AN
ACT Relating to technical, clarifying, nonsubstantive amendments to community mental
health services; amending RCW 71.24.025, 71.24.030, 71.24.035, 71.24.049,
71.24.110, 71.24.220, 71.24.300, 71.24.400, 71.24.405, 71.24.415, and
71.24.460; adding a new section to chapter 71.24 RCW; creating new sections;
repealing RCW 71.24.410; and repealing 1989 c 205 s 23 (uncodified).
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW
SECTION. Sec. 1. The
purpose of this act is to eliminate dates and provisions in chapter 71.24 RCW
which are no longer needed. The legislature does not intend this act to make,
and no provision of this act shall be construed as, a substantive change in the
service delivery system or funding of the community mental health services law.
Sec.
2. RCW
71.24.025 and 1997 c 112 s 38 are each amended to read as follows:
Unless
the context clearly requires otherwise, the definitions in this section apply
throughout this chapter.
(1)
"Acutely mentally ill" means a condition which is limited to a short-term
severe crisis episode of:
(a)
A mental disorder as defined in RCW 71.05.020 or, in the case of a child, as
defined in RCW 71.34.020;
(b)
Being gravely disabled as defined in RCW 71.05.020 or, in the case of a child,
a gravely disabled minor as defined in RCW 71.34.020; or
(c)
Presenting a likelihood of serious harm as defined in RCW 71.05.020 or, in the
case of a child, as defined in RCW 71.34.020.
(2)
"Available resources" means ((those)) funds ((which shall
be)) appropriated ((under this chapter by the legislature during any
biennium)) for the purpose of providing community mental health programs
under RCW 71.24.045((. When regional support networks are established or
after July 1, 1995, "available resources" means)), federal
funds, except those provided according to Title XIX of the Social Security Act,
and state funds appropriated under this chapter or chapter 71.05 RCW by the
legislature during any biennium for the purpose of providing residential
services, resource management services, community support services, and other
mental health services. This does not include funds appropriated for the
purpose of operating and administering the state psychiatric hospitals, except
as negotiated according to RCW 71.24.300(1)(d).
(3)
"Licensed service provider" means an entity licensed according to
this chapter or chapter 71.05 RCW that meets state minimum standards or
individuals licensed under chapter 18.57, 18.71, 18.83, or 18.79 RCW, as it
applies to registered nurses and advanced registered nurse practitioners.
(4)
"Child" means a person under the age of eighteen years.
(5)
"Chronically mentally ill adult" means an adult who has a mental
disorder and meets at least one of the following criteria:
(a)
Has undergone two or more episodes of hospital care for a mental disorder
within the preceding two years; or
(b)
Has experienced a continuous psychiatric hospitalization or residential
treatment exceeding six months' duration within the preceding year; or
(c)
Has been unable to engage in any substantial gainful activity by reason of any
mental disorder which has lasted for a continuous period of not less than
twelve months. "Substantial gainful activity" shall be defined by
the department by rule consistent with Public Law 92‑603, as amended.
(6)
"Severely emotionally disturbed child" means ((an infant or)) a
child who has been determined by the regional support network to be
experiencing a mental disorder as defined in chapter 71.34 RCW, including those
mental disorders that result in a behavioral or conduct disorder, that is
clearly interfering with the child's functioning in family or school or with
peers and who meets at least one of the following criteria:
(a)
Has undergone inpatient treatment or placement outside of the home related to a
mental disorder within the last two years;
(b)
Has undergone involuntary treatment under chapter 71.34 RCW within the last two
years;
(c)
Is currently served by at least one of the following child-serving systems:
Juvenile justice, child-protection/welfare, special education, or developmental
disabilities;
(d)
Is at risk of escalating maladjustment due to:
(i)
Chronic family dysfunction involving a mentally ill or inadequate caretaker;
(ii)
Changes in custodial adult;
(iii)
Going to, residing in, or returning from any placement outside of the home, for
example, psychiatric hospital, short-term inpatient, residential treatment,
group or foster home, or a correctional facility;
(iv)
Subject to repeated physical abuse or neglect;
(v)
Drug or alcohol abuse; or
(vi)
Homelessness.
(7)
"Community mental health service delivery system" means public or
private agencies that provide services specifically to persons with mental
disorders as defined under RCW 71.05.020 and receive funding from ((various))
public sources ((including: (a) Federal medicare, medicaid, or early
periodic screening, diagnostic, and treatment programs; or (b) state funds from
the division of mental health, division of children and family services,
division of alcohol and substance abuse, or division of vocational
rehabilitation of the department of social and health services)).
