AN
ACT Relating to community mental health services; amending RCW 71.24.015,
71.24.025, 71.24.030, 71.24.035, 71.24.037, 71.24.045, 71.24.049, 71.24.155,
71.24.160, 71.24.250, 71.24.400, and 71.24.405; reenacting and amending RCW
71.24.300; adding new sections to chapter 71.24 RCW; and creating a new
section.
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec.
1. RCW
71.24.015 and 1999 c 214 s 7 are each amended to read as follows:
It
is the intent of the legislature to establish a community mental health program
which shall help people experiencing mental illness to retain a respected and
productive position in the community. This will be accomplished through
programs which provide for:
(1)
Access to mental health services for adults of the state who are acutely
mentally ill, chronically mentally ill, or seriously disturbed and children of
the state who are acutely mentally ill, severely emotionally disturbed, or
seriously disturbed, which services recognize the special needs of underserved
populations, including minorities, children, the elderly, disabled, and
low-income persons. Access to mental health services shall not be limited by a
person's history of confinement in a state, federal, or local correctional
facility. It is also the purpose of this chapter to promote the early
identification of mentally ill children and to ensure that they receive the
mental health care and treatment which is appropriate to their developmental
level. This care should improve home, school, and community functioning,
maintain children in a safe and nurturing home environment, and should enable
treatment decisions to be made in response to clinical needs in accordance with
sound professional judgment while also recognizing parents' rights to
participate in treatment decisions for their children;
(2)
Accountability of efficient and effective services through state of
the art outcome and performance measures and statewide standards for
monitoring client and system outcomes, performance, and reporting of
information. These processes shall be designed so as to maximize the use of
available resources for direct care of people with a mental illness;
(3)
Minimum service delivery standards;
(4)
Priorities for the use of available resources for the care of the mentally ill consistent
with the priorities defined in the statute;
(5)
Coordination of services within the department, including those divisions
within the department that provide services to children, between the department
and the office of the superintendent of public instruction, and among state
mental hospitals, county authorities, community mental health services, and
other support services, which shall to the maximum extent feasible also include
the families of the mentally ill, and other service providers; and
(6)
Coordination of services aimed at reducing duplication in service delivery and
promoting complementary services among all entities that provide mental health
services to adults and children.
It
is the policy of the state to encourage the provision of a full range of
treatment and rehabilitation services in the state for mental disorders. The
legislature intends to encourage the development of county-based and
county-managed mental health services with adequate local flexibility to assure
eligible people in need of care access to the least-restrictive treatment
alternative appropriate to their needs, and the availability of treatment
components to assure continuity of care. To this end, counties are encouraged
to enter into joint operating agreements with other counties to form regional
systems of care which integrate planning, administration, and service delivery
duties assigned to counties under chapters 71.05 and 71.24 RCW to consolidate administration,
reduce administrative layering, and reduce administrative costs.
It
is further the intent of the legislature to integrate the provision of services
to provide continuity of care through all phases of treatment. To this end the
legislature intends to promote active engagement with mentally ill persons and
collaboration between families and service providers.
NEW
SECTION. Sec. 2. A
new section is added to chapter 71.24 RCW to read as follows:
The
department shall operate the community mental health service delivery system
authorized under this chapter within the following constraints:
(1)
The full amount of federal funds for mental health services, plus qualifying
state expenditures as appropriated in the biennial operating budget, shall be
appropriated to the department each year in the biennial appropriations act to
carry out the provisions of the community mental health service delivery system
authorized in this chapter.
(2)
The department may expend funds defined in subsection (1) of this section in
any manner that will effectively accomplish the outcome measures defined in
section 5 of this act.
(3)
The department shall implement strategies that accomplish the outcome measures
identified in section 5 of this act that are within the funding constraints in
this section.
(4)
The department shall monitor expenditures against the appropriation levels
provided for in subsection (1) of this section.
NEW
SECTION. Sec. 3. A
new section is added to chapter 71.24 RCW to read as follows:
(1)
The department shall ensure the coordination of allied services for mental
health clients. The department shall implement strategies for resolving
organizational, regulatory, and funding issues at all levels of the system,
including the state, the regional support networks, and local service
providers.
