AN ACT
Relating to a single system of accountability for the mental health service
delivery system; amending RCW 71.24.400, 71.24.405, and 71.24.415; reenacting
and amending RCW 71.24.025; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE
OF THE STATE OF WASHINGTON:
Sec.
1. RCW
71.24.400 and 1994 c 259 s 1 are each amended to read as follows:
The
legislature finds that the current complex set of federal, state, and local
rules and regulations, audited and administered at multiple levels ((of)),
which affect the community mental health service delivery
system, focus primarily on the process of providing mental health services and
do not sufficiently address consumer and system outcomes. To this extent, the
legislature finds that the intent of RCW 71.24.015 related to reduced
administrative layering, duplication, and reduced administrative costs need
much more aggressive action.
Sec.
2. RCW
71.24.405 and 1994 c 259 s 2 are each amended to read as follows:
The
department of social and health services shall establish a single comprehensive
and collaborative project within regional support networks and with local
mental health service providers aimed at creating innovative and streamlined
community mental health service delivery systems, in order to carry out the
purposes set forth in RCW 71.24.400 and to capture the diversity of the
community mental health service delivery system.
The
project must accomplish the following:
(1)
Identification, review, and cataloging of all rules, regulations, duplicative
administrative and monitoring functions, and other requirements that currently
lead to inefficiencies in the community mental health service delivery system
and, if possible, eliminate the requirements;
(2)
The systematic and incremental development of a single system of accountability
for all ((appropriated funds used to provide)) federal, state, and
local funds provided to the community mental health ((services.
Assessment must be made regarding the feasibility of also including)) service
delivery system. Systematic efforts should be made to include federal and
local funds into the single system of accountability;
(3)
The elimination of process regulations and related contract and reporting
requirements. In place of the regulations and requirements, a set of outcomes
for mental health adult and children clients according to chapter 71.24 RCW
must be used to measure the performance of mental health service providers and
regional support networks. Such outcomes shall focus on stabilizing
out-of-home and hospital care, increasing stable community living, increasing
age-appropriate activities, achieving family and consumer satisfaction with
services, and system efficiencies;
(4)
Evaluation of the feasibility of contractual agreements between the department
of social and health services and regional support networks and mental health
service providers that link financial incentives to the success or failure of
mental health service providers and regional support networks to meet outcomes
established for mental health service clients;
(5)
The involvement of mental health consumers and their representatives in the
pilot projects. Mental health consumers and their representatives will be
involved in the development of outcome standards for mental health clients and
other related aspects of the pilot projects; and
(6) An
independent evaluation component to measure the success of the projects.
Sec.
3. RCW
71.24.415 and 1994 c 259 s 4 are each amended to read as follows:
To
carry out the purposes specified in RCW 71.24.400, the department of social and
health services is encouraged to utilize its authority to immediately eliminate
any unnecessary rules, regulations, standards, or contracts, to immediately
eliminate duplication of audits or any other unnecessarily duplicated
functions, and to seek any waivers of federal or state rules or regulations
necessary to achieve the purpose of streamlining the community mental
health service delivery system and infusing it with incentives that
reward efficiency, positive outcomes for clients, and quality services.
Sec.
4. RCW
71.24.025 and 1994 sp.s. c 9 s 748 and 1994 c 204 s 1 are each reenacted and
amended to read as follows:
Unless
the context clearly requires otherwise, the definitions in this section apply
throughout this chapter.
(1)
"Acutely mentally ill" means a condition which is limited to a
short-term severe crisis episode of:
(a) A
mental disorder as defined in RCW 71.05.020(2) or, in the case of a child, as
defined in RCW 71.34.020(12);
(b)
Being gravely disabled as defined in RCW 71.05.020(1) or, in the case of a
child, as defined in RCW 71.34.020(8); or
(c)
Presenting a likelihood of serious harm as defined in RCW 71.05.020(3) or, in
the case of a child, as defined in RCW 71.34.020(11).
(2)
"Available resources" means those funds which shall be appropriated
under this chapter by the legislature during any biennium for the purpose of
providing community mental health programs under RCW 71.24.045. When regional
support networks are established or after July 1, 1995, "available
resources" means federal funds, except those provided according to Title
XIX of the Social Security Act, and state funds appropriated under this chapter
or chapter 71.05 RCW by the legislature during any biennium for the purpose of
providing residential services, resource management services, community support
services, and other mental health services. This does not include funds
appropriated for the purpose of operating and administering the state
psychiatric hospitals, except as negotiated according to RCW 71.24.300(1)(d).
