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Dennis Malmer, Office Chief Certification, Licensing, and Customer Relations August 2013

Dennis Malmer, Office Chief Certification, Licensing, and Customer Relations August 2013. Washington State Behavioral Health Services Administrative Rules. Behavioral Health Administrative Rules. What’s New!. WAC History. Collaboration. Brainstorming.

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Dennis Malmer, Office Chief Certification, Licensing, and Customer Relations August 2013

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  1. Dennis Malmer, Office Chief Certification, Licensing, and Customer Relations August 2013 Washington State Behavioral Health Services Administrative Rules Behavioral Health Administrative Rules What’s New!

  2. WAC History Collaboration Brainstorming Partnerships Feb 2012 Sept 2013 Feb 2012 Dec 2012 June 2013 Oct 2010 Sept 2010 May 2011 April 2012 Dec 2010 June 2011 Nov 2012 April 2011 Oct 2011 DBHR letter/ charter to stake-holders WAC brain-storm session (Yakima) Com- munity Partner Advisory Group Filed CR-101 under WSR 11-09-067 Contract with NW Resource Assoc. for meetingsand drafting new rules Comments for external review draft of proposed language Third statewide stake-holder meeting (Yakima) Work groups discuss final draft of proposed rules Rules Effective July 1, 2013 Imple-mentation Second statewide stake-holder meeting (Yakima) Submit final rules Public hearing (Olympia) File formal proposed rule for public hearing 2010 2012 2011 2013

  3. Why Integrate? • Eliminate need for multiple audits • Single set of administrative, personnel, and clinical policies and procedures that support program-specific rules • Behavioral Health Services Administrative Requirements • Chapter • 388-877 WAC Standardization for all behavioral health service programs Streamline certification/ licensure processes

  4. Disclaimer • It is the responsibility of each agency to understand and comply with WAC 388-877, Chapter 388-877A WAC, Chapter 388-877B WAC, and Chapter 388-877C WAC. • These slides highlight some new requirements, and are not meant to be all-inclusive.

  5. BEHAVIORAL HEALTH AGENCY LICENSE Chapter 388-877 WAC (formerly Chapter 388-865 WAC and 388-816 WAC, and sections in Chapter 388-865 WAC) CERTIFIED SERVICES Chemical Dependency Chapter 388-877B WAC Problem Gambling Chapter 388-877C WAC Mental Health Chapter 388-877A WAC • Outpatient Services • Brief Intervention • Group Therapy • Family Therapy • Case Management • Psychiatric Medication • Day Support • Less Restrictive Alternative • Residential Treatment • Crisis Services • Crisis Telephone Support • Crisis Outreach • Crisis Stabilization • Crisis Peer Support Services • Emergency Involuntary • Detention • Recovery Support • Services Requiring Program-specific Certification • Employment Services • Peer Support Services • Wraparound Facilitation Services • Medication Support Services Problem and Pathological Gambling Services • Detoxification Services • Youth Detoxification • Residential Treatment • Services • Intensive Inpatient Services • Recovery House • Long-term Treatment Services • Youth Residential Services • Outpatient Treatment Services • Level II Intensive Outpatient • Services • Level I Outpatient Treatment Services • Opiate Substitution • Services • Assessment and Assessment -only Services • DUI Assessment • Assessment Only • Information and Assistance • Services • Alcohol and Drug Information • School Services • Information and Crisis Services • Emergency Service Patrol Services • Screening and Brief Intervention

  6. Chapter 388-877 WACChanges Specific to Mental Health Providers

  7. Chapter 388-877 WACChanges Specific to Chemical Dependency Providers

  8. WAC ChangesDefinitions • Definitions (WAC 388-877-0200). • Definitions in this section are inclusive of outpatient mental health, chemical dependency, and problem and pathological gambling program terms and phrases in chapters 388-877A, 388-877B, and 388-877C WAC.

  9. Agency Licensure WAC 388-877-0300 • An agency must report to DBHR any changes made after the initial licensing of the agency or certification of any behavioral health services. • If an agency closes or cancels a program-specific certification, the agency must provide each individual currently being served: • A 30-day notice, in writing. • Help with relocation to another provider. • Obtaining his/her records.

  10. Agency Licensure WAC 388-877-0305 • Along with an application, an agency must submit: • A copy of its master business license. • A statement that it meets American Disabilities Act standards. • A staff roster that includes Department of Health credentials if required for the position. • A copy of any Department of Health Residential Treatment Facility certificate if the agency is providing chemical dependency or mental health residential treatment.

  11. Adding a Branch Site, Change in Ownership, Change in Location and Facility Remodel WAC 388-877-0340 and WAC 388-877-0360 • An agency must notify DBHR if: • Adding a branch site (WAC 388-877-0340). • Changing ownership (WAC 388-877-0350). • Change in location (WAC 388-877-0355). • Remodeling its facility (WAC 388-877-0360).

