Current through Register Vol. 24-18, September 15, 2024
At the discretion of the health care authority (HCA) or HCA's
designee, an exception may be granted to a facility that is not certified under
chapter 246-341 WAC, for a person on an initial detention, a five-day detention
pending a revocation proceeding, or a fourteen-day commitment in order to allow
timely and appropriate treatment. An exception may also be granted for
renewable periods of thirty days to allow a community facility to provide
treatment to a person on a ninety- or one hundred eighty-day inpatient
involuntary commitment order or to a person who has been revoked from a less
restrictive alternative order or conditional release. For involuntarily
detained or committed children, an exception may be granted to allow timely and
appropriate treatment in a facility not certified under chapter 246-341 WAC,
until the child's discharge from that setting to the community, or until they
transfer to a bed in a children's long-term inpatient program (CLIP).
(1) In the case of an adult, the behavioral
health administrative services organization (BH-ASO) or a designee must submit
a written request for a single bed certification to HCA or HCA's designee. In
the case of a child, the facility must submit the written request to HCA or
HCA's designee and provide a copy to the BH-ASO. HCA or HCA's designee must
receive and approve the request in order for a facility to accept a person for
timely and appropriate treatment under this section. If HCA or HCA's designee
has assumed the duties assigned to a nonparticipating BH-ASO, HCA or HCA's
designee may designate an entity to request a single bed certification as
described in this section.
(2) HCA
or HCA's designee may issue a single bed certification in writing to the
facility for timely and appropriate mental health treatment when the following
requirements are met in each instance where such certification is sought for a
person:
(a) The facility that is the site of
the proposed single bed certification confirms that it is willing and able to
provide directly, or by direct arrangement with other public or private
agencies, timely and appropriate mental health treatment to the person for whom
the single bed certification is sought; and
(b) The request for single bed certification
describes why the person meets at least one of the following criteria:
(i) The person is expected to be ready for
discharge from inpatient services at the facility referred to in (a) of this
subsection within the next thirty days and remaining at that facility would
facilitate continuity of care, consistent with the person's individual
treatment needs;
(ii) The person
can receive appropriate mental health treatment in a residential treatment
facility, as defined in WAC
246-337-005;
or
(iii) The person can receive
appropriate mental health treatment in a hospital with a psychiatric unit, a
psychiatric hospital, or a hospital that is willing and able to provide timely
and appropriate mental health treatment, including a temporary health care
facility that has a mental health component credentialed or approved by the
department of health.
(3) In order to provide timely and
appropriate mental health treatment, the facility receiving the single bed
certification, or the public or private agency the facility has a direct
arrangement with to provide mental health treatment, must:
(a) Implement standards for administration
that include written procedures to assure that a mental health professional, as
defined in
RCW
71.05.020, and a licensed physician,
psychiatric advanced registered nurse practitioner, or physician assistant are
available for consultation and communication with both the person and the
direct patient care staff;
(b) Use
a plan of care or treatment. The person's medical or clinical record must
contain documentation that:
(i) An
individualized mental health treatment plan was developed, when possible,
collaboratively with the person. If the person is unwilling or unable to
participate in development of the plan, documentation must be made in the
record. Development of this plan may include participation of a
multidisciplinary team, a mental health professional as defined in
RCW
71.05.020, or collaboration with members of
the person's support system as identified by the person; and
(ii) A mental health professional, as defined
in
RCW
71.05.020, has had contact with the person at
least daily for the purposes of:
(A)
Observation and evaluation;
(B)
Assessing whether the person is appropriate for release from involuntary
commitment to accept treatment on a voluntary basis; and
(c) Have standards for
administration and monitoring of medication, including psychiatric medications.
A person has a right to make an informed decision regarding the use of
antipsychotic medication consistent with
RCW
71.05.215.
(4) If a person requires medical services
that are not generally available at a facility certified under chapter 246-341
WAC, or at a state psychiatric hospital, or a facility that meets the
requirements of subsections (2) and (3) of this section, HCA or HCA's designee
may issue a single bed certification to that facility for the person as
follows:
(a) The single bed certification
request must adequately describe why the person requires medical services that
are not available at a facility certified under chapter 246-341 WAC, a state
psychiatric hospital, or a facility that meets the requirements of subsections
(2) and (3) of this section;
(b)
The facility that is the site of the requested single bed certification must
confirm that it is willing and able to provide the medical services;
and
(c) The facility has documented
that one of the following has been met:
(i)
With the authorization of the facility, and consistent with any applicable
facility policies and procedures, the BH-ASO assigns a mental health
professional to provide the person appropriate mental health treatment at the
facility, including observation and evaluation, during the period of time the
person is provided medical services; or
(ii) The facility provides medical services
and a plan that addresses the person's mental health treatment needs until the
person is medically stable and the BH-ASO or a designee identifies an
appropriate facility for the person that is one of the following:
(A) The facility providing
services;
(B) A facility that is
certified as an evaluation and treatment (E&T) facility; or
(C) A facility that can meet the person's
needs under the single bed certification criteria in this section.
(d) If a qualified
medical professional determines that mental health treatment for the person is
not appropriate due to medical instability, the requirements in (c) of this
subsection do not apply. When the person is determined to be medically stable,
the facility must ensure the requirements in (c) of this subsection are
met;
(e) A person who receives
services under a single bed certification under this section must be
transferred to an evaluation and treatment facility, state hospital, or other
placement as soon as the attending physician considers the person medically
stable and a bed becomes available, unless the treating facility consents to
continue treatment and continued treatment in the current setting is consistent
with the best clinical interests of the person.
(5) HCA or HCA's designee may make site
visits at any time to verify that the terms of the single bed certification are
being met. Failure to comply with any term of this exception may result in
corrective action. If HCA or HCA's designee determines that the violation
places people in imminent jeopardy, immediate revocation of this exception can
occur.
(6) The BH-ASO retains the
responsibility for ensuring due process required by
RCW
71.24.300(6)(b).
(7) Neither a person nor a facility has fair
hearing rights as defined under chapter 182-526 WAC regarding single bed
certification decisions made by HCA or HCA's designee staff.
