WSR 18-06-043

PERMANENT RULES

[Filed March 1, 2018, 3:20 p.m., effective April 1, 2018]

Effective Date of Rule: Thirty-one days after filing.

Purpose: The department is amending existing rules and creating new rules in chapter 388-877 WAC regarding behavioral health services to provide a single set of regulations for behavioral health agencies to follow in order to provide mental health, substance use disorder, cooccurring, and pathological and problem gambling services. The department is also proposing to repeal chapters 388-810, 388-877A, 388-877B, 388-877C WAC, and repeal specific sections of chapters 388-865 and 388-877 WAC. A crosswalk table of existing and new WAC sections is available upon request.

Citation of Rules Affected by this Order: New WAC 388-877-0110, 388-877-0342, 388-877-0425, 388-877-0515, 388-877-0700, 388-877-0702, 388-877-0704, 388-877-0706, 388-877-0708, 388-877-0710, 388-877-0712, 388-877-0714, 388-877-0716, 388-877-0718, 388-877-0720, 388-877-0722, 388-877-0724, 388-877-0726, 388-877-0728, 388-877-0730, 388-877-0732, 388-877-0734, 388-877-0736, 388-877-0738, 388-877-0740, 388-877-0742, 388-877-0744, 388-877-0746, 388-877-0748, 388-877-0750, 388-877-0752, 388-877-0754, 388-877-0800, 388-877-0805, 388-877-0810, 388-877-0815, 388-877-0820, 388-877-0900, 388-877-0905, 388-877-0910, 388-877-0915, 388-877-0920, 388-877-1000, 388-877-1005, 388-877-1010, 388-877-1015, 388-877-1020, 388-877-1025, 388-877-1100, 388-877-1102, 388-877-1104, 388-877-1106, 388-877-1108, 388-877-1110, 388-877-1112, 388-877-1114, 388-877-1116, 388-877-1118, 388-877-1120, 388-877-1122, 388-877-1124, 388-877-1126, 388-877-1128, 388-877-1130, 388-877-1132, 388-877-1134, 388-877-1136, 388-877-1138, 388-877-1140, 388-877-1142, 388-877-1144, 388-877-1146, 388-877-1148, 388-877-1150, 388-877-1152, 388-877-1154, 388-877-1156 and 388-877-1158; and repealing WAC 388-810-005, 388-810-010, 388-810-020, 388-810-030, 388-810-040, 388-810-050, 388-810-060, 388-810-070, 388-810-080, 388-810-090, 388-865-0500, 388-865-0511, 388-865-0520, 388-865-0531, 388-865-0536, 388-865-0541, 388-865-0545, 388-865-0546, 388-865-0547, 388-865-0551, 388-865-0561, 388-865-0566, 388-865-0570, 388-865-0575, 388-865-0576, 388-865-0578, 388-865-0580, 388-865-0585, 388-865-0700, 388-865-0705, 388-865-0710, 388-865-0715, 388-865-0720, 388-865-0725, 388-865-0750, 388-865-0755, 388-865-0760, 388-865-0765, 388-865-0770, 388-865-0775, 388-865-0780, 388-865-0785, 388-865-0800, 388-865-0810, 388-865-0820, 388-865-0830, 388-865-0840, 388-865-0850, 388-865-0860, 388-865-0870, 388-865-0880, 388-865-0900, 388-865-0910, 388-865-0920, 388-865-0930, 388-865-0940, 388-865-0950, 388-865-0960, 388-865-0970, 388-877-0530, 388-877-0630, 388-877A-0100, 388-877A-0110, 388-877A-0120, 388-877A-0130, 388-877A-0135, 388-877A-0138, 388-877A-0140, 388-877A-0150, 388-877A-0155, 388-877A-0170, 388-877A-0180, 388-877A-0190, 388-877A-0195, 388-877A-0197, 388-877A-0200, 388-877A-0210, 388-877A-0220, 388-877A-0230, 388-877A-0240, 388-877A-0260, 388-877A-0270, 388-877A-0280, 388-877A-0300, 388-877A-0310, 388-877A-0320, 388-877A-0330, 388-877A-0335, 388-877A-0340, 388-877A-0350, 388-877A-0360, 388-877A-0370, 388-877B-0100, 388-877B-0110, 388-877B-0120, 388-877B-0130, 388-877B-0200, 388-877B-0210, 388-877B-0220, 388-877B-0230, 388-877B-0240, 388-877B-0250, 388-877B-0260, 388-877B-0270, 388-877B-0280, 388-877B-0300, 388-877B-0310, 388-877B-0320, 388-877B-0330, 388-877B-0340, 388-877B-0350, 388-877B-0360, 388-877B-0370, 388-877B-0400, 388-877B-0405, 388-877B-0410, 388-877B-0420, 388-877B-0430, 388-877B-0440, 388-877B-0450, 388-877B-0500, 388-877B-0510, 388-877B-0530, 388-877B-0540, 388-877B-0550, 388-877B-0600, 388-877B-0610, 388-877B-0630, 388-877B-0640, 388-877B-0650, 388-877B-0660, 388-877B-0700, 388-877B-0710, 388-877B-0720, 388-877B-0730, 388-877B-0740, 388-877C-0100, 388-877C-0110, 388-877C-0120 and 388-877C-0130; and amending WAC 388-877-0100, 388-877-0200, 388-877-0300, 388-877-0305, 388-877-0310, 388-877-0315, 388-877-0320, 388-877-0325, 388-877-0330, 388-877-0335, 388-877-0340, 388-877-0345, 388-877-0350, 388-877-0355, 388-877-0360, 388-877-0365, 388-877-0370, 388-877-0400, 388-877-0410, 388-877-0420, 388-877-0430, 388-877-0500, 388-877-0510, 388-877-0520, 388-877-0600, 388-877-0605, 388-877-0610, 388-877-0620, 388-877-0640, and 388-877-0650.