(3)
"Licensed service provider" means an entity licensed according to
this chapter or chapter 71.05 RCW that meets state minimum standards or
individuals licensed under chapter 18.57, 18.71, 18.83, or 18.79 RCW, as it
applies to registered nurses and advanced registered nurse practitioners.
(4)
"Child" means a person under the age of eighteen years.
(5)
"Chronically mentally ill adult" means an adult who has a mental
disorder and meets at least one of the following criteria:
(a)
Has undergone two or more episodes of hospital care for a mental disorder
within the preceding two years; or
(b)
Has experienced a continuous psychiatric hospitalization or residential
treatment exceeding six months' duration within the preceding year; or
(c)
Has been unable to engage in any substantial gainful activity by reason of any
mental disorder which has lasted for a continuous period of not less than
twelve months. "Substantial gainful activity" shall be defined by
the department by rule consistent with Public Law 92‑603, as amended.
(6)
"Severely emotionally disturbed child" means an infant or child who
has been determined by the regional support network to be experiencing a mental
disorder as defined in chapter 71.34 RCW, including those mental disorders that
result in a behavioral or conduct disorder, that is clearly interfering with
the child's functioning in family or school or with peers and who meets at
least one of the following criteria:
(a)
Has undergone inpatient treatment or placement outside of the home related to a
mental disorder within the last two years;
(b)
Has undergone involuntary treatment under chapter 71.34 RCW within the last two
years;
(c) Is
currently served by at least one of the following child-serving systems:
Juvenile justice, child-protection/welfare, special education, or developmental
disabilities;
(d) Is
at risk of escalating maladjustment due to:
(i)
Chronic family dysfunction involving a mentally ill or inadequate caretaker;
(ii)
Changes in custodial adult;
(iii)
Going to, residing in, or returning from any placement outside of the home, for
example, psychiatric hospital, short-term inpatient, residential treatment,
group or foster home, or a correctional facility;
(iv)
Subject to repeated physical abuse or neglect;
(v)
Drug or alcohol abuse; or
(vi)
Homelessness.
(7) "Community
mental health service delivery system" means public or private agencies
that provide services specifically to persons with mental disorders as defined
under RCW 71.05.020 and receive funding from various public sources including:
(a) Federal medicare, medicaid, or early periodic screening, diagnostic, and
treatment programs; or (b) state funds from the division of mental health,
division of children and family services, division of alcohol and substance
abuse, or division of vocational rehabilitation of the department of social and
health services.
(8)
"Community mental health program" means all mental health services
established by a county authority. After July 1, 1995, or when the regional
support networks are established, "community mental health program"
means all activities or programs using available resources.
(((8)))
(9) "Community support services" means services for acutely
mentally ill persons, chronically mentally ill adults, and severely emotionally
disturbed children and includes: (a) Discharge planning for clients leaving
state mental hospitals, other acute care inpatient facilities, inpatient
psychiatric facilities for persons under twenty-one years of age, and other
children's mental health residential treatment facilities; (b) sufficient
contacts with clients, families, schools, or significant others to provide for
an effective program of community maintenance; and (c) medication monitoring.
After July 1, 1995, or when regional support networks are established, for
adults and children "community support services" means services
authorized, planned, and coordinated through resource management services
including, at least, assessment, diagnosis, emergency crisis intervention
available twenty-four hours, seven days a week, prescreening determinations for
mentally ill persons being considered for placement in nursing homes as
required by federal law, screening for patients being considered for admission
to residential services, diagnosis and treatment for acutely mentally ill and severely
emotionally disturbed children discovered under screening through the federal
Title XIX early and periodic screening, diagnosis, and treatment program,
investigation, legal, and other nonresidential services under chapter 71.05
RCW, case management services, psychiatric treatment including medication
supervision, counseling, psychotherapy, assuring transfer of relevant patient
information between service providers, other services determined by regional
support networks, and maintenance of a patient tracking system for chronically
mentally ill adults and severely emotionally disturbed children.
(((9)))
(10) "County authority" means the board of county
commissioners, county council, or county executive having authority to
establish a community mental health program, or two or more of the county
authorities specified in this subsection which have entered into an agreement
to provide a community mental health program.
(((10)))
(11) "Department" means the department of social and health
services.
(((11)))
(12) "Mental health services" means community services
pursuant to RCW 71.24.035(5)(b) and other services provided by the state for
the mentally ill. When regional support networks are established, or after
July 1, 1995, "mental health services" shall include all services
provided by regional support networks.
