READ FIRST TIME 02/11/14.   

     AN ACT Relating to state purchasing of mental health and chemical dependency treatment services; amending RCW 71.24.015, 71.24.016, 71.24.025, 71.24.035, 71.24.045, 71.24.100, 71.24.110, 71.24.340, 71.24.420, 70.96A.020, 70.96A.040, 70.96A.050, 70.96A.080, 70.96A.320, 71.24.049, 71.24.061, 71.24.155, 71.24.160, 71.24.250, 71.24.300, 71.24.310, 71.24.350, 71.24.370, 71.24.455, 71.24.470, 71.24.480, 71.24.845, 71.24.055, 71.24.065, 71.24.240, 71.24.320, 71.24.330, 71.24.360, 71.24.405, 71.24.430, and 74.09.522; amending 2013 c 338 s 1 (uncodified); adding new sections to chapter 43.20A RCW; adding new sections to chapter 71.24 RCW; providing an effective date; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   2013 c 338 s 1 (uncodified) is amended to read as follows:
     (1)(a) Beginning ((May)) April 1, 2014, the legislature shall convene a task force to examine reform of the adult behavioral health system, with voting members as provided in this subsection.
     (i) The president of the senate shall appoint ((one)) two members from each of the two largest caucuses of the senate.
     (ii) The speaker of the house of representatives shall appoint ((one)) two members from each of the two largest caucuses in the house of representatives.
     (iii) The governor shall appoint five members consisting of the secretary of the department of social and health services or the secretary's designee, the director of the health care authority or the director's designee, the director of the office of financial management or the director's designee, the secretary of the department of corrections or the secretary's designee, and a representative of the governor.
     (iv) The Washington state association of counties shall appoint three members.
     (v) The governor shall request participation by a representative of tribal governments.
     (b) The task force shall choose two cochairs from among its legislative members.
     (c) The task force shall adopt a bottom-up approach and welcome input and participation from all stakeholders interested in the improvement of the adult behavioral health system. To that end, the task force must invite participation from, at a minimum, the following: The department of commerce, behavioral health service recipients and their families; local government; representatives of regional support networks; representatives of county coordinators; law enforcement; city and county jails; tribal representatives; behavioral health service providers; housing providers; labor representatives; counties with state hospitals; mental health advocates; chemical dependency advocates; public defenders with involuntary mental health commitment or mental health court experience; chemical dependency experts working with drug courts; medicaid managed care plan and associated delivery system representatives; long-term care service providers; the Washington state hospital association; and individuals with expertise in evidence-based and research-based behavioral health service practices. Leadership of subcommittees formed by the task force may be drawn from this body of invited participants.
     (2) The task force shall undertake a systemwide review of the adult behavioral health system and make recommendations for reform concerning, but not limited to, the following:
     (a) The means by which services are purchased and delivered for adults with mental illness and chemical dependency disorders through the department of social and health services and the health care authority, including:
     (i) Guidance for the creation of common regional service areas for purchasing behavioral health services and medical care services by the department and the authority, taking into consideration any proposal submitted by the Washington state association of counties under section 2 of this act; or
     (ii) Identification of key issues that must be addressed by the health care authority and the department of social and health services to achieve the full integration of medical and behavioral health services by January 1, 2019;
     (b) Availability of effective means to promote recovery and prevent harm associated with mental illness and chemical dependency;
     (c) Crisis services, including boarding of mental health patients outside of regularly certified treatment beds;
     (d) Best practices for cross-system collaboration between behavioral health treatment providers, medical care providers, long-term care service providers, entities providing health home services to high-risk medicaid clients, law enforcement, and criminal justice agencies; and
     (e) Public safety practices involving persons with mental illness and chemical dependency with forensic involvement.
     (3) Staff support for the task force must be provided by the senate committee services and the house of representatives office of program research.
     (4) Legislative members of the task force must be reimbursed for travel expenses in accordance with RCW 44.04.120. Nonlegislative members, except those representing an employer or organization, are entitled to be reimbursed for travel expenses in accordance with RCW 43.03.050 and 43.03.060.
     (5) The expenses of the task force must be paid jointly by the senate and house of representatives. Task force expenditures are subject to approval by the senate facilities and operations committee and the house of representatives executive rules committee, or their successor committees.
     (6) The task force shall report its findings and recommendations to the governor and the appropriate committees of the legislature by January 1, 2015, except that recommendations under subsection (2)(a)(i) of this section must be submitted to the governor by August 1, 2014, and recommendations under subsection (2)(a)(ii) of this section must be submitted to the governor by September 1, 2014.
     (7) This section expires June 1, 2015.

NEW SECTION.  Sec. 2   A new section is added to chapter 43.20A RCW to read as follows:
     (1) The department and the health care authority shall jointly establish regional service areas by September 1, 2014, as provided in this section.
     (2) Counties, through the Washington state association of counties, must be given the opportunity to propose the composition of no more than nine regional service areas. Each service area must:
     (a) Include a sufficient number of medicaid lives to support full financial risk managed care contracting for services included in contracts with the department or the health care authority;
     (b) Include full counties that are contiguous with one another; and
     (c) Reflect natural medical and behavioral health service referral patterns and shared clinical, health care service, behavioral health service, and behavioral health crisis response resources.
     (3) The Washington state association of counties must submit their recommendations to the department, the health care authority, and the task force described in section 1 of this act on or before July 1, 2014.

NEW SECTION.  Sec. 3   A new section is added to chapter 43.20A RCW to read as follows:
     (1) Any agreement or contract by the department or the health care authority to provide behavioral health services as defined under RCW 71.24.025 to persons eligible for benefits under medicaid, Title XIX of the social security act, and to persons not eligible for medicaid must include the following:
     (a) Contractual provisions consistent with the intent expressed in RCW 71.24.015, 71.36.005, 70.96A.010, and 70.96A.011;
     (b) Standards regarding the quality of services to be provided, including increased use of evidence-based, research-based, and promising practices, as defined in RCW 71.24.025;
     (c) Accountability for the client outcomes established in RCW 43.20A.895, 70.320.020, and 71.36.025 and performance measures linked to those outcomes;
     (d) Standards requiring behavioral health organizations to maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the department or the health care authority and to protect essential existing behavioral health system infrastructure and capacity, including a continuum of chemical dependency services;
     (e) Provisions to require that behavioral health organizations offer contracts to managed health care systems under chapter 74.09 RCW or primary care practice settings to provide access to chemical dependency professional services and mental health services integrated in primary care settings for individuals with behavioral health and medical comorbidities;
     (f) Provisions to require that medically necessary chemical dependency treatment services be available to clients;
     (g) Standards requiring the use of behavioral health service provider reimbursement methods that incentivize improved performance with respect to the client outcomes established in RCW 43.20A.895 and 71.36.025, integration of behavioral health and primary care services at the clinical level, and improved care coordination for individuals with complex care needs;
     (h) Standards related to the financial integrity of the responding organization. The department shall adopt rules establishing the solvency requirements and other financial integrity standards for behavioral health organizations. This subsection does not limit the authority of the department to take action under a contract upon finding that a behavioral health organization's financial status jeopardizes the organization's ability to meet its contractual obligations;
     (i) Mechanisms for monitoring performance under the contract and remedies for failure to substantially comply with the requirements of the contract including, but not limited to, financial deductions, termination of the contract, receivership, reprocurement of the contract, and injunctive remedies;
     (j) Provisions to maintain the decision-making independence of designated mental health professionals or designated chemical dependency specialists; and
     (k) Provisions stating that public funds appropriated by the legislature may not be used to promote or deter, encourage, or discourage employees from exercising their rights under Title 29, chapter 7, subchapter II, United States Code or chapter 41.56 RCW.
     (2) The following factors must be given significant weight in any purchasing process:
     (a) Demonstrated commitment and experience in serving low-income populations;
     (b) Demonstrated commitment and experience serving persons who have mental illness, chemical dependency, or co-occurring disorders;
     (c) Demonstrated commitment to and experience with partnerships with county and municipal criminal justice systems, housing services, and other critical support services necessary to achieve the outcomes established in RCW 43.20A.895, 70.320.020, and 71.36.025;
     (d) Recognition that meeting enrollees' physical and behavioral health care needs is a shared responsibility of contracted behavioral health organizations, managed health care systems, service providers, the state, and communities;
     (e) Consideration of past and current performance and participation in other state or federal behavioral health programs as a contractor; and
     (f) The ability to meet requirements established by the department.
     (3) For purposes of purchasing behavioral health services and medical care services for persons eligible for benefits under medicaid, Title XIX of the social security act and for persons not eligible for medicaid, the department and the health care authority must use common regional service areas. The regional service areas must be established by the department and the health care authority as provided in section 2 of this act.
     (4) Consideration must be given to using multiple-biennia contracting periods.
     (5) Each behavioral health organization operating pursuant to a contract issued under this section shall enroll clients within its regional service area who meet the department's eligibility criteria for mental health and chemical dependency services.

NEW SECTION.  Sec. 4   A new section is added to chapter 71.24 RCW to read as follows:
     (1) The secretary shall purchase mental health and chemical dependency treatment services primarily through managed care contracting.
     (2)(a) The secretary shall request a detailed plan from the entities identified in (b) of this subsection that demonstrates compliance with federal regulations related to medicaid managed care contracting, including, but not limited to: Having a sufficient network of providers to provide adequate access to mental health and chemical dependency services for residents of the regional service area that meet eligibility criteria for services, ability to maintain and manage adequate reserves, and maintenance of quality assurance processes. Any responding entity that submits a detailed plan that demonstrates that it can meet the requirements of this section must be awarded the contract to serve as the behavioral health organization.
     (b)(i) For purposes of responding to the request for a detailed plan under (a) of this subsection, all counties within a regional service area that includes more than one county shall form a responding entity through the adoption of an interlocal agreement. The interlocal agreement must specify the terms by which the responding entity shall serve as the behavioral health organization within the regional service area.
     (ii) In the event that a county has made a decision prior to January 1, 2014, not to participate in a regional support network, any private entity that had previously been certified for that county must be offered the opportunity to serve as the single responding entity for that county or group of counties.
     (iii) In the event that a regional service area is comprised of multiple counties including one that has made a decision prior to January 1, 2014, not to participate in a regional support network the counties shall adopt an interlocal agreement and may respond to the request for a detailed plan under (a) of this subsection and the private entity may also respond to the request for a detailed plan. If both responding entities meet the requirements of this section, the responding entities shall follow the department's procurement process established in subsection (2) of this section.
     (2) If an entity that has received a request under this section to submit a detailed plan does not respond to the request, a responding entity under subsection (1) of this section is unable to substantially meet the requirements of the request for a detailed plan, or more than one responding entity substantially meet the requirements for the request for a detailed plan, the department shall use a procurement process in which other entities recognized by the secretary may bid to serve as the behavioral health organization in that regional service area.
     (3) Contracts for behavioral health organizations must begin on April 1, 2016.
     (4) Upon request of one or more county authorities, the department and the health care authority may jointly purchase behavioral health services through an integrated medical and behavioral health services contract with a behavioral health organization or a managed health care system as defined in RCW 74.09.522. Any contract for such a purchase must comply with all federal medicaid and state law requirements related to managed health care contracting.