  12. Governing BodyWAC 388-877-0400 • An agency’s governing body must: • Assure there is an administrator responsible for the day-to-day operation of services. • Maintain a current job description for the administrator, including the administrator’s authority and duties. • Approve the mission statement and quality management plan. • Notify DBHR within 30 days of a change in administrator.

  13. Administrator Key ResponsibilitiesWAC 388-877-0410 • The administrator must ensure that the agency develops and maintains a written internal quality management plan/process that: • Addresses the clinical supervision and training of the clinical staff. • Monitors compliance with the rules in this chapter, and other state and federal rules and laws that govern agency licensing and certification requirements.

  14. Administrator Key ResponsibilitiesWAC 388-877-0410 • The administrator must ensure the agency develops and maintains a written internal quality management plan/process that: • Continuously improves the quality of care in: Cultural competency Use of evidence based and promising practices. In response to: Critical incidents Complaints Grievances

  15. Agency Administration of Policies and ProceduresWAC 388-877-0420 • An agency must: • Develop, implement, and maintain administrative policies and procedures to meet the minimum standards of this chapter regarding: Ownership Licensure Organizational description Agency staffing and supervision Interpreter services Reasonable access for individuals with disabilities Nondiscrimination Fee schedules

  16. Agency Administration of Policies and ProceduresWAC 388-877-0420 • An agency must (continued): Funding options for treatment costs State and federal rules on confidentiality Reporting and documentation of suspected abuse, neglect or exploitation Protection of youth Reporting the death of any individual seeking or receiving services Reporting of critical incidents Smoking policy Outpatient evacuation plan Individual rights Individual complaints and grievances

  17. Agency Personnel RequirementsWAC 388-877-0500 and 388-877-0510 • An agency must: • Utilize the excluded provider list (LEIE), a searchable database found at http://oig.hhs.gov when hiring a new employee. (WAC 388-877-0500) • Provide staff training regarding cultural competency. Staff training. A description of how the agency provides training within thirty days of an employee's hire date and annually thereafter: (a) Consistent with the agency's certified services.

  18. Agency Personnel RequirementsWAC 388-877-0500 and 388-877-0510 (b) On cultural competency that assists staff in recognizing when cultural barriers interfere with clinical care that includes a review of: (i) Populations specific to the agency's geographic service area; and (ii) Applicable available community resources. • Ensure a staff member who has received agency services has a personnel record separate from a clinical record and no indication in the personnel record of receiving such services.

  19. Agency Personnel Requirements for Supervision of Trainees and Interns and Requirements for Volunteers and Student PracticumWAC 388-877-0520 and WAC 388-877-0530 • An agency must ensure supervision requirements for trainees and interns are met. • An agency is responsible to: • Provide orientation to any volunteer or student assisting at the agency. • Ensure qualifications are met for the position assigned. • Ensure a written agreement between the agency and educational institution exists. • Ensure there is a plan for supervision. • Ensure a confidentiality statement is completed.

  20. Agency Personnel Requirements for Supervision of Trainees and Interns and Requirements for Volunteers and Student PracticumWAC 388-877-0520 and WAC 388-877-0530(continued) • An agency must ensure: • Background checks are completed for providers of youth services. • The requirements of WAC 388-06-0170 are met if the agency provides services to youths.

  21. Background Check Requirements for Children’s Administration & Division of Developmental DisabilitiesWAC 388-06-0170 • The following are criminal conviction that will permanently prohibit a person from being licensed, contracted, or authorized to have unsupervised access to children or to individuals with developmental disability: (1) There are convictions for certain crimes that will permanently prohibit you from being licensed, contracted, or authorized to have unsupervised access to children or to individuals with developmental disability.

  22. Background Check Requirements for Children’s Administration & Division of Developmental DisabilitiesWAC 388-06-0170 Those felony convictions are as follows: (a) Child abuse and/or neglect. (b) Spousal abuse. (c) A crime against a child (including child pornography). (d) A crime involving violence (including rape, sexual assault, or homicide but not including other physical assault). (e) Any federal or out-of-state conviction for an offense that under the laws of this state would disqualify him/her from having unsupervised access to children or individuals with developmental disabilities in any home or facility.

  23. Background Check Requirements for Children’s Administration & Division of Developmental DisabilitiesWAC 388-06-0170 (2) If a person is convicted of one of the crimes listed in WAC 388-06-0170 (1)(a) through (e) (s)he will not be able to: (a) Receive a license to provide care to children. (b) Be approved for adoption of a child. (c) Be a contractor. (d) Be employed by a licensed agency or contractor, if you will have unsupervised access to children or to individuals with a developmental disability. (e) Volunteer or participate as an intern in a home or facility that offers care to children or to individuals with a developmental disability; or (f) Provide any type of care to children or to individuals with a developmental disability, if the care is funded by the state.

