The legislature finds that involuntary treatment is a safety net service for adults and children experiencing a behavioral health crisis in Washington, some of whom experience anosognosia, a condition in which a person is unaware of having a brain disease. Washington law requires managed care organizations and behavioral health administrative services organizations to provide an adequate network of involuntary treatment services under RCW 71.24.045 and 71.24.490. This safety net is undermined when facilities decline to admit certain persons despite having certified treatment capacity available. This legislation provides a means to collect information about why persons in crisis who are denied admission into facilities with available capacity and a means to enlist managed care organizations and behavioral health administrative services organizations to support placement efforts for persons in crisis.
This section adds a new section to an existing chapter 71.05. Here is the modified chapter for context.
An evaluation and treatment facility or secure withdrawal management and stabilization facility that has treatment capacity available shall admit a person who has been detained for inpatient treatment at the request of the designated crisis responder unless:
The person requires medical services not generally available at a facility certified under this chapter;
A more appropriate facility exists to serve the specific needs of the person that has agreed to admit the person;
Unusual reasons specific to the person or to their prior relationship with the facility exist that make the facility unable to admit the person; or
The services offered by the facility are targeted for a specific population and the person is not among that specific population and therefore is not appropriate for admission.
An evaluation and treatment facility or secure withdrawal management and stabilization facility that has treatment capacity available shall admit a person who is receiving temporary services under a single bed certification upon application for transfer by the facility when the attending physician considers the person medically stable unless an exception under subsection (1) of this section applies.
An evaluation and treatment facility or secure withdrawal management and stabilization facility which declines to admit a person after receiving a request under subsection (1) or (2) of this section shall document receiving the request and the statutorily permitted reason for declining admission with a brief explanation in its records and immediately provide a copy to the designated crisis responder or facility providing services under a single bed certification.
This section adds a new section to an existing chapter 71.05. Here is the modified chapter for context.
When a designated crisis responder, or a facility providing services under a single bed certification seeking to transfer the patient to a certified facility, is unable to find a placement for a detained person, and the designated crisis responder or facility has obtained at least two denials of admission under section 2 of this act, the designated crisis responder or facility shall immediately transmit notification to the managed care organization responsible for the cost of the person's care, or if not enrolled in a managed care organization the behavioral health administrative services organization, in the manner prescribed by the organization, of the need for emergency intervention to secure access to crisis services for the person. The designated crisis responder or facility shall forward documentation received from facilities that declined admission to the person under section 2 of this act when such documentation is available.
If the person is being held for investigation and evaluation under RCW 71.05.150 or 71.05.153, upon notification under subsection (1) of this section, the person's initial evaluation hold shall be extended for an emergency period of up to 24 hours. The designated crisis responder shall provide notice of the emergency hold to the person. The person must be provided access to a mental health professional during this emergency period.
A managed care organization or behavioral health administrative services organization that receives notice under subsection (1) of this section shall obtain a placement or safe discharge for the person within the 24-hour emergency hold period. The managed care organization or behavioral health administrative services organization may share information and coordinate with other public or private entities, if any, that provide coverage to the person. If the managed care organization or behavioral health administrative services organization is unable to obtain a placement or safe discharge for the person during the emergency hold period, the hold shall dissolve, and the managed care organization or behavioral health administrative services organization shall make a report under RCW 71.05.750.
The managed care organization or behavioral health administrative services organization is responsible for the cost of care for the person during the 24-hour emergency hold period, unless coverage is provided by another entity.
This section modifies existing section 71.05.750. Here is the modified chapter for context.
A managed care organization or behavioral health administrative services organization shall make a report to the authority when after the expiration of a 24-hour emergency hold period under section 3 of this act and despite the efforts of the managed care organization or behavioral health administrative services organization to obtain a placement or safe discharge for the person there are not any beds available at an evaluation and treatment facilityor secure withdrawal management and stabilization facility and the person cannot be served on a single bed certification or less restrictive alternative. The managed care organization or behavioral health administrative services organization has 24 hours from the expiration of the 24-hour emergency period to submit a completed report to the authority.
The report required under subsection (1) of this section must contain at a minimum:
The date and time that the designated crisis responder investigation was completed;
The identity of the responsible behavioral health administrative services organization and managed care organization;
The county in which the person met detention criteria;
A list of facilities which declined to admit the person;
A summary of the efforts undertaken by the managed care organization or behavioral health administrative services organization; and
Identifying information for the person, including age or date of birth.
The authority shall develop a standardized reporting form or modify the current form used for single bed certifications for the report required under subsection (2) of this section and may require additional reporting elements as it determines are necessary or supportive. The authority shall also determine the method for the transmission of the completed report to the authority.