(8)
"Community mental health program" means all mental health services ((established
by a county authority. After July 1, 1995, or when the regional support
networks are established, "community mental health program" means all)),
activities, or programs using available resources.
(9)
"Community support services" means ((services for acutely mentally
ill persons, chronically mentally ill adults, and severely emotionally
disturbed children and includes: (a) Discharge planning for clients leaving
state mental hospitals, other acute care inpatient facilities, inpatient
psychiatric facilities for persons under twenty-one years of age, and other children's
mental health residential treatment facilities; (b) sufficient contacts with
clients, families, schools, or significant others to provide for an effective
program of community maintenance; and (c) medication monitoring. After July 1,
1995, or when regional support networks are established, for adults and
children "community support services" means)) services
authorized, planned, and coordinated through resource management services
including, at least, assessment, diagnosis, emergency crisis intervention
available twenty-four hours, seven days a week, prescreening determinations for
mentally ill persons being considered for placement in nursing homes as
required by federal law, screening for patients being considered for admission
to residential services, diagnosis and treatment for acutely mentally ill and
severely emotionally disturbed children discovered under screening through the
federal Title XIX early and periodic screening, diagnosis, and treatment
program, investigation, legal, and other nonresidential services under chapter
71.05 RCW, case management services, psychiatric treatment including medication
supervision, counseling, psychotherapy, assuring transfer of relevant patient
information between service providers, other services determined by regional
support networks, and maintenance of a patient tracking system for chronically
mentally ill adults and severely emotionally disturbed children.
(10)
"County authority" means the board of county commissioners, county
council, or county executive having authority to establish a community mental
health program, or two or more of the county authorities specified in this
subsection which have entered into an agreement to provide a community mental
health program.
(11)
"Department" means the department of social and health services.
(12)
"Mental health services" means ((community services pursuant to
RCW 71.24.035(5)(b) and other services provided by the state for the mentally
ill. When regional support networks are established, or after July 1, 1995,
"mental health services" shall include)) all services provided by
regional support networks and other services provided by the state for the
mentally ill.
(13)
"Mentally ill persons" and "the mentally ill" mean persons
and conditions defined in subsections (1), (5), (6), and (17) of this section.
(14)
"Regional support network" means a county authority or group of
county authorities recognized by the secretary that enter into joint operating
agreements to contract with the secretary pursuant to this chapter.
(15)
"Residential services" means ((a facility or distinct part thereof
which provides food and shelter, and may include treatment services.
When
regional support networks are established, or after July 1, 1995, for adults
and children "residential services" means)) a
complete range of residences and supports authorized by resource management
services and which may involve a facility, a distinct part thereof, or services
which support community living, for acutely mentally ill persons, chronically
mentally ill adults, severely emotionally disturbed children, or seriously
disturbed adults determined by the regional support network to be at risk of
becoming acutely or chronically mentally ill. The services shall include at
least evaluation and treatment services as defined in chapter 71.05 RCW, acute
crisis respite care, long-term adaptive and rehabilitative care, and supervised
and supported living services, and shall also include any residential services
developed to service mentally ill persons in nursing homes. Residential
services for children in out-of-home placements related to their mental
disorder shall not include the costs of food and shelter, except for children's
long-term residential facilities existing prior to January 1, 1991.
(16)
"Resource management services" mean the planning, coordination, and
authorization of residential services and community support services
administered pursuant to an individual service plan for: (a) Acutely
mentally ill adults and children((,)); (b) chronically mentally
ill adults((,)); (c) severely emotionally disturbed children((,));
or (d) seriously disturbed adults determined solely by ((the))
a regional support network ((at their sole discretion)) to be at
risk of becoming acutely or chronically mentally ill. Such planning,
coordination, and authorization shall include mental health screening for
children eligible under the federal Title XIX early and periodic screening,
diagnosis, and treatment program. Resource management services include seven
day a week, twenty-four hour a day availability of information regarding
mentally ill adults' and children's enrollment in services and their individual
service plan to county-designated mental health professionals, evaluation and
treatment facilities, and others as determined by the regional support network.
(17)
"Seriously disturbed person" means a person who:
(a)
Is gravely disabled or presents a likelihood of serious harm to himself or
herself or others, or to the property of others, as a result of a mental
disorder as defined in chapter 71.05 RCW;
(b)
Has been on conditional release status, or under a less restrictive
alternative order, at some time during the preceding two years from an
evaluation and treatment facility or a state mental health hospital;
(c)
Has a mental disorder which causes major impairment in several areas of daily
living;
(d)
Exhibits suicidal preoccupation or attempts; or
(e)
Is a child diagnosed by a mental health professional, as defined in ((RCW
71.05.020)) chapter 71.34 RCW, as experiencing a mental disorder
which is clearly interfering with the child's functioning in family or school
or with peers or is clearly interfering with the child's personality
development and learning.
