer's name, address, and telephone number and a brief explanation of the issue and resolution being requested;

     (b) The consumer also has the right to use the state administrative hearing process as described in chapter 388-02 WAC;

     (c) A consumer who completes the administrative hearing process may request reconsideration in accordance with chapter 388-02 WAC but does not have recourse to review by the DSHS board of appeals.

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     "Certified peer counselor" is defined as a consumer of mental health services who has met the registration, experience, and training requirements, has satisfactorily passed the examination, and has been issued a certificate by the mental health division as specified in WAC 388-865-0107.

     "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 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 chapters 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 psychiatric indigent inpatient program that is administered by the DSHS 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, 71.34.800, and 2003 1st sp.s. c 25. 03-24-030, § 388-865-0150, filed 11/24/03, effective 12/25/03. 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.]

     (1) Provide the following services directly, or contract with sufficient numbers and variety of licensed and/or certified service providers to ensure that persons eligible for regional support network services have access to at least the following services:

     (a) Emergency crisis intervention services;

     (b) Case management services;

     (c) Psychiatric treatment including medication supervision;

     (d) Counseling and psychotherapy services;

     (e) Day treatment services as defined in RCW 71.24.300(5) and 71.24.035(7); ((and))

     (f) Consumer employment services as defined in RCW 71.24.035 (5)(e); and

     (g) Peer support services.

     (2) Conduct prescreening determinations for providing community support services for persons with mental illness who are being considered for placement in nursing homes (RCW 71.24.025(7) and 71.24.025(9)); and

     (3) Complete screening for persons with mental illness who are being considered for admission to residential services funded by the regional support network (RCW 71.24.025 and 71.24.025(9)).

[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, § 388-865-0230, filed 5/31/01, effective 7/1/01.]

     (1) Emergency crisis intervention services;

     (2) Case management services;

     (3) Psychiatric treatment, including medication supervision;

     (4) Counseling and psychotherapy services;

     (5) Day treatment services; ((and/or))

     (6) Consumer employment services; and/or

     (7) Peer support services.

[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, § 388-865-0400, filed 5/31/01, effective 7/1/01.]

     (2) The community support service provider that is licensed to provide peer support services must assure that all general minimum standards for community support services are met.

     (3) Services must be provided by a peer counselor who has been certified consistent with WAC 388-865-0107 and who discloses him/herself to be a consumer of mental health services.

     (4) Services must be documented in the clinical record at least monthly, including objective progress toward goals established in the individual service plan.

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