The authority shall create quarterly reports displayed on its web site that summarize the information reported under subsection (2) of this section. At a minimum, the reports must display data by county and by month. The reports must also include the number of single bed certifications granted by category. The categories must include all of the reasons that the authority recognizes for issuing a single bed certification, as identified in rule.
The reports provided according to this section may not display "protected health information" as that term is used in the federal health insurance portability and accountability act of 1996, nor information prohibited from disclosure under chapter 70.02 RCW or elsewhere in state law, and must otherwise be compliant with state and federal privacy laws.
For purposes of this section, the term "single bed certification" means a situation in which an adult on a one hundred twenty hour detention, fourteen-day commitment, ninety-day commitment, or one hundred eighty-day commitment is detained to a facility that is:
Not licensed or certified as an inpatient evaluation and treatment facility; or
A licensed or certified inpatient evaluation and treatment facility that is already at capacity.
This section modifies existing section 71.05.755. Here is the modified chapter for context.
A behavioral health administrative services organization or managed care organizationthat files a report under RCW 71.05.750 must continue to attempt to engage the person in appropriate services for which the person is eligible and report back again within seven days to the authority.
The authority shall track and analyze reports submitted under RCW 71.05.750. The authority must initiate corrective action when appropriate to ensure that each behavioral health administrative services organization or managed care organization has implemented an adequate network and plan to provide evaluation and treatment services. Corrective actions may include remedies under the authority's contract with such entity. An adequate plan may include development of less restrictive alternatives to involuntary commitment such as crisis triage, crisis diversion, voluntary treatment, or prevention programs reasonably calculated to reduce demand for evaluation and treatment under this chapter.
This section modifies existing section 71.24.045. Here is the modified chapter for context.
The behavioral health administrative services organization contracted with the authority pursuant to RCW 71.24.381 shall:
Administer crisis services for the assigned regional service area. Such services must include:
A behavioral health crisis hotline for its assigned regional service area;
Crisis response services twenty-four hours a day, seven days a week, three hundred sixty-five days a year;
Services related to involuntary commitments under chapters 71.05 and 71.34 RCW;
Additional noncrisis behavioral health services, within available resources, to individuals who meet certain criteria set by the authority in its contracts with the behavioral health administrative services organization. These services may include services provided through federal grant funds, provisos, and general fund state appropriations;
Care coordination, diversion services, and discharge planning for nonmedicaid individuals transitioning from state hospitals or inpatient settings to reduce rehospitalization and utilization of crisis services, as required by the authority in contract; and
Administer and provide for the availability of an adequate network of evaluation and treatment services to ensure access to treatment, investigation, transportation, court-related, and other services provided as required under chapters 71.05 and 71.34 RCW;
Provide emergency services and reporting under section 3 of this act and RCW 71.05.750, including providing for and publicizing a suitable means of receiving timely notification under section 3 of this act;
Coordinate services for individuals under RCW 71.05.365;
Administer and provide for the availability of resource management services, residential services, and community support services as required under its contract with the authority;
Contract with a sufficient number, as determined by the authority, of licensed or certified providers for crisis services and other behavioral health services required by the authority;
Maintain adequate reserves or secure a bond as required by its contract with the authority;
Establish and maintain quality assurance processes;
Meet established limitations on administrative costs for agencies that contract with the behavioral health administrative services organization; and
Maintain patient tracking information as required by the authority.
The behavioral health administrative services organization must collaborate with the authority and its contracted managed care organizations to develop and implement strategies to coordinate care with tribes and community behavioral health providers for individuals with a history of frequent crisis system utilization.
The behavioral health administrative services organization shall:
Assure that the special needs of minorities, older adults, individuals with disabilities, children, and low-income persons are met;
Collaborate with local government entities to ensure that policies do not result in an adverse shift of persons with mental illness into state and local correctional facilities; and
Work with the authority to expedite the enrollment or reenrollment of eligible persons leaving state or local correctional facilities and institutions for mental diseases.
This section modifies existing section 71.24.490. Here is the modified chapter for context.
The authority must collaborate with behavioral health administrative services organizations, managed care organizations, and the Washington state institute for public policy to estimate the capacity needs for evaluation and treatment services within each regional service area. Estimated capacity needs shall include consideration of the average occupancy rates needed to provide an adequate network of evaluation and treatment services to ensure access to treatment. Behavioral health administrative services organizations and managed care organizations must develop and maintain an adequate plan to provide for evaluation and treatment needs.
A managed care organization must provide emergency services and reporting under section 3 of this act and RCW 71.05.750, including providing for and publicizing a suitable means of receiving timely notification under section 3 of this act.