(((12)))
(13) "Mentally ill persons" and "the mentally ill"
mean persons and conditions defined in subsections (1), (5), (6), and (((16)))
(17) of this section.
(((13)))
(14) "Regional support network" means a county authority or
group of county authorities recognized by the secretary that enter into joint
operating agreements to contract with the secretary pursuant to this chapter.
(((14)))
(15) "Residential services" means a facility or distinct part
thereof which provides food and shelter, and may include treatment services.
When
regional support networks are established, or after July 1, 1995, for adults
and children "residential services" means a complete range of residences
and supports authorized by resource management services and which may involve a
facility, a distinct part thereof, or services which support community living,
for acutely mentally ill persons, chronically mentally ill adults, severely
emotionally disturbed children, or seriously disturbed adults determined by the
regional support network to be at risk of becoming acutely or chronically
mentally ill. The services shall include at least evaluation and treatment
services as defined in chapter 71.05 RCW, acute crisis respite care, long-term
adaptive and rehabilitative care, and supervised and supported living services,
and shall also include any residential services developed to service mentally
ill persons in nursing homes. Residential services for children in out-of-home
placements related to their mental disorder shall not include the costs of food
and shelter, except for children's long-term residential facilities existing
prior to January 1, 1991.
(((15)))
(16) "Resource management services" mean the planning,
coordination, and authorization of residential services and community support
services administered pursuant to an individual service plan for acutely
mentally ill adults and children, chronically mentally ill adults, severely
emotionally disturbed children, or seriously disturbed adults determined by the
regional support network at their sole discretion to be at risk of becoming
acutely or chronically mentally ill. Such planning, coordination, and
authorization shall include mental health screening for children eligible under
the federal Title XIX early and periodic screening, diagnosis, and treatment
program. Resource management services include seven day a week, twenty-four
hour a day availability of information regarding mentally ill adults' and
children's enrollment in services and their individual service plan to
county-designated mental health professionals, evaluation and treatment
facilities, and others as determined by the regional support network.
(((16)))
(17) "Seriously disturbed person" means a person who:
(a) Is
gravely disabled or presents a likelihood of serious harm to oneself or others
as a result of a mental disorder as defined in chapter 71.05 RCW;
(b)
Has been on conditional release status at some time during the preceding two
years from an evaluation and treatment facility or a state mental health
hospital;
(c)
Has a mental disorder which causes major impairment in several areas of daily
living;
(d)
Exhibits suicidal preoccupation or attempts; or
(e) Is
a child diagnosed by a mental health professional, as defined in RCW 71.05.020,
as experiencing a mental disorder which is clearly interfering with the child's
functioning in family or school or with peers or is clearly interfering with
the child's personality development and learning.
(((17)))
(18) "Secretary" means the secretary of social and health
services.
(((18)))
(19) "State minimum standards" means: (a) Minimum
requirements for delivery of mental health services as established by
departmental rules and necessary to implement this chapter, including but not
limited to licensing service providers and services; (b) minimum service
requirements for licensed service providers for the provision of mental health
services as established by departmental rules pursuant to chapter 34.05 RCW as
necessary to implement this chapter, including, but not limited to:
Qualifications for staff providing services directly to mentally ill persons;
the intended result of each service; and the rights and responsibilities of
persons receiving mental health services pursuant to this chapter; (c) minimum
requirements for residential services as established by the department in rule
based on clients' functional abilities and not solely on their diagnoses,
limited to health and safety, staff qualifications, and program outcomes.
Minimum requirements for residential services are those developed in
collaboration with consumers, families, counties, regulators, and residential
providers serving the mentally ill. Minimum requirements encourage the
development of broad-range residential programs, including integrated housing
and cross-systems programs where appropriate, and do not unnecessarily restrict
programming flexibility; and (d) minimum standards for community support
services and resource management services, including at least qualifications
for resource management services, client tracking systems, and the transfer of
patient information between service providers.
(((19)))
(20) "Tribal authority," for the purposes of this section and
RCW 71.24.300 only, means: The federally recognized Indian tribes and the
major Indian organizations recognized by the secretary insofar as these
organizations do not have a financial relationship with any regional support
network that would present a conflict of interest.
NEW SECTION. Sec. 5. This act
is necessary for the immediate preservation of the public peace, health, or
safety, or support of the state government and its existing public
institutions, and shall take effect immediately.
