HOUSE BILL REPORT
HB 1876
BYRepresentatives Bristow, Winsley, Vekich, Scott, Rayburn, Kremen, Sprenkle, Braddock, Morris, P. King, Prentice, Leonard, Phillips, Nelson and Todd
Establishing a community mental health program.
House Committe on Human Services
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. (10)
Signed by Representatives Bristow, Chair; Scott, Vice Chair; Moyer, Ranking Republican Member; Tate, Assistant Ranking Republican Member; Brekke, Hargrove, Leonard, Padden, Raiter and Winsley.
House Staff:Jean Wessman (786-7132)
AS REPORTED BY COMMITTEE ON HUMAN SERVICES FEBRUARY 27, 1989
BACKGROUND:
Deinstitutionalization, the advent of psychotropic medications, and the expansion of civil rights protections for mentally ill persons during the 1960s and 1970s dramatically reduced state hospital populations. Washington might be housing as many as 10,080 persons in state hospitals had these trends not occurred.
In 1988, Washington's state hospital population averaged approximately 1,700, and community hospital population was about 750. In 1984, Washington ranked thirty-ninth in the nation in the number of psychiatric hospital beds per 100,000, with 66.7 as compared to a national average of 112.9.
Nursing homes and other community residential programs house an additional 3,500 to 4,000 mentally ill persons. In addition, community mental health centers provide outpatient services to an estimated 60,000, many of whom meet much broader eligibility criteria.
The federal Omnibus Budget Reconciliation Act will result in a loss of at least several hundred nursing home beds for the mentally ill.
A recent report to the Legislature documents the shortage of residences and describes the current administration and delivery of mental health services as fragmented, and overly focused on providing expensive inpatient acute care. It also reports on current national trends and models of integrated, community-based mental health systems which have assisted in stabilizing the populations of the state hospitals and provided incentives for the development of community residential options.
Consistent with these national trends, testimony from several public hearings indicated the desires of counties, mental health providers, consumers, and advocates, to design and participate in an integrated, decentralized, community-based delivery system that provides the entire continuum of care.
Based on such testimony, the report recommends that the authority and responsibility for delivering mental health services be decentralized to the local communities along with adequate funding to expand residential facilities and supports.
In addition, testimony indicated that our current confidentiality and record keeping statutes should be modified to ensure accurate patient tracking.
SUMMARY:
SUBSTITUTE BILL: It is the intent of the Legislature to encourage the development of county-based mental health services by encouraging counties to enter into regional systems of care which integrate planning, administration, and service delivery for community mental health and involuntary treatment services.
A county authority or a group of county authorities may enter into a joint operating agreement to form a regional support network (RSN). The RSN must develop and implement a plan to assume responsibility for planning, administering, and assuring the availability of mental health services for mentally ill persons within their areas no later than July 1, 1995. These responsibilities are to be assumed through contractual agreements with the Department of Social and Health Services (DSHS). The Department shall assure that a single authority within the network has final responsibility for resources and performance under the contract.
A RSN shall appoint a mental health advisory board to review and comment on all plans and policies developed under this act.
When RSNs are established, or on July 1, 1995, certain terms are redefined including "available resources," "community mental health program," "community support services," "mental health services," and "residential services."
Mental health services are redefined to include all services provided by the RSN, including residential services.
Regional support networks (RSN) are defined as a county authority or group of county authorities recognized by the Secretary of DSHS, who enter into joint operating agreements to contract with the Secretary for the administration, planning, and delivery of mental health services.
Resource management services are defined as the responsibility of the RSN and mean the planning, coordination, and authorization of residential and community support services pursuant to an individual service plan for those who are acutely or chronically mentally ill, the seriously disturbed, and for those seriously disturbed individuals that the RSN finds to be at risk of becoming acutely or chronically mentally ill.
The Mental Health Quality Authority is established within the Department of Health, if created. The Authority shall establish minimum standards for the delivery of mental health services. It shall also license service providers, certify RSNs, inspect RSNs and providers, fix fees, receive data from RSNs, suspend, revoke, limit, or restrict a certification or license, and adopt rules to implement their duties.