(2)
The department shall propose, in operating budget requests, transfers of
funding among programs to support collaborative service delivery to persons who
require services from multiple department programs. The department shall
report annually to the appropriate committees of the senate and house of
representatives on actions and projects it has taken to promote collaborative
service delivery.
NEW
SECTION. Sec. 4. A
new section is added to chapter 71.24 RCW to read as follows:
It
is the intent of the legislature that the community mental health service
delivery system focus on maintaining mentally ill individuals in the
community. The program shall be evaluated and managed through a limited number
of performance measures designed to hold each regional support network
accountable for program success.
*NEW
SECTION. Sec. 5.
A new section is added to chapter 71.24 RCW to read as follows:
(1)
The department, in collaboration with a work group appointed by the secretary
and made up of consumers, advocates, service providers, and representatives of
regional support networks, shall develop performance measures for use in
evaluating and managing the community mental health service delivery system
authorized under this chapter. The performance measures shall be consistent
with the provisions of RCW 71.24.405(3) which may include but are not limited
to:
(a)
Access to services;
(b)
Quality and appropriateness of care;
(c)
Outcome measures; including, but not limited to:
(i)
Consumer change over time;
(ii)
Consumer perception of hope for the future;
(iii)
Percent of consumers who have safe and stable housing;
(iv)
Percent of adults employed for one or more days in the last thirty days;
(v)
Percent of consumers without a jail or detention stay;
(vi)
Percent of available school days attended in the past thirty days;
(vii)
Percent of consumers without a psychiatric hospitalization; and
(d)
Structure and plan management.
(2)
The department shall require that service providers and regional support
networks collect uniform performance measure information and report it to the
department regularly. The department shall develop benchmarks that compare
performance measure information from all regional support networks and
providers to provide a clear indication of the most effective regional support
networks and providers. Benchmark information shall be published quarterly and
provided to the legislature, the governor, regional support networks, and all
providers of mental health services.
*Sec. 5 was vetoed. See message at end of chapter.
*NEW
SECTION. Sec. 6.
A new section is added to chapter 71.24 RCW to read as follows:
Every
regional support network and mental health services provider shall be evaluated
using the criteria in section 5 of this act.
*Sec. 6 was vetoed. See message at end of chapter.
*NEW
SECTION. Sec. 7.
A new section is added to chapter 71.24 RCW to read as follows:
The
department shall provide a report to the appropriate committees of the
legislature on the development, implementation, and achievement of the
performance measures by regional support networks and service providers on an
annual basis, no later than June 30th of each year, beginning in 2002. The
report shall include how the department is using the outcome measure information
obtained under section 5 of this act to manage the community mental health
service delivery system.
*Sec. 7 was vetoed. See message at end of chapter.
Sec.
8. RCW
71.24.025 and 1999 c 10 s 2 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 funds appropriated for the purpose of
providing community mental health programs under RCW 71.24.045, 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))) (e).
(3)
"Child" means a person under the age of eighteen years.
(4)
"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.
(5)
"Community mental health program" means all mental health services,
activities, or programs using available resources.
(6)
"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 public
sources.
(7)
"Community support services" means services authorized, planned, and
coordinated through resource management services including, at ((least))
a minimum, 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, and other services determined by
regional support networks((, and maintenance of a patient tracking system
for chronically mentally ill adults and severely emotionally disturbed children)).
(8)
"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.
(9)
"Department" means the department of social and health services.
(10)
"Licensed service provider" means an entity licensed according to
this chapter or chapter 71.05 RCW or an entity deemed to meet state minimum
standards as a result of accreditation by a recognized behavioral health
accrediting body recognized and having a current agreement with the department,
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.
(11)
"Mental health services" means all services provided by regional
support networks and other services provided by the state for the mentally ill.
(12)
"Mentally ill persons" and "the mentally ill" mean persons
and conditions defined in subsections (1), (4), (17), and (18) of this section.
(13)
"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.
(14)
"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.
(15)
"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 a regional support network 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.
(16)
"Secretary" means the secretary of social and health services.
(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 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)
"Severely emotionally disturbed child" means 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.