Statutory Authority for Adoption: RCW 71.24.870, 70.02.290, 70.02.340, 71.05.560, 71.24.035, 71.34.380.

Other Authority: RCW 71.24.870.

Adopted under notice filed as WSR 17-24-079 on December 5, 2017.

Changes Other than Editing from Proposed to Adopted Version: WAC 388-877-0100 Behavioral health services—Purpose and scope, the following was added:

"(3) The department requires all agencies and providers affected by this rule to fully comply with the applicable requirements in chapter 388-877 WAC, chapter 388-877A WAC, chapter 388-877B WAC, and chapter 388-877C WAC no later than September 1, 2013 July 1, 2018."

WAC 388-877-0200 Behavioral health services—Definitions, the following definitions were changed: "agency," "behavioral health agency," and "community mental health agency" were consolidated into one definition under "behavioral health agency."

"Consultation" was clarified as follows: "Consultation" means the clinical review of recommendations by persons with appropriate knowledge and experience regarding activities or decisions of clinical staff, contracted employees, volunteers, or students.

"Mental health professional" was clarified as follows: "Mental health professional" or "MHP" means a designation given by the department to an agency staff member or an attestation by the licensed behavioral health agency that the person meets the following:

(c) … recognized by the department or attested to by the licensed behavioral health agency.

The definitions for "patient placement criteria," "quality assurance and quality improvement," and "quality strategy" were removed.

WAC 388-877-0310 Agency licensure and certification—Deeming, was reworded for clarity: "(1) If an agency is currently accredited by a national accreditation organization that is recognized by and has a current agreement with the department, the department must deem the agency to be in compliance with state standards for licensure and certification."

WAC 388-877-0510 Personnel—Agency record requirements, was amended to add the word "annual" back in:

(1)(a) Documentation of annual training, ….

WAC 388-877-0515 Personnel—Agency staff requirements, was amended as follows:

(1)(c) Staff access to consultation with a psychiatrist, physician, physician assistant, advanced registered nurse practitioner (ARNP), or psychologist ….

WAC 388-877-0605 DBHR complaint process, was amended to remove the specific contact information for the DBHR complaint manager and replaced with a link to the department's public web site.

WAC 388-877-0610 Clinical—Assessment, was amended as follows:

(2) The assessment must document that the clinician conducted an age-appropriate, strengths-based psychosocial assessment that considered current needs and the patient's relevant history according to best practices. Such information may include, if applicable:

WAC 388-877-0640 Clinical—Additional record content, was amended to add the credential of the staff member when noting who provided the session in the progress notes.

WAC 388-877-0706 Outpatient services—Group mental health therapy services, subsection (2) was amended to increase maximum group size from fifteen to sixteen individuals.

