SENATE BILL REPORT
SB 5400
BYSenators 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)
March 17, 1989
AS REPORTED BY COMMITTEE ON WAYS & MEANS, MARCH 17, 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, designated by the Secretary of the Department of Social and Health Services (DSHS), 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 no later than July 1, 1995. These responsibilities are assumed by contractual agreements with DSHS.
Mental health services are redefined, 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.
RSNs must administer 90 percent of the appropriated funds for housing mentally ill persons in state hospitals, except mentally ill offenders. If RSNs use state hospitals, they must pay for such use at a rate equal to 90 percent of appropriated funds for housing persons at state institutions.
The RSNs may administer other funds and assure the availability of other services now administered by individual counties including children's mental health, day treatment, outpatient counseling, and education and consultation.
RSNs shall accept designation by the Governor as "institutions" for the mentally ill, excluding mentally ill offenders.
An RSN may appoint a mental health advisory board to review and comment on all plans and policies.
When RSNs are established or on July 1, 1995, "available resources," "community mental health program," "community support services," "mental health services," and "residential services" will be redefined.
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.
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 designate no more than ten RSNs by November 1, 1989 after considering (1) the boundaries suggested by groups of counties and (2) the proposed RSNs' ability to efficiently serve within their boundaries at least 85 percent of their population in need of evaluation and treatment services and long term residential services.
All counties shall submit their intentions regarding participation in the RSNs by September 30, 1989. The secretary shall assume all duties of the nonparticipating counties under the Involuntary Treatment Act (ITA) and the Community Mental Health Services on July 1, 1995. The implementation of the RSNs and 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 in a single grant but separate grants may be made to county authorities providing services not required by the RSNs.
The secretary shall 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 by September 1, 1989.
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.
EFFECT OF PROPOSED SUBSTITUTE:
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."
Pre-admission screening for hospitals and other residential services is limited to those patients who are publicly funded.
Case management services is added to the definition of "community support services."
The definitions of "available resources," "mental health services," duties of the secretary and the responsibilities of regional support networks (RSNs) include children's mental health services, and all other mental health services currently administered by the county authorities. RSNs must assume responsibility for all elements of the existing community mental health program.
State minimum standards are not required to include standards for management, county administration, information, accountability and contracts.
The Department of Social and Health Services (DSHS) is required to promulgate rules by September 1, 1989, and to submit them to the Legislature for review and comment prior to adoption.
The secretary is to recognize networks requested by counties or groups of counties. Required standards to be considered in establishing RSNs are eliminated.
The secretary is to contract biennially with RSNs. The secretary is authorized to audit and monitor the terms of the contract and deny funds based on noncompliance. If funds are denied, RSNs may appeal according to the provisions of the Administrative Procedure Act.
The requirement that the secretary complete a study on the use of Title XIX funds for the mental health program is expanded.
The mental health quality authority is established. The authority's duties exclude setting minimum standards for management of mental health services, county administration, and information assuring accountability of services. The duty to set minimum standards for RSNs is established. Procedures for licensing, monitoring, decertifying, sanctioning, and proscribing penalties are added. Duplicative authority to certify evaluation and treatment facilities is repealed from the Involuntary Treatment Act.
Provisions are deleted that modify the ability of county authorities or RSNs to act as licensed service providers.
RSNs are to prepare a six-year plan, budget and timeline 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.
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.
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 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, 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.
Appropriations sections are added as follows: 1) $3.2 million for staffing levels at Eastern and Western; 2) $4.5 million for Involuntary Treatment Act administration; 3) $9.6 million for regional support network services; and 4) $5.0 million in reserve for the state hospitals, to be released to RSNs on July 1, 1990, if not used to reduce overcrowding or to meet certification requirements at Eastern or Western.
EFFECT OF PROPOSED SECOND SUBSTITUTE:
The provisions of the regional support networks are expanded to include children.
The reference to acute hospitalization and evaluation and treatment is removed from the definition of "community support services." Legal and other nonresidential civil commitment services are added to the definition of "community support services." Residential services are removed from the definition.
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.
The dates for reports required from DSHS to the Legislature are changed.
Inconsistent language is removed to clarify that priority populations for RSN services are acutely mentally ill persons, chronically mentally ill persons and persons who are at risk of becoming acutely and chronically mentally ill as determined by regional support networks.
The study of Title XIX funds is expanded to include the impact of the new federal definition of institutions for the mentally diseased.
A requirement is added that DSHS 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 implementation of RSNs is specified 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.
Regional support networks are required to establish standards and procedures for reviewing individual service plans and making determinations regarding an individual's discharge from resource management services.
Hospital boards at the state psychiatric hospitals are required to include one family member of a current or recent patient of the hospitals.
Nursing staff representation on each hospital board is changed to a representative from other professional staff.
A new requirement is added for the LBC to 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: $3.2 million for staffing levels at Eastern and Western; $4.5 million for Involuntary Treatment Act administration; $9.6 million for regional support network services; and $5.0 million in reserve for the state hospitals.
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)