BILL REQ. #: H-4203.1
| State of Washington | 63rd Legislature | 2014 Regular Session |
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, 74.09.520, 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:
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 procurement regions 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, 2020;
(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 must
contract either with managed care health plans under chapter 74.09 RCW
or primary care practice settings to provide access to integrated
chemical dependency professional services and mental health services in
primary care settings;
(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
seriously 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 penalties,
termination of the contract, receivership, and reprocurement of the
contract;
(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-year 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 they
have developed 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. Any responding entity that submits a detailed plan that
substantially demonstrates that it can provide adequate access to
mental health and chemical dependency services for residents of the
regional service area 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 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 substantially meet the requirements of the request
for qualifications, the responding entities shall follow the
department's procurement process established in subsection (2) of this
section.
(2) If 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.
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, 2020, the community behavioral health program must be
fully integrated in a managed care health system that provides mental
health services, chemical dependency services, and medical care
services to medicaid clients. Beginning December 1, 2014, the
department and the health care authority shall submit an annual report
to the governor and the legislature regarding progress toward full
integration and any policy, administrative, or fiscal impediments that
may prevent the realization of full integration by January 1, 2020.
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
procurement region. 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 chemical dependency treatment services as
described in chapters 70.96A, 71.24, and 71.36 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:)) 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;
(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
(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;)) Periodically monitor the compliance of certified ((
(j)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 primary care 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 procurement for
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 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 full 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)), behavioral health services, including 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 alcohol
and drug use disorders.
(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)) (iii) Outpatient treatment, including medication assisted
treatment; and
(c)
(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.
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 74.09.520 and 2011 1st sp.s. c 15 s 27 are each
amended to read as follows:
(1) The term "medical assistance" may include the following care
and services subject to rules adopted by the authority or department:
(a) Inpatient hospital services; (b) outpatient hospital services; (c)
other laboratory and X-ray services; (d) nursing facility services; (e)
physicians' services, which shall include prescribed medication and
instruction on birth control devices; (f) medical care, or any other
type of remedial care as may be established by the secretary or
director; (g) home health care services; (h) private duty nursing
services; (i) dental services; (j) physical and occupational therapy
and related services; (k) prescribed drugs, dentures, and prosthetic
devices; and eyeglasses prescribed by a physician skilled in diseases
of the eye or by an optometrist, whichever the individual may select;
(l) personal care services, as provided in this section; (m) hospice
services; (n) other diagnostic, screening, preventive, and
rehabilitative services; and (o) like services when furnished to a
child by a school district in a manner consistent with the requirements
of this chapter. For the purposes of this section, neither the
authority nor the department may cut off any prescription medications,
oxygen supplies, respiratory services, or other life-sustaining medical
services or supplies.
"Medical assistance," notwithstanding any other provision of law,
shall not include routine foot care, or dental services delivered by
any health care provider, that are not mandated by Title XIX of the
social security act unless there is a specific appropriation for these
services.
(2) The department shall adopt, amend, or rescind such
administrative rules as are necessary to ensure that Title XIX personal
care services are provided to eligible persons in conformance with
federal regulations.
(a) These administrative rules shall include financial eligibility
indexed according to the requirements of the social security act
providing for medicaid eligibility.
(b) The rules shall require clients be assessed as having a medical
condition requiring assistance with personal care tasks. Plans of care
for clients requiring health-related consultation for assessment and
service planning may be reviewed by a nurse.
(c) The department shall determine by rule which clients have a
health-related assessment or service planning need requiring registered
nurse consultation or review. This definition may include clients that
meet indicators or protocols for review, consultation, or visit.
(3) The department shall design and implement a means to assess the
level of functional disability of persons eligible for personal care
services under this section. The personal care services benefit shall
be provided to the extent funding is available according to the
assessed level of functional disability. Any reductions in services
made necessary for funding reasons should be accomplished in a manner
that assures that priority for maintaining services is given to persons
with the greatest need as determined by the assessment of functional
disability.
(4) Effective July 1, 1989, the authority shall offer hospice
services in accordance with available funds.
(5) For Title XIX personal care services administered by aging and
disability services administration of the department, the department
shall contract with area agencies on aging:
(a) To provide case management services to individuals receiving
Title XIX personal care services in their own home; and
(b) To reassess and reauthorize Title XIX personal care services or
other home and community services as defined in RCW 74.39A.009 in home
or in other settings for individuals consistent with the intent of this
section:
(i) Who have been initially authorized by the department to receive
Title XIX personal care services or other home and community services
as defined in RCW 74.39A.009; and
(ii) Who, at the time of reassessment and reauthorization, are
receiving such services in their own home.
(6) In the event that an area agency on aging is unwilling to enter
into or satisfactorily fulfill a contract or an individual consumer's
need for case management services will be met through an alternative
delivery system, the department is authorized to:
(a) Obtain the services through competitive bid; and
(b) Provide the services directly until a qualified contractor can
be found.
(7) Subject to the availability of amounts appropriated for this
specific purpose, the authority may offer medicare part D prescription
drug copayment coverage to full benefit dual eligible beneficiaries.
(8) 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 contract with either
behavioral health organizations or mental health or chemical dependency
treatment providers to assure that primary care services are available
in and integrated into behavioral health treatment clinical settings.
The managed health care system contracts shall serve geographic areas
that correspond to the regional service areas established in section 2
of this act.
Sec. 43 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, assuring
integrated care 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) 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) 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) 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) Payments under RCW 74.60.130 are exempt from this section.
(11) Subsections (7) through (9) of this section expire July 1,
2016.
NEW SECTION. Sec. 44 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. 45 Sections 6, 7, and 9 through 42 of this act
take effect April 1, 2016.