SENATE BILL REPORT
2SSB 5400
BYSenate Committee on Ways & Means (originally sponsored by Senators Niemi, West, Kreidler, Wojahn and Talmadge)
Regarding mental health systems.
Senate Committee on Health Care & Corrections
Senate Hearing Date(s):January 31, 1989; February 9, 1989; February 15, 1989; February 21, 1989
Majority Report: That Substitute Senate Bill No. 5400 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.
Signed by Senators West, Chairman; Smith, Vice Chairman; Amondson, Johnson, Kreidler, Niemi, Wojahn.
Senate Staff:Don Sloma (786-7414)
February 23, 1989
Senate Committee on Ways & Means
Senate Hearing Date(s):March 16, 1989; March 17, 1989
Majority Report: That Second Substitute Senate Bill No. 5400 be substituted therefor, and the second substitute bill do pass.
Signed by Senators McDonald, Chairman; Craswell, Vice Chairman; Amondson, Bailey, Bauer, Bluechel, Cantu, Gaspard, Hayner, Johnson, Lee, Newhouse, Niemi, Owen, Saling, Smith, Williams, Wojahn.
Senate Staff:Jan Sharar (786-7715)
April 20, 1989
House Committe on Human Services
Rereferred House Committee on Appropriations
AS PASSED SENATE, MARCH 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 populations averaged 1,700 and community hospitals about 750. In 1984, Washington ranked 39th in the nation in the number of psychiatric hospital beds per 100,000 population; 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. 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 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 other mental health services as fragmented, and overly focused on providing expensive acute care.
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.
SUMMARY:
It is the intent of the Legislature to encourage the development of county-based mental health services. Counties are encouraged 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 adults and children no later than July 1, 1995. These responsibilities are assumed by contractual agreements with DSHS.
Mental health services are redefined on July 1, 1995 or when RSNs are established, and must include investigation, detention, evaluation and treatment, transportation, court-related procedures, and other services required by the Involuntary Treatment Act. Also required are residential, community support, and resource management services.
All counties must submit their intentions regarding participation in the RSNs by September 30, 1989. The secretary must assume all duties of the nonparticipating counties under the Involuntary Treatment Act (ITA) and the Community Mental Health Services Act by July 1, 1995. The implementation of the RSNs or the secretary's assumption of nonparticipating counties' duties are to be included in all state and federal plans affecting the state mental health program.
Implementation of the RSNs must begin by July 1, 1990 and be completed by June 30, 1995. One hundred percent of available resources are allocated to the RSNs as follows: (1) By January 1, 1990 RSNs could receive two block grants, one for short-term evaluation and treatment facilities, and a second for all other mental health services; (2) by July 1, 1993 RSNs would receive all funds for those services in a single grant.
RSNs are responsible for resource management services, including planning, coordination, and authorization of residential and community support services pursuant to an individual service plan for acutely or chronically mentally ill, and for those seriously disturbed individuals that the RSN finds to be at risk of becoming acutely or chronically mentally ill.
RSNs are to prepare six-year plans, budgets and timelines by January 1990, with biennial progress reports and plan updates beginning in January 1992.
The RSNs assumption of duties is limited by available resources. RSNs must provide for the availability of services.
By July 1, 1993, RSNs must provide short term evaluation and treatment services (up to 17 days) within their boundaries for at least 85 percent of their residents needing such services. The state's responsibility is limited to provide evaluation and treatment services under the Involuntary Treatment Act at the state hospitals.
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 state hospitals accept persons detained under the Involuntary Treatment Act may be limited by the provisions of the Community Mental Health Services Act.
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.
RSNs must develop procedures requiring consultation with resource management services by county designated mental health professionals and evaluation and treatment facilities to assure that determinations made to detain, commit, treat or release persons under the ITA are made only after appropriate information is sought.
Procedures for the confidentiality of patient registration and treatment records and authorization of the release of these records to patients, families, courts, corrections officials and persons providing care and treatment are established. These procedures take effect with the establishment of RSNs or on July 1, 1995.
The mental health quality authority is defined as the Department of Health, if created, or DSHS and must establish minimum standards for the mental health program and its components, for service providers and county administration. The mental health quality authority must license service providers and certify RSNs which meet standards.
The secretary of DSHS must report to the Legislature the effects of utilizing federal Title XIX funds for services to acutely and chronically mentally ill and persons at risk of becoming so and on the effect of the new federal definition of institutions of mental diseases by October 1, 1989.
The Legislature declares its intention to improve the quality of care, to eliminate overcrowding, and to redefine the role of state hospitals. The state hospitals are to become clinical centers for the most complicated long term care needs of the mentally ill, and have a reduced role in providing short term and acute care.
Boards are established at Eastern and Western State Hospitals composed of a consumer, a patient's family member, citizens, various hospital staff, a RSN representative, a community mental health service provider and the director of the institute for the study and treatment of mental disorders. All members must be appointed by the Governor and confirmed by the Senate.
The boards must 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. Whenever a vacancy occurs in the position of hospital superintendent, the board must consult with the DSHS secretary regarding a replacement.
