The path of reform for the behavioral health system must include transitioning state purchasing of long-term involuntary treatment services to a regionally-based system under a managed care framework. SB 5894 does the following:
-HCA must integrate risk for long-term involuntary treatment provided by state hospitals into managed care contracts by January 1, 2020.
-Requires the Department of Social and Health Services (DSHS) to purchase a portion of the long-term involuntary treatment services provided in state hospital bed allocations in community facilities.
-Discharge planning for long-term involuntary treatment must start at admission. State hospitals must screen patients upon admission for medical necessity for substance use disorder treatment, and provide coordinated substance use disorder treatment services to patients with an identified need. Within 14 days of a state hospital’s designation of a patient as ready for discharge, a BHO or FIMCO must establish an individualized discharge plan arranging for transition of the patient to an identified community placement.
-The role of directing psychiatric treatment in state hospitals is expanded to include participation of qualified psychiatric advanced registered nurse practitioners and physician assistants supervised by a psychiatrist.
-Amends requirements for assisted outpatient mental health treatment.
-Amends availability of forensic inpatient commitment services.
-HCA must establish a workgroup to examine options for structuring full integration of physical and behavioral health by January 1, 2020. The workgroup must consist of no more than fifteen members, including one Legislative member from each caucus of the House of Representatives and the Senate, and submit a report by December 1, 2017. HCA and DSHS must form a small work group to develop performance expectations to align purchasing expectations for fully integrated physical and behavioral health care.
-The Washington Institute for Public Policy must evaluate changes to the behavioral health system and the effectiveness of specific investments in order to provide policymakers with information to aid decision-making on an ongoing basis.
Ways and Means Amendments:
-eliminates reporting requirements for community facilities certified to provide longterm involuntary treatment, but require DSHS to structure long-term treatment contracts to ensure access by DSHS to complete patient identification information, admission dates, and discharge dates;
-prohibits a managed care entity from using the authority to designate a treatment facility to delay the transfer of a patient to a state hospital or certified facility;
-expands AOT effective April 1, 2018, to include treatment for a substance use disorder; specify that a role of state hospital psychiatrists is to provide mentoring to psychiatric advanced registered nurse practitioners and expand the training program developed by DSHS and the University of Washington Department of Psychiatry to include input from appropriate schools of nursing and to accommodate physician assistants;
-removes sections that would eliminate competency restoration treatment for defendants whose highest charge is a nonfelony offense and limit defendants whose highest offense is a Class C or nonviolent Class B felony to one period of competency restoration.
Striker Amendment Adopted on Senate Floor:
Makes technical amendments. Clarifies process for designation of a treatment facility for long-term involuntary care. Removes requirement for behavioral health organizations to coordinate delivery of community long-term treatment. Clarifies which discharge planning requirements applied to state hospitals also apply to community long-term involuntary treatment facilities. Exempts contract for consultant services from competitive solicitation requirements. Requires DSHS to also work with Washington State University to develop the training program for psychiatric advanced registered nurse practitioners and physician assistants. Requires DSHS and HCA to work through existing processes to develop performance terms for integrated managed care contracts. Requires DSHS and DOH to confer with hospitals to identify changes to laws and regulations necessary to address care delivery and cost-effective long-term involuntary treatment.