FINAL BILL REPORT
2SSB 5400
C 205 L 89
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 and Committee on Ways & Means
House Committe on Human Services
Rereferred House Committee on Appropriations
SYNOPSIS AS ENACTED
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:
The Legislature intends 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. The Legislature intends that enhanced program funding for mental health services be made available primarily to counties participating in regional support networks.
A county or group of counties whose combined population is no less than 40,000 persons 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 area by July 1, 1995. Interim dates for the transition of certain responsibilities are specified. These responsibilities are to be assumed through contractual agreements with the Department of Social and Health Services (DSHS). The department may not determine the roles and responsibilities of counties within an RSN, but must assure that a single authority within the network has final responsibility for resources and performance under the contract.
An RSN must 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 will be redefined to include all services provided by the RSN including residential 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 for those who are 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.
Counties seeking to form RSNs must submit their intentions regarding participation by October 30, 1989, or, if they wish to delay such designation, by November 30, 1992. DSHS must assume the responsibilities of an RSN by July 1, 1995 for areas of the state in which a county has not entered into a joint operating agreement to operate an RSN.
The implementation of the RSNs is to be included in all state and federal plans affecting the state mental health program. The first RSN may include a pilot project demonstrating the relationship between organic disease and mental illness.
The secretary must begin implementation of the RSNs between January 1, 1990 and March 1, 1990, and complete implementation by June 1995. By July 1, 1993, the secretary must allocate 100 percent of available resources to RSNs in a single grant. By July 1, 1995 allocation of funds shall be in a single grant for RSNs established during 1992. Up to that time, funds for establishing and operating evaluation and treatment facilities shall be allocated separately from other funds.
The secretary must 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 December 1, 1989.
The secretary must have an adequate interim tracking system available for an RSN that will allow it to perform its responsibilities. The secretary shall establish a task force on recruitment and retention of qualified community mental health professionals and report to the appropriate committees of the Legislature by January 1, 1990.
By July 1, 1993 the first RSNs must be responsible for at least 85 percent of the acute care population within their boundaries who are subject to civil commitments of 17 days or less. Also by July 1, 1993, the first RSNs must administer a portion of the funds appropriated to state hospitals for care of those needing evaluation and treatment for up to 17 days in residential services, including in state hospitals. If state hospitals are used after this date, the RSNs must buy bed days at a rate equal to that indicated by the Legislature for that biennium. The duty of the state hospitals to accept persons for short term acute care is limited by the duties of the RSNs. The second wave of RSNs shall assume these responsibilities by July 1, 1995. RSNs with total population of less than 150,000 persons may contract with neighboring RSNs for evaluation and treatment services.
Requests by the RSNs for the utilization of state-owned land previously used for the care of the mentally ill shall be given first priority by the administering state agency.
The Legislature will receive DSHS studies on a proposed funding distribution formula and on administrative costs in 1993.
RSN contracts must include progress toward taking responsibility for short-term civil commitments, residential services and crisis services.
Chapter 71.05 RCW, the Involuntary Treatment Act (ITA) is modified to require RSNs to develop procedures for coordination between county-designated mental health professionals and resource management services.
Procedures are established regarding confidentiality of patient registration and treatment records which authorize the release of specific portions 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.
The Legislature intends to change the role of state mental hospitals from short-term acute care to care of the most difficult populations including mentally ill offenders and long-term care patients.
Advisory boards are created at each state mental hospital to monitor and review operations of the hospitals, to make recommendations to the Legislature and the Governor regarding implementation of the changing role of the state hospitals, and to advise on persons who might be selected as superintendent, if a vacancy occurs.
Institutes for the Study and Treatment of Mental Disorders are created at each state mental hospital to improve the training, recruitment and retention of staff, to engage in clinical research, and to encourage cross staffing of state hospitals and community programs, through joint operating agreements with state universities and institutions of higher education.
The Legislative Budget Committee is to complete a study plan for an evaluation of the implementation of this act. It must determine the progress of the first wave RSNs in meeting the requirement to serve 85 percent of their short-term commitments by 1993. The Department of Health, if created, or the Office of Financial Management is required to complete a review of rates paid to local hospitals for care of mentally ill persons.
Representatives from underserved populations are included on the state hospital boards and shall participate in developing the state's mental health plan.
VOTES ON FINAL PASSAGE:
Senate 42 4
House 94 2 (House amended)
Senate (Senate refused to concur)
Free Conference Committee
House 97 0
Senate 43 2
EFFECTIVE:May 3, 1989