Sec. 5   RCW 71.24.015 and 2005 c 503 s 1 are each amended to read as follows:
     It is the intent of the legislature to establish a community mental health program which shall help people experiencing mental illness to retain a respected and productive position in the community. This will be accomplished through programs that focus on resilience and recovery, and practices that are evidence-based, research-based, consensus-based, or, where these do not exist, promising or emerging best practices, which provide for:
     (1) Access to mental health services for adults ((of the state who are acutely mentally ill, chronically mentally ill,)) with acute mental illness, chronic mental illness, or who are seriously disturbed and children ((of the state who are acutely mentally ill)) with acute mental illness, or who are severely emotionally disturbed, or seriously disturbed, which services recognize the special needs of underserved populations, including minorities, children, the elderly, ((disabled)) individuals with disabilities, and low-income persons. Access to mental health services shall not be limited by a person's history of confinement in a state, federal, or local correctional facility. It is also the purpose of this chapter to promote the early identification of ((mentally ill)) children with mental illness and to ensure that they receive the mental health care and treatment which is appropriate to their developmental level. This care should improve home, school, and community functioning, maintain children in a safe and nurturing home environment, and should enable treatment decisions to be made in response to clinical needs in accordance with sound professional judgment while also recognizing parents' rights to participate in treatment decisions for their children;
     (2) The involvement of persons with mental illness, their family members, and advocates in designing and implementing mental health services that reduce unnecessary hospitalization and incarceration and promote the recovery and employment of persons with mental illness. To improve the quality of services available and promote the rehabilitation, recovery, and reintegration of persons with mental illness, consumer and advocate participation in mental health services is an integral part of the community mental health system and shall be supported;
     (3) Accountability of efficient and effective services through state-of-the-art outcome and performance measures and statewide standards for monitoring client and system outcomes, performance, and reporting of client and system outcome information. These processes shall be designed so as to maximize the use of available resources for direct care of people with a mental illness and to assure uniform data collection across the state;
     (4) Minimum service delivery standards;
     (5) Priorities for the use of available resources for the care of ((the mentally ill)) individuals with mental illness consistent with the priorities defined in the statute;
     (6) Coordination of services within the department, including those divisions within the department that provide services to children, between the department and the office of the superintendent of public instruction, and among state mental hospitals, county authorities, ((regional support networks)) behavioral health organizations, community mental health services, and other support services, which shall to the maximum extent feasible also include the families of ((the mentally ill)) individuals with mental illness, and other service providers; and
     (7) Coordination of services aimed at reducing duplication in service delivery and promoting complementary services among all entities that provide mental health services to adults and children.
     It is the policy of the state to encourage the provision of a full range of treatment and rehabilitation services in the state for mental disorders including services operated by consumers and advocates. The legislature intends to encourage the development of regional mental health services with adequate local flexibility to assure eligible people in need of care access to the least-restrictive treatment alternative appropriate to their needs, and the availability of treatment components to assure continuity of care. To this end, counties ((are encouraged to)) must enter into joint operating agreements with other counties to form regional systems of care that are consistent with the regional service areas established under section 2 of this act. Regional systems of care, whether operated by a county, group of counties, or another entity shall integrate planning, administration, and service delivery duties under chapters 71.05 and 71.24 RCW to consolidate administration, reduce administrative layering, and reduce administrative costs. The legislature hereby finds and declares that sound fiscal management requires vigilance to ensure that funds appropriated by the legislature for the provision of needed community mental health programs and services are ultimately expended solely for the purpose for which they were appropriated, and not for any other purpose.
     It is further the intent of the legislature to integrate the provision of services to provide continuity of care through all phases of treatment. To this end, the legislature intends to promote active engagement with ((mentally ill)) persons with mental illness and collaboration between families and service providers.

Sec. 6   RCW 71.24.016 and 2006 c 333 s 102 are each amended to read as follows:
     (1) The legislature intends that eastern and western state hospitals shall operate as clinical centers for handling the most complicated long-term care needs of patients with a primary diagnosis of mental disorder. It is further the intent of the legislature that the community mental health service delivery system focus on maintaining ((mentally ill)) individuals with mental illness in the community. The program shall be evaluated and managed through a limited number of outcome and performance measures ((designed to hold each regional support network accountable for program success)), as provided in RCW 43.20A.895, 70.320.020, and 71.36.025.
     (2) The legislature intends to address the needs of people with mental disorders with a targeted, coordinated, and comprehensive set of evidence-based practices that are effective in serving individuals in their community and will reduce the need for placements in state mental hospitals. The legislature further intends to explicitly hold ((regional support networks)) behavioral health organizations accountable for serving people with mental disorders within the boundaries of their ((geographic boundaries)) regional service area and for not exceeding their allocation of state hospital beds. ((Within funds appropriated by the legislature for this purpose, regional support networks shall develop the means to serve the needs of people with mental disorders within their geographic boundaries. Elements of the program may include:
     (a) Crisis triage;
     (b) Evaluation and treatment and community hospital beds;
     (c) Residential beds;
     (d) Programs for community treatment teams; and
     (e) Outpatient services.
     (3) The regional support network shall have the flexibility, within the funds appropriated by the legislature for this purpose, to design the mix of services that will be most effective within their service area of meeting the needs of people with mental disorders and avoiding placement of such individuals at the state mental hospital. Regional support networks are encouraged to maximize the use of evidence-based practices and alternative resources with the goal of substantially reducing and potentially eliminating the use of institutions for mental diseases.))

NEW SECTION.  Sec. 7   A new section is added to chapter 71.24 RCW to read as follows:
     By January 1, 2019, the department and the health care authority must transition community behavioral health services to a system of fully integrated managed health care purchasing that provides mental health services, chemical dependency services, and medical care services to medicaid clients.

NEW SECTION.  Sec. 8   A new section is added to chapter 71.24 RCW to read as follows:
     (1) Within funds appropriated by the legislature for this purpose, behavioral health organizations shall develop the means to serve the needs of people with mental disorders within the boundaries of their regional service area. Elements of the program may include:
     (a) Crisis diversion services;
     (b) Evaluation and treatment and community hospital beds;
     (c) Residential treatment;
     (d) Programs for community treatment teams;
     (e) Outpatient services;
     (f) Peer support services;
     (g) Community support services;
     (h) Resource management services; and
     (i) Supported housing and supported employment services.
     (2) The behavioral health organization shall have the flexibility, within the funds appropriated by the legislature for this purpose and the terms of their contract, to design the mix of services that will be most effective within their service area of meeting the needs of people with mental disorders and avoiding placement of such individuals at the state mental hospital. Behavioral health organizations are encouraged to maximize the use of evidence-based practices and alternative resources with the goal of substantially reducing and potentially eliminating the use of institutions for mental diseases.

Sec. 9   RCW 71.24.025 and 2013 c 338 s 5 are each 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 or, in the case of a child, as defined in RCW 71.34.020;
     (b) Being gravely disabled as defined in RCW 71.05.020 or, in the case of a child, a gravely disabled minor as defined in RCW 71.34.020; or
     (c) Presenting a likelihood of serious harm as defined in RCW 71.05.020 or, in the case of a child, as defined in RCW 71.34.020.
     (2) "Available resources" means funds appropriated for the purpose of providing community mental health programs, 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.
     (3) "Child" means a person under the age of eighteen years.
     (4) "Chronically mentally ill adult" or "adult who is chronically mentally ill" 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.
     (5) "Clubhouse" means a community-based program that provides rehabilitation services and is certified by the department of social and health services.
     (6) "Community mental health program" means all mental health services, activities, or programs using available resources.
     (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 public sources.
     (8) "Community support services" means services authorized, planned, and coordinated through resource management services including, at a minimum, assessment, diagnosis, emergency crisis intervention available twenty-four hours, seven days a week, prescreening determinations for persons who are mentally ill 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 children who are acutely mentally ill or severely emotionally disturbed 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, recovery services, and other services determined by ((regional support networks)) behavioral health organizations.
     (9) "Consensus-based" means a program or practice that has general support among treatment providers and experts, based on experience or professional literature, and may have anecdotal or case study support, or that is agreed but not possible to perform studies with random assignment and controlled groups.
     (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.
     (11) "Department" means the department of social and health services.
     (12) "Designated mental health professional" means a mental health professional designated by the county or other authority authorized in rule to perform the duties specified in this chapter.
     (13) "Emerging best practice" or "promising practice" means a program or practice that, based on statistical analyses or a well established theory of change, shows potential for meeting the evidence-based or research-based criteria, which may include the use of a program that is evidence-based for outcomes other than those listed in subsection (14) of this section.
     (14) "Evidence-based" means a program or practice that has been tested in heterogeneous or intended populations with multiple randomized, or statistically controlled evaluations, or both; or one large multiple site randomized, or statistically controlled evaluation, or both, where the weight of the evidence from a systemic review demonstrates sustained improvements in at least one outcome. "Evidence-based" also means a program or practice that can be implemented with a set of procedures to allow successful replication in Washington and, when possible, is determined to be cost-beneficial.
     (15) "Licensed service provider" means an entity licensed according to this chapter or chapter 71.05 RCW or an entity deemed to meet state minimum standards as a result of accreditation by a recognized behavioral health accrediting body recognized and having a current agreement with the department, that meets state minimum standards or persons licensed under chapter 18.57, 18.71, 18.83, or 18.79 RCW, as it applies to registered nurses and advanced registered nurse practitioners.
     (16) "Long-term inpatient care" means inpatient services for persons committed for, or voluntarily receiving intensive treatment for, periods of ninety days or greater under chapter 71.05 RCW. "Long-term inpatient care" as used in this chapter does not include: (a) Services for individuals committed under chapter 71.05 RCW who are receiving services pursuant to a conditional release or a court-ordered less restrictive alternative to detention; or (b) services for individuals voluntarily receiving less restrictive alternative treatment on the grounds of the state hospital.
     (17) "Mental health services" means all services provided by ((regional support networks)) behavioral health organizations and other services provided by the state for persons who are mentally ill.
     (18) "Mentally ill persons," "persons who are mentally ill," and "the mentally ill" mean persons and conditions defined in subsections (1), (4), (27), and (28) of this section.
     (19) "Recovery" means the process in which people are able to live, work, learn, and participate fully in their communities.
     (20) "((Regional support network)) Behavioral health organization" means ((a)) any county authority or group of county authorities or other entity recognized by the secretary in contract in a defined region.
     (21) "Registration records" include all the records of the department, ((regional support networks)) behavioral health organizations, treatment facilities, and other persons providing services to the department, county departments, or facilities which identify persons who are receiving or who at any time have received services for mental illness.
     (22) "Research-based" means a program or practice that has been tested with a single randomized, or statistically controlled evaluation, or both, demonstrating sustained desirable outcomes; or where the weight of the evidence from a systemic review supports sustained outcomes as described in subsection (14) of this section but does not meet the full criteria for evidence-based.
     (23) "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 persons who are acutely mentally ill, adults who are chronically mentally ill, children who are severely emotionally disturbed, or adults who are seriously disturbed and determined by the ((regional support network)) behavioral health organization 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 persons who are mentally ill in nursing homes, assisted living facilities, and adult family homes, and may include outpatient services provided as an element in a package of services in a supported housing model. 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.
     (24) "Resilience" means the personal and community qualities that enable individuals to rebound from adversity, trauma, tragedy, threats, or other stresses, and to live productive lives.
     (25) "Resource management services" mean the planning, coordination, and authorization of residential services and community support services administered pursuant to an individual service plan for: (a) Adults and children who are acutely mentally ill; (b) adults who are chronically mentally ill; (c) children who are severely emotionally disturbed; or (d) adults who are seriously disturbed and determined solely by a ((regional support network)) behavioral health organization 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 enrollment of adults and children who are mentally ill in services and their individual service plan to designated mental health professionals, evaluation and treatment facilities, and others as determined by the ((regional support network)) behavioral health organization.
     (26) "Secretary" means the secretary of social and health services.
     (27) "Seriously disturbed person" means a person who:
     (a) Is gravely disabled or presents a likelihood of serious harm to himself or herself or others, or to the property of others, as a result of a mental disorder as defined in chapter 71.05 RCW;
     (b) Has been on conditional release status, or under a less restrictive alternative order, 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 chapter 71.34 RCW, 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.
     (28) "Severely emotionally disturbed child" or "child who is severely emotionally disturbed" means a child who has been determined by the ((regional support network)) behavioral health organization 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 caretaker who is mentally ill or inadequate;
     (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.
     (29) "State minimum standards" means minimum requirements established by rules adopted by the secretary and necessary to implement this chapter for: (a) Delivery of mental health services; (b) licensed service providers for the provision of mental health services; (c) residential services; and (d) community support services and resource management services.
     (30) "Treatment records" include registration and all other records concerning persons who are receiving or who at any time have received services for mental illness, which are maintained by the department, by ((regional support networks)) behavioral health organizations and their staffs, and by treatment facilities. Treatment records do not include notes or records maintained for personal use by a person providing treatment services for the department, ((regional support networks)) behavioral health organizations, or a treatment facility if the notes or records are not available to others.
     (31) "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)) behavioral health organization that would present a conflict of interest.
     (32) "Behavioral health services" means mental health services as described in this chapter and chapter 71.36 RCW and chemical dependency treatment services as described in chapter 70.96A RCW.