Institutes for the study and treatment of mental disorders are established at Eastern and Western State Hospitals. The institutes must 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, implementing loan forgiveness programs and other measures to recruit and retain qualified staff, engaging in clinical research, effecting the exchange of staff between the hospitals and community mental health service providers, and providing for expanded training of hospital staff. The institutes are authorized to seek public and private grants, contracts and gifts.
DSHS must track the use of state and local mental health facilities and the associated costs by region and county.
DSHS must consult with affected parties in establishing a distribution formula for funds disbursed under the Community Mental Health Services Act.
DSHS must cooperate with the state congressional delegation to actively seek necessary regulatory or statutory changes to obtain federal reimbursement for treatment in free standing evaluation and treatment facilities.
The LBC must provide for a study of inpatient psychiatric bed utilization as impacted by this act.
The Secretary of DSHS is directed to identify persons with organic brain syndrome or other similar long-term care needs who are presently in the state psychiatric hospitals and submit a plan to the Legislature to place these persons in Medicaid reimbursable nursing homes or in another appropriate setting.
The Department of Health or the Office of Financial Management must conduct a study of compensation for involuntary treatment services and a review of Division of Medical Assistance rates paid to hospitals by December 1, 1989.
The act is null and void if funding is not provided in the omnibus appropriations act.
Appropriation: none
Revenue: none
Fiscal Note: available
Senate Committee - Testified: HEALTH CARE & CORRECTIONS: Rick Jessel, Skamania County Counseling Center (pro); Vernon Young, WE-CAN; Vicki Johnson, Alliance for the Mentally Ill of Washington State (pro); Steven Norsen, Washington Community Mental Health Coalition (pro); Nancy Caldwell, Association of County Human Services (pro); Jim Andrych, Consumer Support Group Resources (pro); Ilene Norsen, Washington Community Mental Health (pro); Ross Kane, Snohomish County Mental Health (pro); Rose Bond, Well Mind Association; Nancy Caldwell, Washington State Association of County Human Services (pro); Eleanor Owen, WAMI; Theresa Fujiwara, Asian Counseling and Referral Service; Doug Stevenson, Mental Health Coalition, King County; Jean Soliz, Governor's office; Helen Schwedenberg, Community Psychiatric Clinic; Elizabeth Gentala, Well Mind Association; Doris Davis, Well Mind Association; Betty Brearley, Snohomish AMI; Mark Brown, Washington Federation of State Employees; Dan Conray, WSH; Dennis Mahar, Washington State Association of Area Agencies on Aging; Jud Cunningham, Washington Community Mental Health Council; Evan Iverson, Senior Lobby; Bernice Buchheit, AMI/WS
Senate Committee - Testified: WAYS & MEANS: Jack Bilsborough, Sno-AMI (pro); Eleanor Owen, WAMI (pro); Kay Day (pro); Steve Dorsen, Washington Community Mental Health (pro); Bernie Buchheit, AMI; Doug Stevenson, Association of Counties (pro); Jean Soliz, OFM; Ralph Hawley, Snohomish County; Maureen McLaughlin, King County (pro); Scott Bond, Spokane County (pro)
HOUSE AMENDMENTS:
The intention of the Legislature is amended to emphasize the importance of retaining a respective and productive position in the community for persons with mental illness. Doctors of osteopathy are added as licensed service providers. Emergency intervention must be available 24 hours per day, seven days per week. The mental health quality authority is removed but its authority and duties are retained within DSHS. Available resources do not include state hospital funds.
The department is required to provide an interim tracking system for regional support networks as they come on line. Timelines are established for a second wave of counties to become regional support networks. Funding is to be disbursed beginning January 1, 1990 or within 60 days of approval as a network. Networks may not be smaller than 40,000 in population. Networks of less than 150,000 may contract outside their boundaries for evaluation and treatment services. The department must approve contracts and plans for networks. A specific portion of state hospital funds must be allocated to the networks in 1993. The Legislature shall approve a funding distribution formula during the 1993 session.
The study of Title XIX must be completed by December, 1989. A study of administrative costs must be completed by OFM and must include licensed service providers, state hospitals and the department and be presented to the Legislature during the 1991 session. Agreements to reduce detentions and short-term commitments must be contained in RCW contracts in 1991 and are subject to review by the Legislature during the 1991 session. The intent that networks receive most additional funding for implementing the Involuntary Treatment Act or the Community Mental Health Services Act is deleted.
Counties who have state hospitals located within their boundaries are required to provide short-term treatment as are all other networks. Resource management services must establish procedures for allowing access to an individual's treatment records. The nursing staff and a union member are to be represented on the state hospital advisory boards. The department shall review all state hospital patients for placement in more appropriate settings.
Specific provision is added for counties to enter network agreements in 1991-93 as well as in 1989-91. Counties entering in 1991-93 have until 1995 to assume full network responsibility.
A specific provision is made for inclusion of minority representatives on program planning bodies and hospital advisory committees. A pilot project demonstrating the relationship between organic disease and mental health problems is added. A report on possible solutions to the problem of staff recruitment and retention throughout the mental health system is added.
LBC study requirements are modified.