All counties shall submit their intentions regarding participation in the RSNs by September 30, 1989. The implementation of the RSNs is to be included in all state and federal plans affecting the state mental health program.
The Secretary shall begin implementation of the RSNs by July 1,1990 and complete implementation by June 30, 1995. By July 1, 1993, he or she shall allocate 100 percent of available resources to the RSNs in a single grant. Up to that time, funds for establishing and operating evaluation and treatment facilities shall be allocated separately from other funds.
The Secretary shall report to the Legislature on the effects of federal Title XIX funds and the 16 bed limit on Institutions for Mental Diseases, on services for acute and chronic persons and those at risk of becoming so by September 1, 1989.
By July 1, 1993 the RSNs shall be responsible for at least 85 percent of the short-term acute care population within their boundaries who are subject to commitments of 17 days or less. Also by July 1, 1993, the RSNs shall administer 15 percent of the funds appropriated by the Legislature for the state hospitals for the care of those needing evaluation and treatment services for up to 17 days in residential services including the state hospitals. If state hospitals are used, the RSNs shall buy bed days at a rate equal to that assumed by the Legislature during that biennium. The duty of the state hospitals to accept persons for short term acute care is limited by the duties of the RSNs.
Requests by the RSNs for the utilization of state-owned land ever used for the care of the mentally ill shall be given first priority by the administering state agency.
Chapter 71.05 RCW, the Involuntary Treatment Act (ITA) is modified to require coordination between the county-designated mental health professional and resource management services.
Legislative intent is declared to change the role of the state mental hospitals from short-term acute care to long-term care of the most difficult populations, including mentally ill offenders.
Procedures are established which provide for the confidentiality of patient registration and treatment records, and which authorize the release of specific portions of these records to patients, families, courts, corrections officials and persons providing care and treatment under the authority of state law. These procedures take effect with the establishment of RSNs, or on July 1, 1995.
Advisory boards are created at each state mental hospital to monitor and review operations of the hospitals, and make recommendations to the Legislature and the Governor regarding implementation of the changing role of the state hospitals.
Institutes for the Study and Treatment of Mental Disorders are created at each state mental hospital to improve the skill levels and quantity of staff through joint operating agreements with state universities and institutions of higher education.
The Legislative Budget Committee is required to conduct or contract for an evaluation of the implementation of this act. The Department of Health, if created, or the Office of Financial Management is required to complete a hospital rate review.
SUBSTITUTE BILL COMPARED TO ORIGINAL: Legislative intent is established that joint operating agreements among counties should result in consolidation and reduction of administrative layering and costs.
Medicaid funds are excluded from the definition of "available resources" allowing them to continue to be administered as they are currently.
Case management services is added to the definition of "community support services" and residential services are deleted.
The definitions of "available resources," "mental health services," duties of the Secretary and the responsibilities of regional support networks (RSNs) are all modified to remove the exclusion of childrens mental health services, and all other mental health services currently administered by the county authorities. All such services are to be administered by the regional support networks.
The requirement is removed that state minimum standards established by the Mental Health Quality Authority, include standards for management, county administration, information, accountability and contracts.
The Department of Social and Health Services (DSHS) is required to promulgate rules for the implementation of this act by September 1, 1989, and to submit them to the Legislature for review and comment prior to adoption.
The Secretary's duty to designate RSNs is modified to a duty to recognize networks requested by counties or groups of counties. All standards which had been required to be considered in establishing RSNs are eliminated.
The requirement that RSNs administer 90 percent of state hospital funds is removed. However, by July 1, 1993, RSNs must administer up to 15 percent of the funds appropriated by the Legislature for all but mentally ill offenders at the State hospitals, and may contract for use of State hospital beds.
The requirement that RSNs accept designation as state institutions is deleted.
A RSN may request that any state owned property ever used for care of the mentally ill be made available to support the operations of the RSN. State agencies must give first priority to such requests.
Each RSN is required to establish an advisory board to review and comment on the planning and operations of the RSN.