WAC 388-877-0710 Outpatient services—Rehabilitative case management mental health services, subsection (1) was reworded for clarity:

(1) Rehabilitative case management services support individual employment, education, and participation in other daily activities appropriate to the individual's age, gender, and culture, and assist individuals in resolving crises in the least restrictive setting.

WAC 388-877-0712 Outpatient services—Psychiatric medication mental health services and medication support, was amended to add subsection [(1)](e):

(e) Must ensure that all medications maintained by the agency are safely and securely stored, including assurance that:

(i) Medications are kept in locked cabinets within a well-lit, locked and properly ventilated room;

(ii) Medications kept for individuals on medication administration or self-administration programs are clearly labeled and stored separately from medication samples kept on site;

(iii) Medications marked "for external use only" are stored separately from oral or injectable medications;

(iv) Refrigerated food or beverages used in the administration of medications are kept separate from the refrigerated medications by the use of trays or other designated containers;

(v) Syringes and sharp objects are properly stored and disposed of;

(vi) Refrigerated medications are maintained at the required temperature; and

(vii) Outdated medications are disposed of in accordance with the regulations of the state board of pharmacy and no outdated medications are retained.

WAC 388-877-0738 Outpatient services—Level one outpatient substance use disorder services, was amended to add subsection (3):

(3) An agency certified to provide level one outpatient substance use disorder services must ensure both of the following:

(a) Group therapy services are provided with a staff ratio of one staff member for every sixteen individuals; and

(b) A group counseling session with twelve to sixteen youths includes a second staff member.

WAC 388-877-0740 Outpatient services—Level two intensive outpatient substance use disorder services, was amended to add subsection (3):

(3) An agency certified to provide level two intensive outpatient substance use disorder services must ensure both of the following:

(a) Group therapy services are provided with a staff ratio of one staff member for every sixteen individuals; and

(b) A group counseling session with twelve to sixteen youths includes a second staff member.

WAC 388-877-0754 Outpatient services—Problem and pathological gambling treatment services, subsection (3) was amended to change the maximum size of group counseling from twelve to sixteen individuals.

WAC 388-877-1000 Opioid treatment programs (OTP)—General, subsection (7)(b) was amended to change the group counseling session from "nine to twelve" to "twelve to sixteen."

WAC 388-877-1104 Secure withdrawal management and stabilization services—Adults, subsection (2) was amended to add subsection (f):

(f) Procedures to assure at least daily contact between each involuntary individual and a chemical dependency professional or a trained professional person for the purpose of:

(i) Observation;

(ii) Evaluation;

(iii) Release from involuntary commitment to accept treatment on a voluntary basis; and

(iv) Discharge from the facility to accept voluntary treatment upon referral;

And (i) was amended to add physician assistant and advanced registered nurse practitioner (ARNP) to the list of professionals that are available for consultation.

(2)(k) was amended to add "one hundred and eighty days."

(3) was amended as follows: 

(3)(a) A telephone screened [screening] reviewed by a nurse, as defined in chapter 18.79 RCW, or a medical practitioner prior to admission ….

WAC 388-877-1108 Residential substance use disorder treatment services—General, subsection (2)(j) maximum group size was changed to sixteen.

WAC 388-877-1116 Residential substance use disorder treatment services—Youth residential services, subsection (2) was amended to change "nine to twelve" youths to "twelve to sixteen" youths.

WAC 388-877-1126 Mental health inpatient services—Policies and procedures—Adult, subsection (4)(e) was amended to include physician assistant and psychiatric advanced registered nurse practitioner (ARNP).

Subsection (4)(g) was amended to add "one hundred and eighty days."

WAC 388-877-1140 Mental health inpatient services—Crisis stabilization unit—Agency facility and administrative standards, subsection (4)(f) was amended to include physician assistant and psychiatric advanced registered nurse practitioner (ARNP).

A final cost-benefit analysis is available by contacting Stephanie Vaughn, Division of Behavioral Health and Recovery, P.O. Box 45330, Olympia, WA 98504-5330, phone 360-725-1342, fax 360-586-0341, TTY 1-800-833-6384, email stephanie.vaughn@dshs.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 78, Amended 30, Repealed 140.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 78, Amended 30, Repealed 140.

Date Adopted: March 1, 2018.

Cheryl Strange

Secretary