(19)
"State minimum standards" means minimum requirements established by
rules adopted by the secretary and necessary to implement this chapter for:
(a) Delivery of mental health services; (b) licensed service providers for the
provision of mental health services; (c) residential services; and (d) community
support services and resource management services.
(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.
9. RCW
71.24.030 and 1999 c 10 s 3 are each amended to read as follows:
The
secretary is authorized to make grants to and/or purchase services from
counties or combinations of counties in the establishment and operation of
community mental health programs.
Sec.
10. RCW
71.24.035 and 1999 c 10 s 4 are each amended to read as follows:
(1)
The department is designated as the state mental health authority.
(2)
The secretary ((may)) shall provide for public, client, and
licensed service provider participation in developing the state mental health
program, developing contracts with regional support networks, and any waiver
request to the federal government under medicaid.
(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 regional or 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 RCW 71.24.037 including, but not limited
to:
(i)
Licensed service providers. The secretary shall provide for deeming of
compliance with state minimum standards for those entities accredited by
recognized behavioral health accrediting bodies recognized and having a current
agreement with the department;
(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)) in contracting with
regional support networks or counties. The standard contract shall
include a maximum fund balance, which shall not exceed ten percent;
(f)
Establish, to the extent possible, a standardized auditing procedure which
minimizes paperwork requirements of county authorities and licensed service
providers. The audit procedure shall focus on the outcomes of service and
not the processes for accomplishing them;
(g)
Develop and maintain an information system to be used by the state, counties,
and regional support networks 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 design of the system
and the data elements to be collected shall be reviewed by the work group
appointed by the secretary under section 5(1) of this act and representing the
department, regional support networks, service providers, consumers, and
advocates. The data elements shall be designed to provide information that is
needed to measure performance and achieve the service outcomes identified in
section 5 of this act;
(h)
License service providers who meet state minimum standards;
(i)
Certify regional support networks that meet state minimum standards;
(j)
Periodically ((inspect)) monitor the compliance of certified
regional support networks and their network of licensed service
providers for compliance with the contract between the department, the
regional support network, and federal and state rules at reasonable times
and in a reasonable manner;
(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)
Adopt such rules as are necessary to implement the department's
responsibilities under this chapter.
(6)
The secretary shall use available resources 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; (c) applicable
standards; or (d) state minimum standards.
(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)
Notwithstanding the existence or pursuit of any other remedy, the secretary may
file an action 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.
(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 of these chapters.
(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. The formula shall
take into consideration the impact on counties of demographic factors in
counties which result in concentrations of priority populations as set forth in
subsection (5)(b) of this section. These factors shall include the population
concentrations resulting from commitments under 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.
(14)
The secretary shall assume all duties assigned to the nonparticipating counties
under chapters 71.05, 71.34, and 71.24 RCW. Such responsibilities shall
include those which would have been assigned to the nonparticipating counties
under regional support networks.
The
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.
(15)
The secretary shall:
(a)
Disburse funds for the regional support networks 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. 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)
Allocate one hundred percent of available resources to the regional support
networks in accordance with subsection (13) of this section.
(d)
Notify regional support networks of their allocation of available resources at
least sixty days prior to the start of a new biennial contract period.
(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.
(((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.))
(16)
The department, 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)) appropriate
committees of the senate and the ((human services committee of the))
house of representatives.
(((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.))
Sec.
11. RCW
71.24.037 and 1999 c 10 s 5 are each amended 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.
The secretary shall provide for deeming of licensed service providers as
meeting state minimum standards as a result of accreditation by a recognized
behavioral health accrediting body recognized and having a current agreement
with the department.
(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.
12. RCW
71.24.045 and 1992 c 230 s 5 are each amended to read as follows:
The
county authority shall:
(1)
Contract as needed with licensed service providers. The county authority may,
in the absence of a licensed service provider entity, become a licensed service
provider entity pursuant to minimum standards required for licensing by the
department for the purpose of providing services not available from licensed
service providers;
(2)
Operate as a licensed service provider if it deems that doing so is more
efficient and cost effective than contracting for services. When doing so, the
county authority shall comply with rules promulgated by the secretary that
shall provide measurements to determine when a county provided service is more
efficient and cost effective;
(3)
Monitor and perform biennial fiscal audits of licensed service providers who
have contracted with the county to provide services required by this chapter.