The Legislature declares its intention to improve the quality of care, to eliminate overcrowding, and to redefine the role of state hospitals. The Legislature intends that the state hospitals become clinical centers for the most complicated long term care needs of the mentally ill, and reduce their role in providing short term and acute care.
Boards are established at Eastern and Western State Hospitals to be composed of a consumer, a patient's family member, various hospital staff, an RSN representative, a community mental health service provider and the director of the Institute for the Study and Treatment of Mental Disorders at each hospital. All members are to be appointed by the governor and confirmed by the State Senate.
The boards shall monitor hospital operations, review budgets and policies, and make recommendations to the governor and the Legislature on implementation of the intent to change the role of the hospitals.
Institutes for the Study and Treatment of Mental Disorders are established at Eastern and Western State Hospitals. The institutes shall be operated by the state universities under contract with DSHS.
The institutes' duties include establishing joint operating agreements with colleges and universities to place students and faculty at the hospitals, to implement loan forgiveness programs and other measures to recruit and retain qualified staff, to engage in clinical research, to effect the exchange of staff between the hospitals and community mental health service providers, and to provide for expanded training of hospital staff. The institutes are authorized to seek public and private grants, contracts and gifts.
The Legislative Budget Committee shall either conduct themselves or contract for evaluation of implementation of this act. The Department of Health, if created, or the Office of Financial Management shall conduct a hospital rate review.
Appropriation: There shall be appropriated from the general fund to the department of social and health services for the biennium ending June 30, 1991, for the following purposes: (1) Three million two hundred thousand dollars to, inrease staffing levels at Eastern and Western State hospitals; (2) Four million five hundred thousand dollars to fund increased costs associated with the administration of the involuntary treatment act for counties or regional support networks if established; (3) Nine million six hundred thousand dollars to fund regional support networks' residential services, crises intervention services, and resource management services. In addition to other funds appropriated by the Legislature for the state hospitals, there is appropriated for the biennium ending June 30, 1991, the sum of five million dollars to the department of social and health services to be placed in reserve for the state hospitals.
Fiscal Note: Available.
Effective Date:The bill contains an emergency clause and takes effect immediately.
House Committee ‑ Testified For: Sharon Stewart-Johnson, Department of Social and Health Services; Thelma Struck, DSHS; Pat Thibaudeau, Washington Community Mental Health; Doug Stevenson, Mental Health Coalition and Washington State Association of Counties; Maureen McLaughlin, Director of Human Resources, King County; Theresa Fujiwara, Asian Counseling and Referral Service; and Michael Shupe, Former Patient.
House Committee - Testified Against: Gary Moore, Washington Federation of State Employees.
House Committee - Testimony For: Administration, planning and service delivery of the mental health system is badly fragmented. No one entity is responsible, and in fact even identifying who is responsible is difficult. The client frequently gets lost in the current system since no one is responsible for overseeing the client's movement from institution to residential placement to outpatient services to the streets. Residential services have not been a mandated service leaving a major gap between acute inpatient care and outpatient treatment. The state hospitals and the local authorities and providers end up "dumping" their clients on the other's area of responsibility. The state hospitals are continually on the verge of federal decertification due to understaffing, questionable patient care and overcrowding. Deinstitutionalization has relegated many of the mentally ill to the streets, jails, and hospital emergency rooms. Residential services are badly needed for this population. The federal Omnibus Budget Reconciliation Act will further exacerbate this situation by requiring the displacement of hundreds of mentally ill persons from nursing homes. Local communities can best meet the needs of this population and should have the authority and responsibility as well as the financial resources to design programs suited to their own needs. The State of Washington is not over bedded in its state hospitals but does need to provide community alternatives to hospital care so that only long-term difficult and complex cases are served in state institutions.
House Committee - Testimony Against: No testimony was presented against the bill. But one neutral witness cautioned that any change should proceed very slowly, that the Legislature should be aware of how moving the mental health program entirely to the community has not occurred smoothly in other states, and that there should be a stronger community-state relationship in community residential programs.