  24. Clinical – Individual Rights WAC 388-877-0600 • An agency must develop a statement of individual participant rights applicable to the service category the agency is certified for to ensure the individual’s rights are protected in compliance with chapters 70.96A, 71.05, 71.12, and 71.34 RCW. • The agency must develop a statement of rights incorporating, at minimum, the statement “you have the right to” then list rights of 388-877-0600.

  25. Clinical – Initial AssessmentWAC 388-877-0610 – Initial Assessment • An agency is responsible for an individual’s initial assessment. • Initial assessments must include and document requests for information regarding problem and pathological gambling history. (1) The initial assessment must be: (a) Conducted in person; and (b) Completed by a professional appropriately credentialed or qualified to provide chemical dependency, mental health, and/or problem and pathological gambling services as determined by state law.

  26. Clinical – Initial AssessmentWAC 388-877-0610 – Initial Assessment (2) The initial assessment must include and document the individual's: (a) Identifying information; (b) Presenting issues; (c) Medical provider's name or medical providers' names; (d) Medical concerns; (e) Medications currently taken; (f) Brief mental health history; (g) Brief substance use history, including tobacco;

  27. Clinical – Initial AssessmentWAC 388-877-0610 – Initial Assessment (h) Brief problem and pathological gambling history; (i) The identification of any risk of harm to self and others, including suicide and/or homicide; (j) A referral for provision of emergency/crisis services must be made if indicated in the risk assessment; (l) Treatment recommendations or recommendations for additional program specific assessment.

  28. Clinical – Individual Service Planformerly known as “Treatment Plan”WAC 388-877-620 • Treatment plan is now referred to as Individual Service Plan (ISP). • The new ISP requirements are as follows: Each agency licensed by the department to provide any behavioral health service is responsible for an individual’s service plan as follows: (1) The individual service plan must: (a) Be completed or approved by a professional appropriately credentialed or qualified to provide mental health, chemical dependency, and/or problem and pathological gambling services.

  29. Clinical – Individual Service Planformerly known as “Treatment Plan”WAC 388-877-620 (b) Address age, gender, cultural, strengths and/or disability issues identified by the individual or, if applicable, the individual's parent(s) or legal representative. (c) Be in a terminology that is understandable to the individual and the individual's family. (d) Document that the plan was mutually agreed upon and a copy was provided to the individual. (e) Demonstrate the individual’s participation in the development of the plan. (f) Document participation of family or significant others, if participation is requested by the individual and is clinically appropriate. (g) Be strength based.

  30. Clinical – Individual Service Planformerly known as “Treatment Plan”WAC 388-877-620 (h) Contain measurable goals or objectives, or both. (i) Be updated to address applicable changes in identified needs and achievement of goals and objectives.

  31. Clinical – Individual Record System & Record ContentWAC 388-877-0630 and 388-877-0640 • An agency utilizing an electronic clinical record system must: • Provide secure limited access. • Backup of records. • Provide for protection from unauthorized access. • Ensure clinical record includes documentation that the individual received a copy of counselor disclosure information.

  32. Clinical – Access to Clinical Records WAC 388-877-0650 • If the agency maintains electronic individual clinical records, it must make records available in paper form, if requested.

  33. Email What Is To Come? • Email Meetings • Websites • FAQs • Trainings • Education Behavioral Health WAC Implementation

  34. Implementation • When an agency’s license is scheduled for renewal, the agency will be required to submit a copy of their Quality Plan/Process and the agency’s hiring policy to DBHR. • DBHR will review and upon approval, will issue a single BHA License which will list the behavioral health services the agency is certified to provide.

  35. Implementation (cont.) • DBHR will develop a single review schedule and will notify the agency in advance of the scheduled survey. • It is the responsibility of each agency to understand and comply with Chapters 388-877, 388-877A, 388-877B, and 388-877CWAC .

  36. What’s Next? • Fix things we have overlooked or do not work. • Applied Behavior Analysis (ABA). • Program-specific rules for co-occurring programs. • Adopt a new section containing rules specific to Medicaid. • Clarify certification requirements for residential treatment certification.

  37. Questions?

  38. Thank You! Send comments or questions to: WAC Integration Certification, Licensing and Customer Relations Post Office Box 45330 Olympia, Washington 98504-5330 (360) 725-3700 WAC Questions - Email: BHArules@dshs.wa.gov WAC Implementation Website: http://www.dshs.wa.gov/DBHR/

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