The monitoring and audits shall be performed by means of a formal process which
insures that the licensed service providers and professionals designated in
this subsection meet the terms of their contracts((, including the minimum
standards of service delivery as established by the department));
(4)
Assure that the special needs of minorities, the elderly, disabled, children,
and low‑income persons are met within the priorities established in this
chapter;
(5)
Maintain patient tracking information in a central location as required for
resource management services and the department's information system;
(6)
Use not more than two percent of state‑appropriated community mental
health funds, which shall not include federal funds, to administer community
mental health programs under RCW 71.24.155: PROVIDED, That county authorities
serving a county or combination of counties whose population is one hundred
twenty‑five thousand or more may be entitled to sufficient state‑appropriated
community mental health funds to employ up to one full‑time employee or
the equivalent thereof in addition to the two percent limit established in this
subsection when such employee is providing staff services to a county mental
health advisory board;
(7)
Coordinate services for individuals who have received services through the
community mental health system and who become patients at a state mental
hospital.
Sec.
13. RCW
71.24.049 and 1999 c 10 s 6 are each amended to read as follows:
By January 1st of each odd-numbered year, the ((county authority))
regional support network 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.
14. RCW
71.24.155 and 1987 c 505 s 65 are each amended to read as follows:
Grants
shall be made by the department to ((counties)) regional support
networks for community mental health programs totaling not less than
ninety-five percent of available resources. The department may use up to forty
percent of the remaining five percent to provide community demonstration
projects, including early intervention or primary prevention programs for
children, and the remainder shall be for emergency needs and technical
assistance under this chapter.
Sec.
15. RCW
71.24.160 and 1989 c 205 s 7 are each amended to read as follows:
The
((county authority)) regional support networks shall make
satisfactory showing to the secretary that state funds shall in no case be used
to replace local funds from any source being used to finance mental health
services prior to January 1, 1990.
Sec.
16. RCW
71.24.250 and 1982 c 204 s 14 are each amended to read as follows:
The
((county authority)) regional support network may accept and
expend gifts and grants received from private, county, state, and federal
sources.
Sec.
17. RCW
71.24.300 and 1999 c 214 s 8 and 1999 c 10 s 9 are each reenacted and 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 counties and the regional support network do not duplicate
functions 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 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:
(a)
Administer and provide for the availability of all resource management
services, residential services, and community support services.
(b)
Assume the powers and duties of county authorities within its area as
described in RCW 71.24.045 (1) through (7).
(c)
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)))
(d) 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.
(((d)))
(e) 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 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 secretary shall submit a report to the
appropriate committees of the senate and house of representatives on the
efforts to implement this section by October 1, 2002. 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.
(((e)))
(f) 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 designed
to achieve the outcomes specified in section 5 of this act.
(((f)))
(g) 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(6).
(7)
((As part of each biennial plan, 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.
18. RCW
71.24.400 and 1999 c 10 s 10 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. The legislature finds that the 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, elimination of process measures not
specifically required by the federal government for the receipt of federal
funds, and reduced administrative costs.
Sec.
19. RCW
71.24.405 and 1999 c 10 s 11 are each amended to read as follows:
The
department shall establish a ((single)) comprehensive and collaborative
((project)) effort 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)) department 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)) under
section 5 of this act; and
(6)
An independent evaluation component to measure the success of the ((projects))
department in fully implementing the provisions of RCW 71.24.400 and this
section.
*NEW
SECTION. Sec. 20.
The legislature finds that an excessive amount
of public funds are spent on administrative activities in the community mental
health system. The department of social and health services shall develop a
plan to reduce administrative expenses in the community mental health system,
including the mental health division, to no more than ten percent of available
funds. The plan shall identify and prioritize core administrative functions
that must be continued to comply with federal or state statutes. The
department shall submit their plan to the appropriate committees of the senate
and house of representatives no later than December 15, 2001. The plan shall
assume an implementation date of July 1, 2003.
*Sec. 20 was vetoed. See message at end of chapter.