Sec. 10   RCW 71.24.035 and 2013 c 200 s 24 are each amended to read as follows:
     (1) The department is designated as the state mental health authority.
     (2) The secretary shall provide for public, client, and licensed service provider participation in developing the state mental health program, developing contracts with ((regional support networks)) behavioral health organizations, and any waiver request to the federal government under medicaid.
     (3) The secretary shall provide for participation in developing the state mental health program for children and other underserved populations, by including representatives on any committee established to provide oversight to the state mental health program.
     (4) The secretary shall be designated as the ((regional support network)) behavioral health organization if the ((regional support network)) behavioral health organization fails to meet state minimum standards or refuses to exercise responsibilities under RCW 71.24.045, until such time as a new ((regional support network)) behavioral health organization is designated ((under RCW 71.24.320)).
     (5) The secretary shall:
     (a) Develop a biennial state mental health program that incorporates regional biennial needs assessments and regional mental health service plans and state services for adults and children with mental illness((. The secretary shall also develop a six-year state mental health plan));
     (b) Assure that any ((regional)) behavioral health organization or county community mental health program provides ((access to treatment for the region's residents, including parents who are respondents in dependency cases, in the following order of priority: (i) Persons with acute mental illness; (ii) adults with chronic mental illness and children who are severely emotionally disturbed; and (iii) persons who are seriously disturbed. Such programs shall provide:
     (A) Outpatient services;
     (B) Emergency care services for twenty-four hours per day;
     (C) Day treatment for persons with mental illness which includes training in basic living and social skills, supported work, vocational rehabilitation, and day activities. Such services may include therapeutic treatment. In the case of a child, day treatment includes age-appropriate basic living and social skills, educational and prevocational services, day activities, and therapeutic treatment;
     (D) Screening for patients being considered for admission to state mental health facilities to determine the appropriateness of admission;
     (E) Employment services, which may include supported employment, transitional work, placement in competitive employment, and other work-related services, that result in persons with mental illness becoming engaged in meaningful and gainful full or part-time work. Other sources of funding such as the division of vocational rehabilitation may be utilized by the secretary to maximize federal funding and provide for integration of services;
     (F) Consultation and education services; and
     (G) Community support services)) medically necessary services to medicaid recipients consistent with the state's medicaid state plan or federal waiver authorities, and nonmedicaid services consistent with priorities established by the department;
     (c) Develop and adopt rules establishing state minimum standards for the delivery of mental health services pursuant to RCW 71.24.037 including, but not limited to:
     (i) Licensed service providers. These rules shall permit a county-operated mental health program to be licensed as a service provider subject to compliance with applicable statutes and rules. The secretary shall provide for deeming of compliance with state minimum standards for those entities accredited by recognized behavioral health accrediting bodies recognized and having a current agreement with the department;
     (ii) ((Regional support networks)) Behavioral health organizations; and
     (iii) Inpatient services, evaluation and treatment services and facilities under chapter 71.05 RCW, resource management services, and community support services;
     (d) Assure that the special needs of persons who are minorities, elderly, disabled, children, low-income, and parents who are respondents in dependency cases are met within the priorities established in this section;
     (e) Establish a standard contract or contracts, consistent with state minimum standards((, RCW 71.24.320 and 71.24.330,)) which shall be used in contracting with ((regional support networks)) behavioral health organizations. The standard contract shall include a maximum fund balance, which shall be consistent with that required by federal regulations or waiver stipulations;
     (f) Establish, to the extent possible, a standardized auditing procedure which is designed to assure compliance with contractual agreements authorized by this chapter and minimizes paperwork requirements of ((regional support networks)) behavioral health organizations and licensed service providers. The audit procedure shall focus on the outcomes of service ((and not the processes for accomplishing them)) as provided in RCW 43.20A.895, 70.320.020, and 71.36.025;
     (g) Develop and maintain an information system to be used by the state and ((regional support networks)) behavioral health organizations that includes a tracking method which allows the department and ((regional support networks)) behavioral health organizations to identify mental health clients' participation in any mental health service or public program on an immediate basis. The information system shall not include individual patient's case history files. Confidentiality of client information and records shall be maintained as provided in this chapter and chapter 70.02 RCW;
     (h) License service providers who meet state minimum standards;
     (i) ((Certify regional support networks that meet state minimum standards;
     (j))) Periodically monitor the compliance of certified ((regional support networks)) behavioral health organizations and their network of licensed service providers for compliance with the contract between the department, the ((regional support network)) behavioral health organization, and federal and state rules at reasonable times and in a reasonable manner;
     (((k))) (j) Fix fees to be paid by evaluation and treatment centers to the secretary for the required inspections;
     (((l))) (k) Monitor and audit ((regional support networks)) behavioral health organizations and licensed service providers as needed to assure compliance with contractual agreements authorized by this chapter;
     (((m))) (l) Adopt such rules as are necessary to implement the department's responsibilities under this chapter;
     (((n))) (m) Assure the availability of an appropriate amount, as determined by the legislature in the operating budget by amounts appropriated for this specific purpose, of community-based, geographically distributed residential services;
     (((o))) (n) Certify crisis stabilization units that meet state minimum standards;
     (((p))) (o) Certify clubhouses that meet state minimum standards; and
     (((q))) (p) Certify triage facilities that meet state minimum standards.
     (6) The secretary shall use available resources only for ((regional support networks)) behavioral health organizations, except:
     (a) To the extent authorized, and in accordance with any priorities or conditions specified, in the biennial appropriations act; or
     (b) To incentivize improved performance with respect to the client outcomes established in RCW 43.20A.895, 70.320.020, and 71.36.025, integration of behavioral health and medical services at the clinical level, and improved care coordination for individuals with complex care needs.
     (7) Each ((certified regional support network)) behavioral health organization and licensed service provider shall file with the secretary, on request, such data, statistics, schedules, and information as the secretary reasonably requires. A ((certified regional support network)) behavioral health organization or licensed service provider which, without good cause, fails to furnish any data, statistics, schedules, or information as requested, or files fraudulent reports thereof, may have its certification or license revoked or suspended.
     (8) The secretary may suspend, revoke, limit, or restrict a certification or license, or refuse to grant a certification or license for failure to conform to: (a) The law; (b) applicable rules and regulations; (c) applicable standards; or (d) state minimum standards.
     (9) The superior court may restrain any ((regional support network)) behavioral health organization or service provider from operating without certification or a license or any other violation of this section. The court may also review, pursuant to procedures contained in chapter 34.05 RCW, any denial, suspension, limitation, restriction, or revocation of certification or license, and grant other relief required to enforce the provisions of this chapter.
     (10) Upon petition by the secretary, and after hearing held upon reasonable notice to the facility, the superior court may issue a warrant to an officer or employee of the secretary authorizing him or her to enter at reasonable times, and examine the records, books, and accounts of any ((regional support network)) behavioral health organizations or service provider refusing to consent to inspection or examination by the authority.
     (11) Notwithstanding the existence or pursuit of any other remedy, the secretary may file an action for an injunction or other process against any person or governmental unit to restrain or prevent the establishment, conduct, or operation of a ((regional support network)) behavioral health organization or service provider without certification or a license under this chapter.
     (12) The standards for certification of evaluation and treatment facilities shall include standards relating to maintenance of good physical and mental health and other services to be afforded persons pursuant to this chapter and chapters 71.05 and 71.34 RCW, and shall otherwise assure the effectuation of the purposes of these chapters.
     (13) The standards for certification of crisis stabilization units shall include standards that:
     (a) Permit location of the units at a jail facility if the unit is physically separate from the general population of the jail;
     (b) Require administration of the unit by mental health professionals who direct the stabilization and rehabilitation efforts; and
     (c) Provide an environment affording security appropriate with the alleged criminal behavior and necessary to protect the public safety.
     (14) The standards for certification of a clubhouse shall at a minimum include:
     (a) The facilities may be peer-operated and must be recovery-focused;
     (b) Members and employees must work together;
     (c) Members must have the opportunity to participate in all the work of the clubhouse, including administration, research, intake and orientation, outreach, hiring, training and evaluation of staff, public relations, advocacy, and evaluation of clubhouse effectiveness;
     (d) Members and staff and ultimately the clubhouse director must be responsible for the operation of the clubhouse, central to this responsibility is the engagement of members and staff in all aspects of clubhouse operations;
     (e) Clubhouse programs must be comprised of structured activities including but not limited to social skills training, vocational rehabilitation, employment training and job placement, and community resource development;
     (f) Clubhouse programs must provide in-house educational programs that significantly utilize the teaching and tutoring skills of members and assist members by helping them to take advantage of adult education opportunities in the community;
     (g) Clubhouse programs must focus on strengths, talents, and abilities of its members;
     (h) The work-ordered day may not include medication clinics, day treatment, or other therapy programs within the clubhouse.
     (15) The department shall distribute appropriated state and federal funds in accordance with any priorities, terms, or conditions specified in the appropriations act.
     (16) The secretary shall assume all duties assigned to the nonparticipating ((regional support networks)) behavioral health organizations under chapters 71.05 and 71.34 RCW and this chapter. Such responsibilities shall include those which would have been assigned to the nonparticipating counties in regions where there are not participating ((regional support networks)) behavioral health organizations.
     The ((regional support networks)) behavioral health organizations, or the secretary's assumption of all responsibilities under chapters 71.05 and 71.34 RCW and this chapter, shall be included in all state and federal plans affecting the state mental health program including at least those required by this chapter, the medicaid program, and P.L. 99-660. Nothing in these plans shall be inconsistent with the intent and requirements of this chapter.
     (17) The secretary shall:
     (a) Disburse funds for the ((regional support networks)) behavioral health organizations within sixty days of approval of the biennial contract. The department must either approve or reject the biennial contract within sixty days of receipt.
     (b) Enter into biennial contracts with ((regional support networks)) behavioral health organizations. The contracts shall be consistent with available resources. No contract shall be approved that does not include progress toward meeting the goals of this chapter by taking responsibility for: (i) Short-term commitments; (ii) residential care; and (iii) emergency response systems.
     (c) Notify ((regional support networks)) behavioral health organizations of their allocation of available resources at least sixty days prior to the start of a new biennial contract period.
     (d) Deny all or part of the funding allocations to ((regional support networks)) behavioral health organizations based solely upon formal findings of noncompliance with the terms of the ((regional support network's)) behavioral health organization's contract with the department. ((Regional support networks)) Behavioral health organizations disputing the decision of the secretary to withhold funding allocations are limited to the remedies provided in the department's contracts with the ((regional support networks)) behavioral health organizations.
     (18) The department, in cooperation with the state congressional delegation, shall actively seek waivers of federal requirements and such modifications of federal regulations as are necessary to allow federal medicaid reimbursement for services provided by freestanding evaluation and treatment facilities certified under chapter 71.05 RCW. The department shall periodically report its efforts to the appropriate committees of the senate and the house of representatives.