(18)
"Secretary" means the secretary of social and health services.
(19)
"State minimum standards" means minimum requirements established
by rules adopted by the secretary and necessary to implement this chapter for:
(a) ((Minimum requirements for)) Delivery of mental health
services ((as established by departmental rules and necessary to implement
this chapter, including but not limited to licensing service providers and
services)); (b) ((minimum service requirements for)) licensed
service providers for the provision of mental health services ((as established
by departmental rules pursuant to chapter 34.05 RCW as necessary to implement
this chapter, including, but not limited to: Qualifications for staff
providing services directly to mentally ill persons; the intended result of
each service; and the rights and responsibilities of persons receiving mental
health services pursuant to this chapter)); (c) ((minimum requirements
for)) residential services ((as established by the department in rule
based on clients' functional abilities and not solely on their diagnoses,
limited to health and safety, staff qualifications, and program outcomes.
Minimum requirements for residential services are those developed in
collaboration with consumers, families, counties, regulators, and residential
providers serving the mentally ill. Minimum requirements encourage the
development of broad-range residential programs, including integrated housing
and cross-systems programs where appropriate, and do not unnecessarily restrict
programming flexibility)); and (d) ((minimum standards for))
community support services and resource management services((, including at
least qualifications for resource management services, client tracking systems,
and the transfer of patient information between service providers)).
(20)
"Tribal authority," for the purposes of this section and RCW
71.24.300 only, means: The federally recognized Indian tribes and the major
Indian organizations recognized by the secretary insofar as these organizations
do not have a financial relationship with any regional support network that
would present a conflict of interest.
Sec.
3. RCW
71.24.030 and 1982 c 204 s 6 are each amended to read as follows:
The
secretary is authorized((, pursuant to this chapter and the rules
promulgated to effectuate its purposes,)) to make grants to counties or
combinations of counties in the establishment and operation of community mental
health programs.
Sec.
4. RCW
71.24.035 and 1998 c 245 s 137 are each amended to read as follows:
(1)
The department is designated as the state mental health authority.
(2)
The secretary may provide for public, client, and licensed service provider
participation in developing the state mental health program.
(3)
The secretary shall provide for participation in developing the state mental
health program for children and other underserved populations, by including
representatives on any committee established to provide oversight to the state
mental health program.
(4)
The secretary shall be designated as the county authority if a county fails to
meet state minimum standards or refuses to exercise responsibilities under RCW
71.24.045.
(5)
The secretary shall:
(a)
Develop a biennial state mental health program that incorporates county
biennial needs assessments and county mental health service plans and state
services for mentally ill adults and children. The secretary may also develop
a six-year state mental health plan;
(b)
Assure that any county community mental health program provides access to
treatment for the county's residents in the following order of priority: (i)
The acutely mentally ill; (ii) chronically mentally ill adults and severely
emotionally disturbed children; and (iii) the seriously disturbed. Such
programs shall provide:
(A)
Outpatient services;
(B)
Emergency care services for twenty-four hours per day;
(C)
Day treatment for mentally ill persons which includes training in basic living
and social skills, supported work, vocational rehabilitation, and day
activities. Such services may include therapeutic treatment. In the case of a
child, day treatment includes age-appropriate basic living and social skills,
educational and prevocational services, day activities, and therapeutic
treatment;
(D)
Screening for patients being considered for admission to state mental health
facilities to determine the appropriateness of admission;
(E)
Employment services, which may include supported employment, transitional work,
placement in competitive employment, and other work-related services, that
result in mentally ill persons becoming engaged in meaningful and gainful full
or part-time work. Other sources of funding such as the division of vocational
rehabilitation may be utilized by the secretary to maximize federal funding and
provide for integration of services;
(F)
Consultation and education services; and
(G)
Community support services;
(c)
Develop and adopt rules establishing state minimum standards for the delivery
of mental health services pursuant to section 5 of this act including,
but not limited to:
(i)
Licensed service providers;
(ii)
Regional support networks; and
(iii)
Residential and inpatient services, evaluation and treatment services and
facilities under chapter 71.05 RCW, resource management services, and community
support services;
(d)
Assure that the special needs of minorities, the elderly, disabled, children,
and low-income persons are met within the priorities established in this
section;
(e)
Establish a standard contract or contracts, consistent with state minimum
standards, which shall be used by the counties;
(f)
