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.