Sec. 11   RCW 71.24.045 and 2006 c 333 s 105 are each amended to read as follows:
     The ((regional support network)) behavioral health organization shall:
     (1) Contract as needed with licensed service providers. The ((regional support network)) behavioral health organization may, in the absence of a licensed service provider entity, become a licensed service provider entity pursuant to minimum standards required for licensing by the department for the purpose of providing services not available from licensed service providers;
     (2) Operate as a licensed service provider if it deems that doing so is more efficient and cost effective than contracting for services. When doing so, the ((regional support network)) behavioral health organization shall comply with rules promulgated by the secretary that shall provide measurements to determine when a ((regional support network)) behavioral health organization provided service is more efficient and cost effective;
     (3) Monitor and perform biennial fiscal audits of licensed service providers who have contracted with the ((regional support network)) behavioral health organization to provide services required by this chapter. The monitoring and audits shall be performed by means of a formal process which insures that the licensed service providers and professionals designated in this subsection meet the terms of their contracts;
     (4) Assure that the special needs of minorities, the elderly, ((disabled)) individuals with disabilities, children, and low-income persons are met within the priorities established in this chapter;
     (5) Maintain patient tracking information in a central location as required for resource management services and the department's information system;
     (6) Collaborate to ensure that policies do not result in an adverse shift of ((mentally ill)) persons with mental illness into state and local correctional facilities;
     (7) Work with the department to expedite the enrollment or re-enrollment of eligible persons leaving state or local correctional facilities and institutions for mental diseases;
     (8) ((If a regional support network is not operated by the county,)) Work closely with the county designated mental health professional or county designated crisis responder to maximize appropriate placement of persons into community services; and
     (9) Coordinate services for individuals who have received services through the community mental health system and who become patients at a state mental hospital to ensure they are transitioned into the community in accordance with mutually agreed upon discharge plans and upon determination by the medical director of the state mental hospital that they no longer need intensive inpatient care.

Sec. 12   RCW 71.24.100 and 2012 c 117 s 442 are each amended to read as follows:
     A county authority or a group of county authorities may enter into a joint operating agreement to ((form)) respond to a request for a detailed plan and contract with the state to operate a ((regional support network)) behavioral health organization whose boundaries are consistent with the regional service areas established under section 2 of this act. Any agreement between two or more county authorities ((for the establishment of a regional support network)) shall provide:
     (1) That each county shall bear a share of the cost of mental health services; and
     (2) That the treasurer of one participating county shall be the custodian of funds made available for the purposes of such mental health services, and that the treasurer may make payments from such funds upon audit by the appropriate auditing officer of the county for which he or she is treasurer.

Sec. 13   RCW 71.24.110 and 1999 c 10 s 7 are each amended to read as follows:
     An agreement ((for the establishment of a community mental health program)) to contract with the state to operate a behavioral health organization under RCW 71.24.100 may also provide:
     (1) For the joint supervision or operation of services and facilities, or for the supervision or operation of service and facilities by one participating county under contract for the other participating counties; and
     (2) For such other matters as are necessary or proper to effectuate the purposes of this chapter.

Sec. 14   RCW 71.24.340 and 2005 c 503 s 13 are each amended to read as follows:
     The secretary shall require the ((regional support networks)) behavioral health organizations to develop ((interlocal agreements pursuant to RCW 74.09.555. To this end, the regional support networks shall)) agreements with city and county jails to accept referrals for enrollment on behalf of a confined person, prior to the person's release.

Sec. 15   RCW 71.24.420 and 2001 c 323 s 2 are each amended to read as follows:
     The department shall operate the community mental health service delivery system authorized under this chapter within the following constraints:
     (1) The full amount of federal funds for mental health services, plus qualifying state expenditures as appropriated in the biennial operating budget, shall be appropriated to the department each year in the biennial appropriations act to carry out the provisions of the community mental health service delivery system authorized in this chapter.
     (2) The department may expend funds defined in subsection (1) of this section in any manner that will effectively accomplish the outcome measures ((defined in section 5 of this act)) established in RCW 43.20A.895 and 71.36.025 and performance measures linked to those outcomes.
     (3) The department shall implement strategies that accomplish the outcome measures ((identified in section 5 of this act that are within the funding constraints in this section)) established in RCW 43.20A.895, 70.320.020, and 71.36.025 and performance measures linked to those outcomes.
     (4) The department shall monitor expenditures against the appropriation levels provided for in subsection (1) of this section.

Sec. 16   RCW 70.96A.020 and 2001 c 13 s 1 are each amended to read as follows:
     For the purposes of this chapter the following words and phrases shall have the following meanings unless the context clearly requires otherwise:
     (1) "Alcoholic" means a person who suffers from the disease of alcoholism.
     (2) "Alcoholism" means a disease, characterized by a dependency on alcoholic beverages, loss of control over the amount and circumstances of use, symptoms of tolerance, physiological or psychological withdrawal, or both, if use is reduced or discontinued, and impairment of health or disruption of social or economic functioning.
     (3) "Approved treatment program" means a discrete program of chemical dependency treatment provided by a treatment program certified by the department of social and health services as meeting standards adopted under this chapter.
     (4) "Chemical dependency" means:
     (a) Alcoholism; (b) drug addiction; or (c) dependence on alcohol and one or more other psychoactive chemicals, as the context requires.
     (5) "Chemical dependency program" means expenditures and activities of the department designed and conducted to prevent or treat alcoholism and other drug addiction, including reasonable administration and overhead.
     (6) "Department" means the department of social and health services.
     (7) "Designated chemical dependency specialist" or "specialist" means a person designated by the county alcoholism and other drug addiction program coordinator designated under RCW 70.96A.310 to perform the commitment duties described in RCW 70.96A.140 and qualified to do so by meeting standards adopted by the department.
     (8) "Director" means the person administering the chemical dependency program within the department.
     (9) "Drug addict" means a person who suffers from the disease of drug addiction.
     (10) "Drug addiction" means a disease characterized by a dependency on psychoactive chemicals, loss of control over the amount and circumstances of use, symptoms of tolerance, physiological or psychological withdrawal, or both, if use is reduced or discontinued, and impairment of health or disruption of social or economic functioning.
     (11) "Emergency service patrol" means a patrol established under RCW 70.96A.170.
     (12) "Gravely disabled by alcohol or other psychoactive chemicals" or "gravely disabled" means that a person, as a result of the use of alcohol or other psychoactive chemicals: (a) Is in danger of serious physical harm resulting from a failure to provide for his or her essential human needs of health or safety; or (b) manifests severe deterioration in routine functioning evidenced by a repeated and escalating loss of cognition or volitional control over his or her actions and is not receiving care as essential for his or her health or safety.
     (13) "History of one or more violent acts" refers to the period of time ten years prior to the filing of a petition under this chapter, excluding any time spent, but not any violent acts committed, in a mental health facility, or a long-term alcoholism or drug treatment facility, or in confinement.
     (14) "Incapacitated by alcohol or other psychoactive chemicals" means that a person, as a result of the use of alcohol or other psychoactive chemicals, is gravely disabled or presents a likelihood of serious harm to himself or herself, to any other person, or to property.
     (15) "Incompetent person" means a person who has been adjudged incompetent by the superior court.
     (16) "Intoxicated person" means a person whose mental or physical functioning is substantially impaired as a result of the use of alcohol or other psychoactive chemicals.
     (17) "Licensed physician" means a person licensed to practice medicine or osteopathic medicine and surgery in the state of Washington.
     (18) "Likelihood of serious harm" means:
     (a) A substantial risk that: (i) Physical harm will be inflicted by an individual upon his or her own person, as evidenced by threats or attempts to commit suicide or inflict physical harm on one's self; (ii) physical harm will be inflicted by an individual upon another, as evidenced by behavior that has caused the harm or that places another person or persons in reasonable fear of sustaining the harm; or (iii) physical harm will be inflicted by an individual upon the property of others, as evidenced by behavior that has caused substantial loss or damage to the property of others; or
     (b) The individual has threatened the physical safety of another and has a history of one or more violent acts.
     (19) "Medical necessity" for inpatient care of a minor means a requested certified inpatient service that is reasonably calculated to: (a) Diagnose, arrest, or alleviate a chemical dependency; or (b) prevent the worsening of chemical dependency conditions that endanger life or cause suffering and pain, or result in illness or infirmity or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no adequate less restrictive alternative available.
     (20) "Minor" means a person less than eighteen years of age.
     (21) "Parent" means the parent or parents who have the legal right to custody of the child. Parent includes custodian or guardian.
     (22) "Peace officer" means a law enforcement official of a public agency or governmental unit, and includes persons specifically given peace officer powers by any state law, local ordinance, or judicial order of appointment.
     (23) "Person" means an individual, including a minor.
     (24) "Professional person in charge" or "professional person" means a physician or chemical dependency counselor as defined in rule by the department, who is empowered by a certified treatment program with authority to make assessment, admission, continuing care, and discharge decisions on behalf of the certified program.
     (25) "Secretary" means the secretary of the department of social and health services.
     (26) "Treatment" means the broad range of emergency, detoxification, residential, and outpatient services and care, including diagnostic evaluation, chemical dependency education and counseling, medical, psychiatric, psychological, and social service care, vocational rehabilitation and career counseling, which may be extended to alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons.
     (27) "Treatment program" means an organization, institution, or corporation, public or private, engaged in the care, treatment, or rehabilitation of alcoholics or other drug addicts.
     (28) "Violent act" means behavior that resulted in homicide, attempted suicide, nonfatal injuries, or substantial damage to property.
     (29) "Behavioral health organization" means a county authority or group of county authorities or other entity recognized by the secretary in contract in a defined regional service area.
     (30) "Behavioral health services" means mental health services as described in chapters 71.24 and 71.36 RCW and chemical dependency treatment services as described in this chapter.

Sec. 17   RCW 70.96A.040 and 1989 c 270 s 5 are each amended to read as follows:
     The department, in the operation of the chemical dependency program may:
     (1) Plan, establish, and maintain prevention and treatment programs as necessary or desirable;
     (2) Make contracts necessary or incidental to the performance of its duties and the execution of its powers, including managed care contracts for behavioral health services, contracts entered into under RCW 74.09.522, and contracts with public and private agencies, organizations, and individuals to pay them for services rendered or furnished to alcoholics or other drug addicts, persons incapacitated by alcohol or other psychoactive chemicals, or intoxicated persons;
     (3) Enter into agreements for monitoring of verification of qualifications of counselors employed by approved treatment programs;
     (4) Adopt rules under chapter 34.05 RCW to carry out the provisions and purposes of this chapter and contract, cooperate, and coordinate with other public or private agencies or individuals for those purposes;
     (5) Solicit and accept for use any gift of money or property made by will or otherwise, and any grant of money, services, or property from the federal government, the state, or any political subdivision thereof or any private source, and do all things necessary to cooperate with the federal government or any of its agencies in making an application for any grant;
     (6) Administer or supervise the administration of the provisions relating to alcoholics, other drug addicts, and intoxicated persons of any state plan submitted for federal funding pursuant to federal health, welfare, or treatment legislation;
     (7) Coordinate its activities and cooperate with chemical dependency programs in this and other states, and make contracts and other joint or cooperative arrangements with state, local, or private agencies in this and other states for the treatment of alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons and for the common advancement of chemical dependency programs;
     (8) Keep records and engage in research and the gathering of relevant statistics;
     (9) Do other acts and things necessary or convenient to execute the authority expressly granted to it;
     (10) Acquire, hold, or dispose of real property or any interest therein, and construct, lease, or otherwise provide treatment programs.