Establish, to the extent possible, a standardized auditing procedure which
minimizes paperwork requirements of county authorities and licensed service
providers;
(g)
Develop and maintain an information system to be used by the state, counties,
and regional support networks ((when they are established which shall)) that
includes a tracking method which allows the department and regional
support networks to identify mental health clients' participation in any mental
health service or public program on an immediate basis. The information system
shall not include individual patient's case history files. Confidentiality of
client information and records shall be maintained as provided in this chapter
and in RCW 71.05.390, 71.05.400, 71.05.410, 71.05.420, 71.05.430, and
71.05.440((. The system shall be fully operational no later than January 1,
1993: PROVIDED, HOWEVER, That when a regional support network is established,
the department shall have an operational interim tracking system for that
network that will be adequate for the regional support network to perform its
required duties under this chapter));
(h)
License service providers who meet state minimum standards;
(i)
Certify regional support networks that meet state minimum standards;
(j)
Periodically inspect certified regional support networks and licensed service
providers at reasonable times and in a reasonable manner; ((and))
(k)
Fix fees to be paid by evaluation and treatment centers to the secretary for
the required inspections;
(l)
Monitor and audit counties, regional support networks, and licensed service
providers as needed to assure compliance with contractual agreements authorized
by this chapter; and
(m)
((Prior to September 1, 1989,)) Adopt such rules as are necessary
to implement the department's responsibilities under this chapter ((pursuant
to chapter 34.05 RCW: PROVIDED, That such rules shall be submitted to the
appropriate committees of the legislature for review and comment prior to
adoption; and
(n)
Beginning July 1, 1989, and continuing through July 1, 1993, track by region
and county the use and cost of state hospital and local evaluation and
treatment facilities for seventy-two hour detention, fourteen, ninety, and one
hundred eighty day commitments pursuant to chapter 71.05 RCW, voluntary care in
state hospitals, and voluntary community inpatient care covered by the medical
assistance program. Service use and cost reports shall be provided to regions
in a timely fashion at six-month intervals)).
(6)
The secretary shall use available resources ((appropriated specifically for
community mental health programs only for programs under RCW 71.24.045. After
July 1, 1995, or when regional support networks are established, available
resources may be used)) only for regional support networks.
(7)
Each certified regional support network and licensed service provider shall
file with the secretary, on request, such data, statistics, schedules, and
information as the secretary reasonably requires. A certified regional support
network or licensed service provider which, without good cause, fails to
furnish any data, statistics, schedules, or information as requested, or files
fraudulent reports thereof, may have its certification or license revoked or
suspended.
(8)
The secretary may suspend, revoke, limit, or restrict a certification or
license, or refuse to grant a certification or license for failure to conform
to: (a) The law((,)); (b) applicable rules and
regulations((, or)); (c) applicable standards((,));
or ((failure to meet the)) (d) state minimum standards ((established
pursuant to this section)).
(9)
The superior court may restrain any regional support network or service
provider from operating without certification or a license or any other
violation of this section. The court may also review, pursuant to procedures
contained in chapter 34.05 RCW, any denial, suspension, limitation,
restriction, or revocation of certification or license, and grant other relief
required to enforce the provisions of this chapter.
(10)
Upon petition by the secretary, and after hearing held upon reasonable notice
to the facility, the superior court may issue a warrant to an officer or
employee of the secretary authorizing him or her to enter at reasonable times,
and examine the records, books, and accounts of any regional support network or
service provider refusing to consent to inspection or examination by the
authority.
(11)
((The secretary shall adopt such rules as may be necessary to effectuate the
intent and purposes of this chapter, which shall include but not be limited to
certification and licensing and other action relevant to certifying regional
support networks and licensing service providers.
(12)))
Notwithstanding the existence or pursuit of any other remedy, the secretary
may((, in the manner provided by law, upon the advice of the attorney
general who shall represent the secretary in the proceedings, maintain)) file
an action ((in the name of the state)) for an injunction or other
process against any person or governmental unit to restrain or prevent the
establishment, conduct, or operation of a regional support network or service
provider without certification or a license under this chapter.
(((13)))
(12) The standards for certification of evaluation and treatment
facilities shall include standards relating to maintenance of good physical and
mental health and other services to be afforded persons pursuant to this
chapter and chapters 71.05 and 71.34 RCW, and shall otherwise
assure the effectuation of the purposes ((and intent of this)) of
these chapters ((and chapter 71.05 RCW)).
(((14)))
(13)(a) The department, in consultation with affected parties, shall
establish a distribution formula that reflects county needs assessments based
on the number of persons who are acutely mentally ill, chronically mentally
ill, severely emotionally disturbed children, and seriously disturbed ((as
defined in chapter 71.24 RCW)). The formula shall take into consideration
the impact on counties of demographic factors in counties which result in
concentrations of priority populations as ((defined)) set forth
in subsection (((15))) (5)(b) of this section. These factors
shall include the population concentrations resulting from commitments under ((the
involuntary treatment act,)) chapters 71.05 and 71.34 RCW((,))
to state psychiatric hospitals, as well as concentration in urban areas, at
border crossings at state boundaries, and other significant demographic and
workload factors.
(b)
The formula shall also include a projection of the funding allocations that
will result for each county, which specifies allocations according to priority
populations, including the allocation for services to children and other
underserved populations.
(((15)
To supersede duties assigned under subsection (5)(a) and (b) of this section,
and to assure a county-based, integrated system of care for acutely mentally
ill adults and children, chronically mentally ill adults, severely emotionally
disturbed children, and seriously disturbed adults and children who are
determined by regional support networks at their sole discretion to be at risk
of becoming acutely or chronically mentally ill, or severely emotionally
disturbed, the secretary shall encourage the development of regional support
networks as follows:
By
December 1, 1989, the secretary shall recognize regional support networks requested
by counties or groups of counties.
All
counties wishing to be recognized as a regional support network on December 1,
1989, shall submit their intentions regarding participation in the regional
support networks by October 30, 1989, along with preliminary plans. Counties
wishing to be recognized as a regional support network by January 1st of any
year thereafter shall submit their intentions by October 30th of the previous
year along with preliminary plans.))
(14)
The secretary shall assume all duties assigned to the nonparticipating counties
under chapters 71.05, 71.34, and 71.24 RCW ((on July 1, 1995)).
Such responsibilities shall include those which would have been assigned to the
nonparticipating counties under regional support networks.
The
((implementation of)) regional support networks, or the secretary's
assumption of all responsibilities under chapters 71.05, 71.34, and
71.24 RCW, shall be included in all state and federal plans affecting the state
mental health program including at least those required by this chapter, the
medicaid program, and P.L. 99‑660. Nothing in these plans shall be
inconsistent with the intent and requirements of this chapter.
(((16)
By January 1, 1992, the secretary shall provide available resources to regional
support networks to operate freestanding evaluation and treatment facilities or
for regional support networks to contract with local hospitals to assure access
for regional support network patients.
(17))) (15)
The secretary shall:
(a)
Disburse ((the first)) funds for the regional support networks ((that
are ready to begin implementation by January 1, 1990, or)) within sixty
days of approval of the biennial contract. The department must either approve
or reject the biennial contract within sixty days of receipt.
(b)
Enter into biennial contracts with regional support networks ((to begin
implementation between January 1, 1990, and March 1, 1990, and complete
implementation by June 1995)). The contracts shall be consistent with
available resources. No contract shall be approved that does not include
progress toward meeting the goals of this chapter by taking responsibility
for: (i) Short-term commitments; (ii) residential care; and (iii) emergency
response systems.
(c)
((By July 1, 1993,)) Allocate one hundred percent of available
resources to the regional support networks ((created by January 1,
1990, in a single grant. Regional support networks created by January 1, 1991,
shall receive a single block grant by July 1, 1993; regional support networks
created by January 1, 1992, shall receive a single block grant by July 1, 1994;
and regional support networks created by January 1, 1993, shall receive a
single block grant by July 1, 1995. The grants shall include funds currently
provided for all residential services, all services pursuant to chapter 71.05
RCW, and all community support services and shall be distributed in accordance
with a formula submitted to the legislature by January 1, 1993,)) in
accordance with subsection (((14))) (13) of this section.
(d)
((By January 1, 1990, allocate available resources to regional support
networks for community support services, resource management services, and
residential services excluding evaluation and treatment facilities provided
pursuant to chapter 71.05 RCW in a single grant using the distribution formula
established in subsection (14) of this section.
(e)
By March 1, 1990, or within sixty days of approval of the contract continuing
through July 1, 1993, provide grants as specifically appropriated by the legislature
to regional support networks for evaluation and treatment facilities for
persons detained or committed for periods up to seventeen days according to
chapter 71.05 RCW. For regional support networks created by January 1, 1993,
provide grants as specifically appropriated by the legislature to regional
support networks for evaluation and treatment facilities for persons detained
or committed for periods up to seventeen days according to chapter 71.05 RCW
through July 1, 1995.
(f)))
Notify regional support networks of their allocation of available resources at
least sixty days prior to the start of a new biennial contract period.
(((g)))
(e) Deny funding allocations to regional support networks based solely
upon formal findings of noncompliance with the terms of the regional support
network's contract with the department. Written notice and at least thirty
days for corrective action must precede any such action. In such cases,
regional support networks shall have full rights to appeal under chapter 34.05
RCW.