Sec. 18   RCW 70.96A.050 and 2001 c 13 s 2 are each amended to read as follows:
     The department shall:
     (1) Develop, encourage, and foster statewide, regional, and local plans and programs for the prevention of alcoholism and other drug addiction, treatment of alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons in cooperation with public and private agencies, organizations, and individuals and provide technical assistance and consultation services for these purposes;
     (2) Assure that any behavioral health organization contract or managed care contract under RCW 74.09.522 for behavioral health services or program for the treatment of persons with alcohol or drug use disorders provides medically necessary services to medicaid recipients. This must include a continuum of mental health and chemical dependency services consistent with the state's medicaid plan or federal waiver authorities, and nonmedicaid services consistent with priorities established by the department;
     (3) Coordinate the efforts and enlist the assistance of all public and private agencies, organizations, and individuals interested in prevention of alcoholism and drug addiction, and treatment of alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons;
     (((3))) (4) Cooperate with public and private agencies in establishing and conducting programs to provide treatment for alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons who are clients of the correctional system;
     (((4))) (5) Cooperate with the superintendent of public instruction, state board of education, schools, police departments, courts, and other public and private agencies, organizations and individuals in establishing programs for the prevention of alcoholism and other drug addiction, treatment of alcoholics or other drug addicts and their families, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons, and preparing curriculum materials thereon for use at all levels of school education;
     (((5))) (6) Prepare, publish, evaluate, and disseminate educational material dealing with the nature and effects of alcohol and other psychoactive chemicals and the consequences of their use;
     (((6))) (7) Develop and implement, as an integral part of treatment programs, an educational program for use in the treatment of alcoholics or other drug addicts, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons, which program shall include the dissemination of information concerning the nature and effects of alcohol and other psychoactive chemicals, the consequences of their use, the principles of recovery, and HIV and AIDS;
     (((7))) (8) Organize and foster training programs for persons engaged in treatment of alcoholics or other drug addicts, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons;
     (((8))) (9) Sponsor and encourage research into the causes and nature of alcoholism and other drug addiction, treatment of alcoholics and other drug addicts, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons, and serve as a clearinghouse for information relating to alcoholism or other drug addiction;
     (((9))) (10) Specify uniform methods for keeping statistical information by public and private agencies, organizations, and individuals, and collect and make available relevant statistical information, including number of persons treated, frequency of admission and readmission, and frequency and duration of treatment;
     (((10))) (11) Advise the governor in the preparation of a comprehensive plan for treatment of alcoholics and other drug addicts, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons for inclusion in the state's comprehensive health plan;
     (((11))) (12) Review all state health, welfare, and treatment plans to be submitted for federal funding under federal legislation, and advise the governor on provisions to be included relating to alcoholism and other drug addiction, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons;
     (((12))) (13) Assist in the development of, and cooperate with, programs for alcohol and other psychoactive chemical education and treatment for employees of state and local governments and businesses and industries in the state;
     (((13))) (14) Use the support and assistance of interested persons in the community to encourage alcoholics and other drug addicts voluntarily to undergo treatment;
     (((14))) (15) Cooperate with public and private agencies in establishing and conducting programs designed to deal with the problem of persons operating motor vehicles while intoxicated;
     (((15))) (16) Encourage general hospitals and other appropriate health facilities to admit without discrimination alcoholics and other drug addicts, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated persons and to provide them with adequate and appropriate treatment;
     (((16))) (17) Encourage all health and disability insurance programs to include alcoholism and other drug addiction as a covered illness; and
     (((17))) (18) Organize and sponsor a statewide program to help court personnel, including judges, better understand the disease of alcoholism and other drug addiction and the uses of chemical dependency treatment programs.

Sec. 19   RCW 70.96A.080 and 1989 c 270 s 18 are each amended to read as follows:
     (1) In coordination with the health care authority, the department shall establish by ((all)) appropriate means, ((including contracting for services,)) a comprehensive and coordinated ((discrete)) program for the treatment of ((alcoholics and other drug addicts and their families, persons incapacitated by alcohol or other psychoactive chemicals, and intoxicated)) persons with chemical dependency.
     (2)(a) The program shall include, but not necessarily be limited to, a continuum of chemical dependency treatment services that includes:
     (((a))) (i) Detoxification services available twenty-four hours a day;
     (((b))) (ii) Residential treatment; ((and
     (c))) (iii) Outpatient treatment, including medication assisted treatment; and
     (iv) Contracts with at least one provider in operation as of January 1, 2014, for case management and residential treatment services for pregnant and parenting women.
     (b) The program may include peer support, supported housing, supported employment, crisis diversion, or recovery support services.
     (3) All appropriate public and private resources shall be coordinated with and used in the program when possible.
     (4) The department may contract for the use of an approved treatment program or other individual or organization if the secretary considers this to be an effective and economical course to follow.
     (5) By April 1, 2016, treatment provided under this chapter must be purchased primarily through managed care contracts.

Sec. 20   RCW 70.96A.320 and 2013 c 320 s 8 are each amended to read as follows:
     (1) A county legislative authority, or two or more counties acting jointly, may establish an alcoholism and other drug addiction program. If two or more counties jointly establish the program, they shall designate one county to provide administrative and financial services.
     (2) To be eligible for funds from the department for the support of the county alcoholism and other drug addiction program, the county legislative authority shall establish a county alcoholism and other drug addiction board under RCW 70.96A.300 and appoint a county alcoholism and other drug addiction program coordinator under RCW 70.96A.310.
     (3) The county legislative authority may apply to the department for financial support for the county program of alcoholism and other drug addiction. To receive financial support, the county legislative authority shall submit a plan that meets the following conditions:
     (a) It shall describe the prevention, early intervention, or recovery support services and activities to be provided;
     (b) It shall include anticipated expenditures and revenues;
     (c) It shall be prepared by the county alcoholism and other drug addiction program board and be adopted by the county legislative authority;
     (d) It shall reflect maximum effective use of existing services and programs; and
     (e) It shall meet other conditions that the secretary may require.
     (4) The county may accept and spend gifts, grants, and fees, from public and private sources, to implement its program of alcoholism and other drug addiction.
     (5) The department shall require that any agreement to provide financial support to a county that performs the activities of a service coordination organization for alcoholism and other drug addiction services must incorporate the expected outcomes and criteria to measure the performance of service coordination organizations as provided in chapter 70.320 RCW.
     (6) The county may subcontract for prevention, early intervention, or recovery support services with approved prevention or treatment programs.
     (7) To continue to be eligible for financial support from the department for the county alcoholism and other drug addiction program, an increase in state financial support shall not be used to supplant local funds from a source that was used to support the county alcoholism and other drug addiction program before the effective date of the increase.

Sec. 21   RCW 71.24.049 and 2001 c 323 s 13 are each amended to read as follows:
     By January 1st of each odd-numbered year, the ((regional support network)) behavioral health organization shall identify: (1) The number of children in each priority group, as defined by this chapter, who are receiving mental health services funded in part or in whole under this chapter, (2) the amount of funds under this chapter used for children's mental health services, (3) an estimate of the number of unserved children in each priority group, and (4) the estimated cost of serving these additional children and their families.

Sec. 22   RCW 71.24.061 and 2007 c 359 s 7 are each amended to read as follows:
     (1) The department shall provide flexibility in provider contracting to ((regional support networks)) behavioral health organizations for children's mental health services. Beginning with 2007-2009 biennium contracts, ((regional support network)) behavioral health organization contracts shall authorize ((regional support networks)) behavioral health organizations to allow and encourage licensed community mental health centers to subcontract with individual licensed mental health professionals when necessary to meet the need for an adequate, culturally competent, and qualified children's mental health provider network.
     (2) To the extent that funds are specifically appropriated for this purpose or that nonstate funds are available, a children's mental health evidence-based practice institute shall be established at the University of Washington division of public behavioral health and justice policy. The institute shall closely collaborate with entities currently engaged in evaluating and promoting the use of evidence-based, research-based, promising, or consensus-based practices in children's mental health treatment, including but not limited to the University of Washington department of psychiatry and behavioral sciences, children's hospital and regional medical center, the University of Washington school of nursing, the University of Washington school of social work, and the Washington state institute for public policy. To ensure that funds appropriated are used to the greatest extent possible for their intended purpose, the University of Washington's indirect costs of administration shall not exceed ten percent of appropriated funding. The institute shall:
     (a) Improve the implementation of evidence-based and research-based practices by providing sustained and effective training and consultation to licensed children's mental health providers and child-serving agencies who are implementing evidence-based or researched-based practices for treatment of children's emotional or behavioral disorders, or who are interested in adapting these practices to better serve ethnically or culturally diverse children. Efforts under this subsection should include a focus on appropriate oversight of implementation of evidence-based practices to ensure fidelity to these practices and thereby achieve positive outcomes;
     (b) Continue the successful implementation of the "partnerships for success" model by consulting with communities so they may select, implement, and continually evaluate the success of evidence-based practices that are relevant to the needs of children, youth, and families in their community;
     (c) Partner with youth, family members, family advocacy, and culturally competent provider organizations to develop a series of information sessions, literature, and online resources for families to become informed and engaged in evidence-based and research-based practices;
     (d) Participate in the identification of outcome-based performance measures under RCW 71.36.025(2) and partner in a statewide effort to implement statewide outcomes monitoring and quality improvement processes; and
     (e) Serve as a statewide resource to the department and other entities on child and adolescent evidence-based, research-based, promising, or consensus-based practices for children's mental health treatment, maintaining a working knowledge through ongoing review of academic and professional literature, and knowledge of other evidence-based practice implementation efforts in Washington and other states.
     (3) To the extent that funds are specifically appropriated for this purpose, the department in collaboration with the evidence-based practice institute shall implement a pilot program to support primary care providers in the assessment and provision of appropriate diagnosis and treatment of children with mental and behavioral health disorders and track outcomes of this program. The program shall be designed to promote more accurate diagnoses and treatment through timely case consultation between primary care providers and child psychiatric specialists, and focused educational learning collaboratives with primary care providers.

Sec. 23   RCW 71.24.155 and 2001 c 323 s 14 are each amended to read as follows:
     Grants shall be made by the department to ((regional support networks)) behavioral health organizations for community mental health programs totaling not less than ninety-five percent of available resources. The department may use up to forty percent of the remaining five percent to provide community demonstration projects, including early intervention or primary prevention programs for children, and the remainder shall be for emergency needs and technical assistance under this chapter.

Sec. 24   RCW 71.24.160 and 2011 c 343 s 6 are each amended to read as follows:
     The ((regional support networks)) behavioral health organizations shall make satisfactory showing to the secretary that state funds shall in no case be used to replace local funds from any source being used to finance mental health services prior to January 1, 1990. Maintenance of effort funds devoted to judicial services related to involuntary commitment reimbursed under RCW 71.05.730 must be expended for other purposes that further treatment for mental health and chemical dependency disorders.

Sec. 25   RCW 71.24.250 and 2001 c 323 s 16 are each amended to read as follows:
     The ((regional support network)) behavioral health organization may accept and expend gifts and grants received from private, county, state, and federal sources.