(((h)))
(f) Identify in its departmental biennial operating and capital budget
requests the funds requested by regional support networks to implement their
responsibilities under this chapter.
(((i)
Contract to provide or, if requested, make grants to counties to provide
technical assistance to county authorities or groups of county authorities to
develop regional support networks.
(18))) (16)
The department ((of social and health services)), in cooperation with
the state congressional delegation, shall actively seek waivers of federal
requirements and such modifications of federal regulations as are necessary to
allow federal medicaid reimbursement for services provided by free-standing
evaluation and treatment facilities certified under chapter 71.05 RCW. The
department shall periodically report its efforts to the health care and
corrections committee of the senate and the human services committee of the
house of representatives.
(((19)))
(17) The secretary shall establish a task force to examine the
recruitment, training, and compensation of qualified mental health
professionals in the community, which shall include the advantages and
disadvantages of establishing a training academy, loan forgiveness program, or
educational stipends offered in exchange for commitments of employment in
mental health.
NEW
SECTION. Sec. 5. A
new section is added to chapter 71.24 RCW to read as follows:
(1)
The secretary shall by rule establish state minimum standards for licensed
service providers and services.
(2)
Minimum standards for licensed service providers shall, at a minimum,
establish: Qualifications for staff providing services directly to mentally
ill persons, the intended result of each service, and the rights and
responsibilities of persons receiving mental health services pursuant to this
chapter.
(3)
Minimum standards for residential services shall be based on clients'
functional abilities and not solely on their diagnoses, limited to health and
safety, staff qualifications, and program outcomes. Minimum standards for
residential services shall be developed in collaboration with consumers,
families, counties, regulators, and residential providers serving the mentally
ill. The minimum standards shall encourage the development of broad-range
residential programs, including integrated housing and cross-systems programs
where appropriate, and shall not unnecessarily restrict programming
flexibility.
(4)
Minimum standards for community support services and resource management
services shall include at least qualifications for resource management
services, client tracking systems, and the transfer of patient information
between service providers.
Sec.
6. RCW
71.24.049 and 1986 c 274 s 6 are each amended to read as follows:
By
January ((1, 1987, and)) 1st of each odd-numbered year ((thereafter)),
the county authority shall identify: (1) The number of children in each
priority group, as defined by this chapter, who are receiving mental health
services funded in part or in whole under this chapter, (2) the amount of funds
under this chapter used for children's mental health services, (3) an estimate
of the number of unserved children in each priority group, and (4) the
estimated cost of serving these additional children and their families.
Sec.
7. RCW
71.24.110 and 1982 c 204 s 8 are each amended to read as follows:
((Such))
An agreement for the establishment of a community mental health program under
RCW 71.24.100 may also provide:
(1)
For the joint supervision or operation of services and facilities, or
for the supervision or operation of service and facilities by one participating
county under contract for the other participating counties; and
(2)
For such other matters as are necessary or proper to effectuate the purposes of
this chapter.
Sec.
8. RCW
71.24.220 and 1982 c 204 s 12 are each amended to read as follows:
The
secretary may withhold state grants in whole or in part for any community
mental health program in the event of a failure to comply with this chapter or
((regulations made)) the related rules adopted by the department
((pursuant thereto relating to the community mental health program or the
administration thereof)).
Sec.
9. RCW
71.24.300 and 1994 c 204 s 2 are each amended to read as follows:
A
county authority or a group of county authorities whose combined population is
no less than forty thousand may enter into a joint operating agreement to form
a regional support network. Upon the request of a tribal authority or
authorities within a regional support network the joint operating agreement or
the county authority shall allow for the inclusion of the tribal authority to
be represented as a party to the regional support network. The roles and
responsibilities of the county and tribal authorities shall be determined by
the terms of that agreement including a determination of membership on the governing
board and advisory committees, the number of tribal representatives to be party
to the agreement, and the provisions of law and shall assure the provision of
culturally competent services to the tribes served. The state mental health
authority may not determine the roles and responsibilities of county
authorities as to each other under regional support networks by rule, except to
assure that all duties required of regional support networks are assigned and
that a single authority has final responsibility for all available resources
and performance under the regional support network's contract with the
secretary.
(1)
Regional support networks shall ((within three months of recognition))
submit an overall six‑year operating and capital plan, timeline, and
budget and submit progress reports and an updated two‑year plan
biennially thereafter, to assume within available resources all of the
following duties ((by July 1, 1995, instead of those presently assigned to
counties under RCW 71.24.045(1))):
(a)
Administer and provide for the availability of all resource management
services, residential services, and community support services.