Sec. 26   RCW 71.24.300 and 2008 c 261 s 4 are each amended to read as follows:
     (1) Upon the request of a tribal authority or authorities within a ((regional support network)) behavioral health organization the joint operating agreement or the county authority shall allow for the inclusion of the tribal authority to be represented as a party to the ((regional support network)) behavioral health organization.
     (2) The roles and responsibilities of the county and tribal authorities shall be determined by the terms of that agreement including a determination of membership on the governing board and advisory committees, the number of tribal representatives to be party to the agreement, and the provisions of law and shall assure the provision of culturally competent services to the tribes served.
     (3) The state mental health authority may not determine the roles and responsibilities of county authorities as to each other under ((regional support networks)) behavioral health organizations by rule, except to assure that all duties required of ((regional support networks)) behavioral health organizations are assigned and that counties and the ((regional support network)) behavioral health organization do not duplicate functions and that a single authority has final responsibility for all available resources and performance under the ((regional support network's)) behavioral health organization's contract with the secretary.
     (4) If a ((regional support network)) behavioral health organization is a private entity, the department shall allow for the inclusion of the tribal authority to be represented as a party to the ((regional support network)) behavioral health organization.
     (5) The roles and responsibilities of the private entity and the tribal authorities shall be determined by the department, through negotiation with the tribal authority.
     (6) ((Regional support networks)) Behavioral health organizations shall submit an overall six-year operating and capital plan, timeline, and budget and submit progress reports and an updated two-year plan biennially thereafter, to assume within available resources all of the following duties:
     (a) Administer and provide for the availability of all resource management services, residential services, and community support services.
     (b) Administer and provide for the availability of all investigation, transportation, court-related, and other services provided by the state or counties pursuant to chapter 71.05 RCW.
     (c) Provide within the boundaries of each ((regional support network)) behavioral health organization evaluation and treatment services for at least ninety percent of persons detained or committed for periods up to seventeen days according to chapter 71.05 RCW. ((Regional support networks)) Behavioral health organizations may contract to purchase evaluation and treatment services from other ((networks)) organizations if they are unable to provide for appropriate resources within their boundaries. Insofar as the original intent of serving persons in the community is maintained, the secretary is authorized to approve exceptions on a case-by-case basis to the requirement to provide evaluation and treatment services within the boundaries of each ((regional support network)) behavioral health organization. Such exceptions are limited to:
     (i) Contracts with neighboring or contiguous regions; or
     (ii) Individuals detained or committed for periods up to seventeen days at the state hospitals at the discretion of the secretary.
     (d) Administer and provide for the availability of all other mental health services, which shall include patient counseling, day treatment, consultation, education services, employment services as ((defined)) described in RCW 71.24.035, and mental health services to children.
     (e) Establish standards and procedures for reviewing individual service plans and determining when that person may be discharged from resource management services.
     (7) A ((regional support network)) behavioral health organization may request that any state-owned land, building, facility, or other capital asset which was ever purchased, deeded, given, or placed in trust for the care of the persons with mental illness and which is within the boundaries of a ((regional support network)) behavioral health organization be made available to support the operations of the ((regional support network)) behavioral health organization. State agencies managing such capital assets shall give first priority to requests for their use pursuant to this chapter.
     (8) Each ((regional support network)) behavioral health organization shall appoint a mental health advisory board which shall review and provide comments on plans and policies developed under this chapter, provide local oversight regarding the activities of the ((regional support network)) behavioral health organization, and work with the ((regional support network)) behavioral health organization to resolve significant concerns regarding service delivery and outcomes. The department shall establish statewide procedures for the operation of regional advisory committees including mechanisms for advisory board feedback to the department regarding ((regional support network)) behavioral health organization performance. The composition of the board shall be broadly representative of the demographic character of the region and shall include, but not be limited to, representatives of consumers and families, law enforcement, and where the county is not the ((regional support network)) behavioral health organization, county elected officials. Composition and length of terms of board members may differ between ((regional support networks)) behavioral health organizations but shall be included in each ((regional support network's)) behavioral health organization's contract and approved by the secretary.
     (9) ((Regional support networks)) Behavioral health organizations shall assume all duties specified in their plans and joint operating agreements through biennial contractual agreements with the secretary.
     (10) ((Regional support networks)) Behavioral health organizations may receive technical assistance from the housing trust fund and may identify and submit projects for housing and housing support services to the housing trust fund established under chapter 43.185 RCW. Projects identified or submitted under this subsection must be fully integrated with the ((regional support network)) behavioral health organization six-year operating and capital plan, timeline, and budget required by subsection (6) of this section.

Sec. 27   RCW 71.24.310 and 2013 2nd sp.s. c 4 s 994 are each amended to read as follows:
     The legislature finds that administration of chapter 71.05 RCW and this chapter can be most efficiently and effectively implemented as part of the ((regional support network)) behavioral health organization defined in RCW 71.24.025. For this reason, the legislature intends that the department and the ((regional support networks)) behavioral health organizations shall work together to implement chapter 71.05 RCW as follows:
     (1) By June 1, 2006, ((regional support networks)) behavioral health organizations shall recommend to the department the number of state hospital beds that should be allocated for use by each ((regional support network)) behavioral health organization. The statewide total allocation shall not exceed the number of state hospital beds offering long-term inpatient care, as defined in this chapter, for which funding is provided in the biennial appropriations act.
     (2) If there is consensus among the ((regional support networks)) behavioral health organizations regarding the number of state hospital beds that should be allocated for use by each ((regional support network)) behavioral health organization, the department shall contract with each ((regional support network)) behavioral health organization accordingly.
     (3) If there is not consensus among the ((regional support networks)) behavioral health organizations regarding the number of beds that should be allocated for use by each ((regional support network)) behavioral health organization, the department shall establish by emergency rule the number of state hospital beds that are available for use by each ((regional support network)) behavioral health organization. The emergency rule shall be effective September 1, 2006. The primary factor used in the allocation shall be the estimated number of adults with acute and chronic mental illness in each ((regional support network)) behavioral health organization area, based upon population-adjusted incidence and utilization.
     (4) The allocation formula shall be updated at least every three years to reflect demographic changes, and new evidence regarding the incidence of acute and chronic mental illness and the need for long-term inpatient care. In the updates, the statewide total allocation shall include (a) all state hospital beds offering long-term inpatient care for which funding is provided in the biennial appropriations act; plus (b) the estimated equivalent number of beds or comparable diversion services contracted in accordance with subsection (5) of this section.
     (5) The department is encouraged to enter performance-based contracts with ((regional support networks)) behavioral health organizations to provide some or all of the ((regional support network's)) behavioral health organization's allocated long-term inpatient treatment capacity in the community, rather than in the state hospital. The performance contracts shall specify the number of patient days of care available for use by the ((regional support network)) behavioral health organization in the state hospital.
     (6) If a ((regional support network)) behavioral health organization uses more state hospital patient days of care than it has been allocated under subsection (3) or (4) of this section, or than it has contracted to use under subsection (5) of this section, whichever is less, it shall reimburse the department for that care, except during the period of July 1, 2012, through December 31, 2013, where reimbursements may be temporarily altered per section 204, chapter 4, Laws of 2013 2nd sp. sess. The reimbursement rate per day shall be the hospital's total annual budget for long-term inpatient care, divided by the total patient days of care assumed in development of that budget.
     (7) One-half of any reimbursements received pursuant to subsection (6) of this section shall be used to support the cost of operating the state hospital and, during the 2007-2009 fiscal biennium, implementing new services that will enable a ((regional support network)) behavioral health organization to reduce its utilization of the state hospital. The department shall distribute the remaining half of such reimbursements among ((regional support networks)) behavioral health organizations that have used less than their allocated or contracted patient days of care at that hospital, proportional to the number of patient days of care not used.

Sec. 28   RCW 71.24.350 and 2013 c 23 s 189 are each amended to read as follows:
     The department shall require each ((regional support network)) behavioral health organization to provide for a separately funded mental health ombuds office in each ((regional support network)) behavioral health organization that is independent of the ((regional support network)) behavioral health organization. The ombuds office shall maximize the use of consumer advocates.

Sec. 29   RCW 71.24.370 and 2006 c 333 s 103 are each amended to read as follows:
     (1) Except for monetary damage claims which have been reduced to final judgment by a superior court, this section applies to all claims against the state, state agencies, state officials, or state employees that exist on or arise after March 29, 2006.
     (2) Except as expressly provided in contracts entered into between the department and the ((regional support networks)) behavioral health organizations after March 29, 2006, the entities identified in subsection (3) of this section shall have no claim for declaratory relief, injunctive relief, judicial review under chapter 34.05 RCW, or civil liability against the state or state agencies for actions or inactions performed pursuant to the administration of this chapter with regard to the following: (a) The allocation or payment of federal or state funds; (b) the use or allocation of state hospital beds; or (c) financial responsibility for the provision of inpatient mental health care.
     (3) This section applies to counties, ((regional support networks)) behavioral health organizations, and entities which contract to provide ((regional support network)) behavioral health organization services and their subcontractors, agents, or employees.

Sec. 30   RCW 71.24.455 and 1997 c 342 s 2 are each amended to read as follows:
     (1) The secretary shall select and contract with a ((regional support network)) behavioral health organization or private provider to provide specialized access and services to ((mentally ill)) offenders with mental illness upon release from total confinement within the department of corrections who have been identified by the department of corrections and selected by the ((regional support network)) behavioral health organization or private provider as high-priority clients for services and who meet service program entrance criteria. The program shall enroll no more than twenty-five offenders at any one time, or a number of offenders that can be accommodated within the appropriated funding level, and shall seek to fill any vacancies that occur.
     (2) Criteria shall include a determination by department of corrections staff that:
     (a) The offender suffers from a major mental illness and needs continued mental health treatment;
     (b) The offender's previous crime or crimes have been determined by either the court or department of corrections staff to have been substantially influenced by the offender's mental illness;
     (c) It is believed the offender will be less likely to commit further criminal acts if provided ongoing mental health care;
     (d) The offender is unable or unlikely to obtain housing and/or treatment from other sources for any reason; and
     (e) The offender has at least one year remaining before his or her sentence expires but is within six months of release to community housing and is currently housed within a work release facility or any department of corrections' division of prisons facility.
     (3) The ((regional support network)) behavioral health organization or private provider shall provide specialized access and services to the selected offenders. The services shall be aimed at lowering the risk of recidivism. An oversight committee composed of a representative of the department, a representative of the selected ((regional support network)) behavioral health organization or private provider, and a representative of the department of corrections shall develop policies to guide the pilot program, provide dispute resolution including making determinations as to when entrance criteria or required services may be waived in individual cases, advise the department of corrections and the ((regional support network)) behavioral health organization or private provider on the selection of eligible offenders, and set minimum requirements for service contracts. The selected ((regional support network)) behavioral health organization or private provider shall implement the policies and service contracts. The following services shall be provided:
     (a) Intensive case management to include a full range of intensive community support and treatment in client-to-staff ratios of not more than ten offenders per case manager including: (i) A minimum of weekly group and weekly individual counseling; (ii) home visits by the program manager at least two times per month; and (iii) counseling focusing on relapse prevention and past, current, or future behavior of the offender.
     (b) The case manager shall attempt to locate and procure housing appropriate to the living and clinical needs of the offender and as needed to maintain the psychiatric stability of the offender. The entire range of emergency, transitional, and permanent housing and involuntary hospitalization must be considered as available housing options. A housing subsidy may be provided to offenders to defray housing costs up to a maximum of six thousand six hundred dollars per offender per year and be administered by the case manager. Additional funding sources may be used to offset these costs when available.
     (c) The case manager shall collaborate with the assigned prison, work release, or community corrections staff during release planning, prior to discharge, and in ongoing supervision of the offender while under the authority of the department of corrections.
     (d) Medications including the full range of psychotropic medications including atypical antipsychotic medications may be required as a condition of the program. Medication prescription, medication monitoring, and counseling to support offender understanding, acceptance, and compliance with prescribed medication regimens must be included.
     (e) A systematic effort to engage offenders to continuously involve themselves in current and long-term treatment and appropriate habilitative activities shall be made.
     (f) Classes appropriate to the clinical and living needs of the offender and appropriate to his or her level of understanding.
     (g) The case manager shall assist the offender in the application and qualification for entitlement funding, including medicaid, state assistance, and other available government and private assistance at any point that the offender is qualified and resources are available.
     (h) The offender shall be provided access to daily activities such as drop-in centers, prevocational and vocational training and jobs, and volunteer activities.
     (4) Once an offender has been selected into the pilot program, the offender shall remain in the program until the end of his or her sentence or unless the offender is released from the pilot program earlier by the department of corrections.
     (5) Specialized training in the management and supervision of high-crime risk ((mentally ill)) offenders with mental illness shall be provided to all participating mental health providers by the department and the department of corrections prior to their participation in the program and as requested thereafter.
     (6) The pilot program provided for in this section must be providing services by July 1, 1998.

Sec. 31   RCW 71.24.470 and 2009 c 319 s 1 are each amended to read as follows:
     (1) The secretary shall contract, to the extent that funds are appropriated for this purpose, for case management services and such other services as the secretary deems necessary to assist offenders identified under RCW 72.09.370 for participation in the offender reentry community safety program. The contracts may be with ((regional support networks)) behavioral health organizations or any other qualified and appropriate entities.
     (2) The case manager has the authority to assist these offenders in obtaining the services, as set forth in the plan created under RCW 72.09.370(2), for up to five years. The services may include coordination of mental health services, assistance with unfunded medical expenses, obtaining chemical dependency treatment, housing, employment services, educational or vocational training, independent living skills, parenting education, anger management services, and such other services as the case manager deems necessary.
     (3) The legislature intends that funds appropriated for the purposes of RCW 72.09.370, 71.05.145, and 71.05.212, and this section and distributed to the ((regional support networks)) behavioral health organizations are to supplement and not to supplant general funding. Funds appropriated to implement RCW 72.09.370, 71.05.145, and 71.05.212, and this section are not to be considered available resources as defined in RCW 71.24.025 and are not subject to the priorities, terms, or conditions in the appropriations act established pursuant to RCW 71.24.035.
     (4) The offender reentry community safety program was formerly known as the community integration assistance program.

Sec. 32   RCW 71.24.480 and 2009 c 319 s 2 are each amended to read as follows:
     (1) A licensed service provider or ((regional support network)) behavioral health organization, acting in the course of the provider's or ((network's)) organization's duties under this chapter, is not liable for civil damages resulting from the injury or death of another caused by a participant in the offender reentry community safety program who is a client of the provider or ((network)) organization, unless the act or omission of the provider or ((network)) organization constitutes:
     (a) Gross negligence;
     (b) Willful or wanton misconduct; or
     (c) A breach of the duty to warn of and protect from a client's threatened violent behavior if the client has communicated a serious threat of physical violence against a reasonably ascertainable victim or victims.
     (2) In addition to any other requirements to report violations, the licensed service provider and ((regional support network)) behavioral health organization shall report an offender's expressions of intent to harm or other predatory behavior, regardless of whether there is an ascertainable victim, in progress reports and other established processes that enable courts and supervising entities to assess and address the progress and appropriateness of treatment.
     (3) A licensed service provider's or ((regional support network's)) behavioral health organization's mere act of treating a participant in the offender reentry community safety program is not negligence. Nothing in this subsection alters the licensed service provider's or ((regional support network's)) behavioral health organization's normal duty of care with regard to the client.
     (4) The limited liability provided by this section applies only to the conduct of licensed service providers and ((regional support networks)) behavioral health organizations and does not apply to conduct of the state.
     (5) For purposes of this section, "participant in the offender reentry community safety program" means a person who has been identified under RCW 72.09.370 as an offender who: (a) Is reasonably believed to be dangerous to himself or herself or others; and (b) has a mental disorder.

Sec. 33   RCW 71.24.845 and 2013 c 230 s 1 are each amended to read as follows:
     The ((regional support networks)) behavioral health organizations shall jointly develop a uniform transfer agreement to govern the transfer of clients between ((regional support networks)) behavioral health organizations. By September 1, 2013, the ((regional support networks)) behavioral health organizations shall submit the uniform transfer agreement to the department. By December 1, 2013, the department shall establish guidelines to implement the uniform transfer agreement and may modify the uniform transfer agreement as necessary to avoid impacts on state administrative systems.

Sec. 34   RCW 71.24.055 and 2007 c 359 s 4 are each amended to read as follows:
     As part of the system transformation initiative, the department of social and health services shall undertake the following activities related specifically to children's mental health services:
     (1) The development of recommended revisions to the access to care standards for children. The recommended revisions shall reflect the policies and principles set out in RCW 71.36.005, 71.36.010, and 71.36.025, and recognize that early identification, intervention and prevention services, and brief intervention services may be provided outside of the ((regional support network)) behavioral health organization system. Revised access to care standards shall assess a child's need for mental health services based upon the child's diagnosis and its negative impact upon his or her persistent impaired functioning in family, school, or the community, and should not solely condition the receipt of services upon a determination that a child is engaged in high risk behavior or is in imminent need of hospitalization or out-of-home placement. Assessment and diagnosis for children under five years of age shall be determined using a nationally accepted assessment tool designed specifically for children of that age. The recommendations shall also address whether amendments to RCW 71.24.025 (((26) and)) (27) and (28) and 71.24.035(5) are necessary to implement revised access to care standards;
     (2) Development of a revised children's mental health benefit package. The department shall ensure that services included in the children's mental health benefit package reflect the policies and principles included in RCW 71.36.005 and 71.36.025, to the extent allowable under medicaid, Title XIX of the federal social security act. Strong consideration shall be given to developmentally appropriate evidence-based and research-based practices, family-based interventions, the use of natural and peer supports, and community support services. This effort shall include a review of other states' efforts to fund family-centered children's mental health services through their medicaid programs;
     (3) Consistent with the timeline developed for the system transformation initiative, recommendations for revisions to the children's access to care standards and the children's mental health services benefits package shall be presented to the legislature by January 1, 2009.

Sec. 35   RCW 71.24.065 and 2007 c 359 s 10 are each amended to read as follows:
     To the extent funds are specifically appropriated for this purpose, the department of social and health services shall contract for implementation of a wraparound model of integrated children's mental health services delivery in up to four ((regional support network)) behavioral health organization regions in Washington state in which wraparound programs are not currently operating, and in up to two ((regional support network)) behavioral health organization regions in which wraparound programs are currently operating. Contracts in regions with existing wraparound programs shall be for the purpose of expanding the number of children served.
     (1) Funding provided may be expended for: Costs associated with a request for proposal and contracting process; administrative costs associated with successful bidders' operation of the wraparound model; the evaluation under subsection (5) of this section; and funding for services needed by children enrolled in wraparound model sites that are not otherwise covered under existing state programs. The services provided through the wraparound model sites shall include, but not be limited to, services covered under the medicaid program. The department shall maximize the use of medicaid and other existing state-funded programs as a funding source. However, state funds provided may be used to develop a broader service package to meet needs identified in a child's care plan. Amounts provided shall supplement, and not supplant, state, local, or other funding for services that a child being served through a wraparound site would otherwise be eligible to receive.
     (2) The wraparound model sites shall serve children with serious emotional or behavioral disturbances who are at high risk of residential or correctional placement or psychiatric hospitalization, and who have been referred for services from the department, a county juvenile court, a tribal court, a school, or a licensed mental health provider or agency.
     (3) Through a request for proposal process, the department shall contract, with ((regional support networks)) behavioral health organizations, alone or in partnership with either educational service districts or entities licensed to provide mental health services to children with serious emotional or behavioral disturbances, to operate the wraparound model sites. The contractor shall provide care coordination and facilitate the delivery of services and other supports to families using a strength-based, highly individualized wraparound process. The request for proposal shall require that:
     (a) The ((regional support network)) behavioral health organization agree to use its medicaid revenues to fund services included in the existing ((regional support network's)) behavioral health organization's benefit package that a medicaid-eligible child participating in the wraparound model site is determined to need;
     (b) The contractor provide evidence of commitments from at least the following entities to participate in wraparound care plan development and service provision when appropriate: Community mental health agencies, schools, the department of social and health services children's administration, juvenile courts, the department of social and health services juvenile rehabilitation administration, and managed health care systems contracting with the department under RCW 74.09.522; and
     (c) The contractor will operate the wraparound model site in a manner that maintains fidelity to the wraparound process as defined in RCW 71.36.010.
     (4) Contracts for operation of the wraparound model sites shall be executed on or before April 1, 2008, with enrollment and service delivery beginning on or before July 1, 2008.
     (5) The evidence-based practice institute established in RCW 71.24.061 shall evaluate the wraparound model sites, measuring outcomes for children served. Outcomes measured shall include, but are not limited to: Decreased out-of-home placement, including residential, group, and foster care, and increased stability of such placements, school attendance, school performance, recidivism, emergency room utilization, involvement with the juvenile justice system, decreased use of psychotropic medication, and decreased hospitalization.
     (6) The evidence-based practice institute shall provide a report and recommendations to the appropriate committees of the legislature by December 1, 2010.

Sec. 36   RCW 71.24.240 and 2005 c 503 s 10 are each amended to read as follows:
     In order to establish eligibility for funding under this chapter, any ((regional support network)) behavioral health organization seeking to obtain federal funds for the support of any aspect of a community mental health program as defined in this chapter shall submit program plans to the secretary for prior review and approval before such plans are submitted to any federal agency.

Sec. 37   RCW 71.24.320 and 2008 c 261 s 5 are each amended to read as follows:
     (1) If an existing ((regional support network)) behavioral health organization chooses not to respond to a request for qualifications, or is unable to substantially meet the requirements of a request for qualifications, or notifies the department of social and health services it will no longer serve as a ((regional support network)) behavioral health organization, the department shall utilize a procurement process in which other entities recognized by the secretary may bid to serve as the ((regional support network)) behavioral health organization.
     (a) The request for proposal shall include a scoring factor for proposals that include additional financial resources beyond that provided by state appropriation or allocation.
     (b) The department shall provide detailed briefings to all bidders in accordance with department and state procurement policies.
     (c) The request for proposal shall also include a scoring factor for proposals submitted by nonprofit entities that include a component to maximize the utilization of state provided resources and the leverage of other funds for the support of mental health services to persons with mental illness.
     (2) A ((regional support network)) behavioral health organization that voluntarily terminates, refuses to renew, or refuses to sign a mandatory amendment to its contract to act as a ((regional support network)) behavioral health organization is prohibited from responding to a procurement under this section or serving as a ((regional support network)) behavioral health organization for five years from the date that the department signs a contract with the entity that will serve as the ((regional support network)) behavioral health organization.

Sec. 38   RCW 71.24.330 and 2013 c 320 s 9 are each amended to read as follows:
     (1)(a) Contracts between a ((regional support network)) behavioral health organization and the department shall include mechanisms for monitoring performance under the contract and remedies for failure to substantially comply with the requirements of the contract including, but not limited to, financial penalties, termination of the contract, and reprocurement of the contract.
     (b) The department shall incorporate the criteria to measure the performance of service coordination organizations into contracts with ((regional support networks)) behavioral health organizations as provided in chapter 70.320 RCW.
     (2) The ((regional support network)) behavioral health organization procurement processes shall encourage the preservation of infrastructure previously purchased by the community mental health service delivery system, the maintenance of linkages between other services and delivery systems, and maximization of the use of available funds for services versus profits. However, a ((regional support network)) behavioral health organization selected through the procurement process is not required to contract for services with any county-owned or operated facility. The ((regional support network)) behavioral health organization procurement process shall provide that public funds appropriated by the legislature shall not be used to promote or deter, encourage, or discourage employees from exercising their rights under Title 29, chapter 7, subchapter II, United States Code or chapter 41.56 RCW.
     (3) In addition to the requirements of RCW 71.24.035, contracts shall:
     (a) Define administrative costs and ensure that the ((regional support network)) behavioral health organization does not exceed an administrative cost of ten percent of available funds;
     (b) Require effective collaboration with law enforcement, criminal justice agencies, and the chemical dependency treatment system;
     (c) Require substantial implementation of department adopted integrated screening and assessment process and matrix of best practices;
     (d) Maintain the decision-making independence of designated mental health professionals;
     (e) Except at the discretion of the secretary or as specified in the biennial budget, require ((regional support networks)) behavioral health organizations to pay the state for the costs associated with individuals who are being served on the grounds of the state hospitals and who are not receiving long-term inpatient care as defined in RCW 71.24.025;
     (f) Include a negotiated alternative dispute resolution clause; and
     (g) Include a provision requiring either party to provide one hundred eighty days' notice of any issue that may cause either party to voluntarily terminate, refuse to renew, or refuse to sign a mandatory amendment to the contract to act as a ((regional support network)) behavioral health organization. If either party decides to voluntarily terminate, refuse to renew, or refuse to sign a mandatory amendment to the contract to serve as a ((regional support network)) behavioral health organization they shall provide ninety days' advance notice in writing to the other party.