(b)
Administer and provide for the availability of all investigation,
transportation, court‑related, and other services provided by the state
or counties pursuant to chapter 71.05 RCW.
(c)
((By July 1, 1993,)) Provide within the boundaries of each
regional support network evaluation and treatment services for at least eighty‑five
percent of persons detained or committed for periods up to seventeen days
according to chapter 71.05 RCW. Regional support networks with populations of
less than one hundred fifty thousand may contract to purchase evaluation and
treatment services from other networks. Insofar as the original intent of
serving persons in the community is maintained, the secretary is authorized to
approve exceptions on a case-by-case basis to the requirement to provide
evaluation and treatment services within the boundaries of each regional
support network. Such exceptions are limited to contracts with neighboring or
contiguous regions. ((For regional support networks that are created after
June 30, 1991, the requirements of (c) of this subsection must be met by July
1, 1995.))
(d)
((By July 1, 1993,)) Administer a portion of funds appropriated
by the legislature to house mentally ill persons in state institutions from
counties within the boundaries of any regional support network, with the
exception of ((mentally ill offenders)) persons currently confined
at, or under the supervision of, a state mental hospital pursuant to chapter
10.77 RCW, and provide for the care of all persons needing evaluation and
treatment services for periods up to seventeen days according to chapter 71.05
RCW in appropriate residential services, which may include state institutions.
The regional support networks shall reimburse the state for use of state
institutions at a rate equal to that assumed by the legislature when
appropriating funds for such care at state institutions during the biennium
when reimbursement occurs. The duty of a state hospital to accept persons for
evaluation and treatment under chapter 71.05 RCW is limited by the
responsibilities assigned to regional support networks under this section. ((For
regional support networks that are created after June 30, 1991, the
requirements of (d) of this subsection must be met by July 1, 1995.))
(e)
Administer and provide for the availability of all other mental health
services, which shall include patient counseling, day treatment, consultation,
education services, employment services as defined in RCW 71.24.035, and mental
health services to children as provided in this chapter.
(f)
Establish standards and procedures for reviewing individual service plans and
determining when that person may be discharged from resource management
services.
(2)
Regional support networks shall assume all duties assigned to county
authorities by this chapter and chapter 71.05 RCW.
(3)
A regional support network may request that any state‑owned land, building,
facility, or other capital asset which was ever purchased, deeded, given, or
placed in trust for the care of the mentally ill and which is within the
boundaries of a regional support network be made available to support the
operations of the regional support network. State agencies managing such
capital assets shall give first priority to requests for their use pursuant to
this chapter.
(4)
Each regional support network shall appoint a mental health advisory board
which shall review and provide comments on plans and policies developed under
this chapter. The composition of the board shall be broadly representative of
the demographic character of the region and the mentally ill persons served
therein. Length of terms of board members shall be determined by the regional
support network.
(5)
Regional support networks shall assume all duties specified in their plans and
joint operating agreements through biennial contractual agreements with the
secretary. Such contracts may include agreements to provide periods of stable
community living and work or other day activities for specific chronically
mentally ill persons who have completed commitments at state hospitals on
ninety‑day or one hundred eighty‑day civil commitments or who have
been residents at state hospitals for no less than one hundred eighty days
within the previous year. Periods of stable community living may involve acute
care in local evaluation and treatment facilities but may not involve use of
state hospitals.
(6)
Counties or groups of counties participating in a regional support network are
not subject to RCW 71.24.045(((7))) (6). ((The office of
financial management shall consider information gathered in studies required in
this chapter and information about the experience of other states to propose a
mental health services administrative cost lid to the 1993 legislature which
shall include administrative costs of licensed service providers, the state
psychiatric hospitals and the department.))
(7)
((By November 1, 1991, and)) As part of each biennial plan ((thereafter)),
each regional support network shall establish and submit to the state,
procedures and agreements to assure access to sufficient additional local
evaluation and treatment facilities to meet the requirements of this chapter
while reducing short‑term admissions to state hospitals. These shall be
commitments to construct and operate, or contract for the operation of,
freestanding evaluation and treatment facilities or agreements with local
evaluation and treatment facilities which shall include (a) required admission
and treatment for short‑term inpatient care for any person enrolled in
community support or residential services, (b) discharge planning procedures,
(c) limitations on admissions or transfers to state hospitals, (d) adequate
psychiatric supervision, (e) prospective payment methods, and (f) contractual
assurances regarding referrals to local evaluation and treatment facilities
from regional support networks.