Sec. 39   RCW 71.24.360 and 2012 c 91 s 1 are each amended to read as follows:
     (1) The department may establish new ((regional support network)) behavioral health organization boundaries in any part of the state:
     (a) Where more than one ((network)) organization chooses not to respond to, or is unable to substantially meet the requirements of, the request for qualifications under RCW 71.24.320;
     (b) Where a ((regional support network)) behavioral health organization is subject to reprocurement under RCW 71.24.330; or
     (c) Where two or more ((regional support networks)) behavioral health organizations propose to reconfigure themselves to achieve consolidation, in which case the procurement process described in RCW 71.24.320 and 71.24.330(2) does not apply.
     (2) The department may establish no fewer than six and no more than fourteen ((regional support networks)) behavioral health organizations under this chapter. No entity shall be responsible for more than three ((regional support networks)) behavioral health organizations.

Sec. 40   RCW 71.24.405 and 2001 c 323 s 19 are each amended to read as follows:
     The department shall establish a comprehensive and collaborative effort within ((regional support networks)) behavioral health organizations 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 department 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 federal, state, and local funds provided to the community mental health 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)) behavioral health organizations. 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)) behavioral health organizations and mental health service providers that link financial incentives to the success or failure of mental health service providers and ((regional support networks)) behavioral health organizations to meet outcomes established for mental health service clients;
     (5) The involvement of mental health consumers and their representatives. Mental health consumers and their representatives will be involved in the development of outcome standards for mental health clients under section 5 of this act; and
     (6) An independent evaluation component to measure the success of the department in fully implementing the provisions of RCW 71.24.400 and this section.

Sec. 41   RCW 71.24.430 and 2001 c 323 s 3 are each amended to read as follows:
     (1) The department shall ensure the coordination of allied services for mental health clients. The department shall implement strategies for resolving organizational, regulatory, and funding issues at all levels of the system, including the state, the ((regional support networks)) behavioral health organizations, and local service providers.
     (2) The department shall propose, in operating budget requests, transfers of funding among programs to support collaborative service delivery to persons who require services from multiple department programs. The department shall report annually to the appropriate committees of the senate and house of representatives on actions and projects it has taken to promote collaborative service delivery.

Sec. 42   RCW 74.09.522 and 2013 2nd sp.s. c 17 s 13 are each amended to read as follows:
     (1) For the purposes of this section:
     (a) "Managed health care system" means any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, health insuring organizations, or any combination thereof, that provides directly or by contract health care services covered under this chapter and rendered by licensed providers, on a prepaid capitated basis and that meets the requirements of section 1903(m)(1)(A) of Title XIX of the federal social security act or federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act;
     (b) "Nonparticipating provider" means a person, health care provider, practitioner, facility, or entity, acting within their scope of practice, that does not have a written contract to participate in a managed health care system's provider network, but provides health care services to enrollees of programs authorized under this chapter whose health care services are provided by the managed health care system.
     (2) The authority shall enter into agreements with managed health care systems to provide health care services to recipients of temporary assistance for needy families under the following conditions:
     (a) Agreements shall be made for at least thirty thousand recipients statewide;
     (b) Agreements in at least one county shall include enrollment of all recipients of temporary assistance for needy families;
     (c) To the extent that this provision is consistent with section 1903(m) of Title XIX of the federal social security act or federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act, recipients shall have a choice of systems in which to enroll and shall have the right to terminate their enrollment in a system: PROVIDED, That the authority may limit recipient termination of enrollment without cause to the first month of a period of enrollment, which period shall not exceed twelve months: AND PROVIDED FURTHER, That the authority shall not restrict a recipient's right to terminate enrollment in a system for good cause as established by the authority by rule;
     (d) To the extent that this provision is consistent with section 1903(m) of Title XIX of the federal social security act, participating managed health care systems shall not enroll a disproportionate number of medical assistance recipients within the total numbers of persons served by the managed health care systems, except as authorized by the authority under federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act;
     (e)(i) In negotiating with managed health care systems the authority shall adopt a uniform procedure to enter into contractual arrangements, to be included in contracts issued or renewed on or after January 1, 2015, including:
     (A) Standards regarding the quality of services to be provided;
     (B) The financial integrity of the responding system;
     (C) Provider reimbursement methods that incentivize chronic care management within health homes, including comprehensive medication management services for patients with multiple chronic conditions consistent with the findings and goals established in RCW 74.09.5223;
     (D) Provider reimbursement methods that reward health homes that, by using chronic care management, reduce emergency department and inpatient use;
     (E) Promoting provider participation in the program of training and technical assistance regarding care of people with chronic conditions described in RCW 43.70.533, including allocation of funds to support provider participation in the training, unless the managed care system is an integrated health delivery system that has programs in place for chronic care management;
     (F) Provider reimbursement methods within the medical billing processes that incentivize pharmacists or other qualified providers licensed in Washington state to provide comprehensive medication management services consistent with the findings and goals established in RCW 74.09.5223; ((and))
     (G) Evaluation and reporting on the impact of comprehensive medication management services on patient clinical outcomes and total health care costs, including reductions in emergency department utilization, hospitalization, and drug costs; and
     (H) Established consistent processes to incentivize integration of behavioral health services in the primary care setting, promoting care that is integrated, collaborative, co-located, and preventive.
     (ii)(A) Health home services contracted for under this subsection may be prioritized to enrollees with complex, high cost, or multiple chronic conditions.
     (B) Contracts that include the items in (e)(i)(C) through (G) of this subsection must not exceed the rates that would be paid in the absence of these provisions;
     (f) The authority shall seek waivers from federal requirements as necessary to implement this chapter;
     (g) The authority shall, wherever possible, enter into prepaid capitation contracts that include inpatient care. However, if this is not possible or feasible, the authority may enter into prepaid capitation contracts that do not include inpatient care;
     (h) The authority shall define those circumstances under which a managed health care system is responsible for out-of-plan services and assure that recipients shall not be charged for such services;
     (i) Nothing in this section prevents the authority from entering into similar agreements for other groups of people eligible to receive services under this chapter; and
     (j) The authority must consult with the federal center for medicare and medicaid innovation and seek funding opportunities to support health homes.
     (3) The authority shall ensure that publicly supported community health centers and providers in rural areas, who show serious intent and apparent capability to participate as managed health care systems are seriously considered as contractors. The authority shall coordinate its managed care activities with activities under chapter 70.47 RCW.
     (4) The authority shall work jointly with the state of Oregon and other states in this geographical region in order to develop recommendations to be presented to the appropriate federal agencies and the United States congress for improving health care of the poor, while controlling related costs.
     (5) The legislature finds that competition in the managed health care marketplace is enhanced, in the long term, by the existence of a large number of managed health care system options for medicaid clients. In a managed care delivery system, whose goal is to focus on prevention, primary care, and improved enrollee health status, continuity in care relationships is of substantial importance, and disruption to clients and health care providers should be minimized. To help ensure these goals are met, the following principles shall guide the authority in its healthy options managed health care purchasing efforts:
     (a) All managed health care systems should have an opportunity to contract with the authority to the extent that minimum contracting requirements defined by the authority are met, at payment rates that enable the authority to operate as far below appropriated spending levels as possible, consistent with the principles established in this section.
     (b) Managed health care systems should compete for the award of contracts and assignment of medicaid beneficiaries who do not voluntarily select a contracting system, based upon:
     (i) Demonstrated commitment to or experience in serving low-income populations;
     (ii) Quality of services provided to enrollees;
     (iii) Accessibility, including appropriate utilization, of services offered to enrollees;
     (iv) Demonstrated capability to perform contracted services, including ability to supply an adequate provider network;
     (v) Payment rates; and
     (vi) The ability to meet other specifically defined contract requirements established by the authority, including consideration of past and current performance and participation in other state or federal health programs as a contractor.
     (c) Consideration should be given to using multiple year contracting periods.
     (d) Quality, accessibility, and demonstrated commitment to serving low-income populations shall be given significant weight in the contracting, evaluation, and assignment process.
     (e) All contractors that are regulated health carriers must meet state minimum net worth requirements as defined in applicable state laws. The authority shall adopt rules establishing the minimum net worth requirements for contractors that are not regulated health carriers. This subsection does not limit the authority of the Washington state health care authority to take action under a contract upon finding that a contractor's financial status seriously jeopardizes the contractor's ability to meet its contract obligations.
     (f) Procedures for resolution of disputes between the authority and contract bidders or the authority and contracting carriers related to the award of, or failure to award, a managed care contract must be clearly set out in the procurement document.
     (6) The authority may apply the principles set forth in subsection (5) of this section to its managed health care purchasing efforts on behalf of clients receiving supplemental security income benefits to the extent appropriate.
     (7) By April 1, 2016, any contract with a managed health care system to provide services to medical assistance enrollees shall require that managed health care systems offer contracts to behavioral health organizations, mental health providers, or chemical dependency treatment providers to provide access to primary care services integrated into behavioral health clinical settings, for individuals with behavioral health and medical comorbidities.
     (8) Managed health care system contracts effective on or after April 1, 2016, shall serve geographic areas that correspond to the regional service areas established in section 2 of this act.
     (9) A managed health care system shall pay a nonparticipating provider that provides a service covered under this chapter to the system's enrollee no more than the lowest amount paid for that service under the managed health care system's contracts with similar providers in the state.
     (((8))) (10) For services covered under this chapter to medical assistance or medical care services enrollees and provided on or after August 24, 2011, nonparticipating providers must accept as payment in full the amount paid by the managed health care system under subsection (7) of this section in addition to any deductible, coinsurance, or copayment that is due from the enrollee for the service provided. An enrollee is not liable to any nonparticipating provider for covered services, except for amounts due for any deductible, coinsurance, or copayment under the terms and conditions set forth in the managed health care system contract to provide services under this section.
     (((9))) (11) Pursuant to federal managed care access standards, 42 C.F.R. Sec. 438, managed health care systems must maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the authority, including hospital-based physician services. The authority will monitor and periodically report on the proportion of services provided by contracted providers and nonparticipating providers, by county, for each managed health care system to ensure that managed health care systems are meeting network adequacy requirements. No later than January 1st of each year, the authority will review and report its findings to the appropriate policy and fiscal committees of the legislature for the preceding state fiscal year.
     (((10))) (12) Payments under RCW 74.60.130 are exempt from this section.
     (((11))) (13) Subsections (((7))) (9) through (((9))) (11) of this section expire July 1, 2016.

NEW SECTION.  Sec. 43   Section 1 of 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 takes effect immediately.

NEW SECTION.  Sec. 44   Sections 6, 7, and 9 through 41 of this act take effect April 1, 2016.