(8)
Regional support networks may receive technical assistance from the housing
trust fund and may identify and submit projects for housing and housing support
services to the housing trust fund established under chapter 43.185 RCW.
Projects identified or submitted under this subsection must be fully integrated
with the regional support network six‑year operating and capital plan,
timeline, and budget required by subsection (1) of this section.
Sec.
10. RCW
71.24.400 and 1995 c 96 s 1 are each amended to read as follows:
The
legislature finds that the current complex set of federal, state, and local
rules and regulations, audited and administered at multiple levels, which
affect the community mental health service delivery system, focus primarily on
the process of providing mental health services and do not sufficiently address
consumer and system outcomes. ((To this extent,)) The
legislature finds that the ((intent of)) department and the community
mental health service delivery system must make ongoing efforts to achieve the
purposes set forth in RCW 71.24.015 related to reduced administrative layering,
duplication, and reduced administrative costs ((need much more aggressive
action)).
Sec.
11. RCW
71.24.405 and 1995 c 96 s 2 are each amended to read as follows:
The
department ((of social and health services)) shall establish a single
comprehensive and collaborative project within regional support networks and
with local mental health service providers aimed at creating innovative and
streamlined community mental health service delivery systems, in order to carry
out the purposes set forth in RCW 71.24.400 and to capture the diversity of the
community mental health service delivery system.
The
project must accomplish the following:
(1)
Identification, review, and cataloging of all rules, regulations, duplicative
administrative and monitoring functions, and other requirements that currently
lead to inefficiencies in the community mental health service delivery system
and, if possible, eliminate the requirements;
(2)
The systematic and incremental development of a single system of accountability
for all federal, state, and local funds provided to the community mental health
service delivery system. Systematic efforts should be made to include federal
and local funds into the single system of accountability;
(3)
The elimination of process regulations and related contract and reporting
requirements. In place of the regulations and requirements, a set of outcomes
for mental health adult and children clients according to chapter 71.24 RCW
must be used to measure the performance of mental health service providers and
regional support networks. Such outcomes shall focus on stabilizing
out-of-home and hospital care, increasing stable community living, increasing
age-appropriate activities, achieving family and consumer satisfaction with
services, and system efficiencies;
(4)
Evaluation of the feasibility of contractual agreements between the department
of social and health services and regional support networks and mental health
service providers that link financial incentives to the success or failure of
mental health service providers and regional support networks to meet outcomes
established for mental health service clients;
(5)
The involvement of mental health consumers and their representatives in the
pilot projects. Mental health consumers and their representatives will be
involved in the development of outcome standards for mental health clients and
other related aspects of the pilot projects; and
(6) An independent evaluation component to measure the success of the
projects.
Sec.
12. RCW
71.24.415 and 1995 c 96 s 3 are each amended to read as follows:
To
carry out the purposes specified in RCW 71.24.400, the department ((of
social and health services)) is encouraged to utilize its authority to ((immediately))
eliminate any unnecessary rules, regulations, standards, or contracts, to
immediately eliminate duplication of audits or any other unnecessarily
duplicated functions, and to seek any waivers of federal or state rules or regulations
necessary to achieve the purpose of streamlining the community mental health
service delivery system and infusing it with incentives that reward efficiency,
positive outcomes for clients, and quality services.
Sec.
13. RCW
71.24.460 and 1997 c 342 s 4 are each amended to read as follows:
The
department, in collaboration with the department of corrections and the
oversight committee created in RCW 71.24.455, shall track outcomes and submit
to the legislature ((a report of)) annual reports regarding
services and outcomes ((by December 1, 1998, and annually thereafter as may
be necessary)). The reports shall include the following: (1) A
statistical analysis regarding the reoffense and reinstitutionalization rate by
the enrollees in the program set forth in RCW 71.24.455; (2) a quantitative
description of the services provided in the program set forth in RCW 71.24.455;
and (3) recommendations for any needed modifications in the services and
funding levels to increase the effectiveness of the program set forth in RCW
71.24.455. By December 1, 2003, the department shall certify the reoffense
rate for enrollees in the program authorized by RCW 71.24.455 to the office of
financial management and the appropriate legislative committees. If the
reoffense rate exceeds fifteen percent, the authorization for the department to
conduct the program under RCW 71.24.455 is terminated on January 1, 2004.
NEW
SECTION. Sec. 14. The
code reviser shall alphabetize the definitions in RCW 71.24.025 and correct any
cross-references.
NEW
SECTION. Sec. 15. 1989
c 205 s 23 (uncodified) is repealed.
NEW
SECTION. Sec. 16. RCW
71.24.410 and 1998 c 245 s 138 & 1994 c 259 s 3 are each
repealed.
