WAC Integration Overview Washington State Behavioral Health Services

WAC Integration Overview Washington State Behavioral Health Services Administrative Rules l a r io v a Beh ealth H e v i t a r t s i n s ew! i e l m

Ru s N Ad t a h W Dennis Malmer, Office Chief Certification, Licensing, and Customer Relations August 2013 Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 1 WAC Integration Overview WAC History COLLABORATION Brainstorming Partnerships Sept 2010 Oct

2010 DBHR letter/ charter to stakeholders WAC brainstorm session (Yakima) 2010 Dec 2010 Community Partner Advisory Group April 2011 May 2011

Filed CR-101 under WSR 11-09-067 Contract with NW Resource Assoc. for meetings and drafting new rules June 2011 Second statewide stakeholder meeting (Yakima) 2011 Oct 2011

April 2012 Third statewide stakeholder meeting (Yakima) Work groups discuss final draft of proposed rules Nov 2012 Comments for external review draft of proposed

language 2012 Dec 2012 Feb 2012 File formal proposed rule for public hearing Public hearing (Olympia) Feb 2012 Submit final rules June

2013 Rules Effective July 1, 2013 Sept 2013 Implementation 2013 Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 2 WAC Integration Overview Why Integrate? Single set of administrative, personnel, and clinical policies and procedures that support

program-specific rules Standardization for all behavioral health service programs Eliminate need for multiple audits Behavioral Health Services Administrative Requirements Chapter 388-877 WAC Streamline certification/ licensure processes Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 3 WAC Integration Overview

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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 4 WAC Integration Overview 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 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 Chemical Dependency Problem Gambling Chapter 388-877C WAC Chapter 388-877B WAC Detoxification Services Youth Detoxification Problem and Pathological Gambling Services Residential Treatment Services Intensive Inpatient Services Recovery House Long-term Treatment Services Youth Residential Services

Crisis Services Crisis Telephone Support Crisis Outreach Crisis Stabilization Crisis Peer Support Services Emergency Involuntary Detention Outpatient Treatment Services Level II Intensive Outpatient Services Level I Outpatient Treatment Services Recovery Support Services Requiring Programspecific Certification Employment Services Peer Support Services Wraparound Facilitation Services Medication Support Services Assessment and Assessment -only Services DUI Assessment Assessment Only Opiate Substitution Services

Information and Assistance Services Alcohol and Drug Information School Services Information and Crisis Services Emergency Service Patrol Services Screening and Brief Intervention Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 5 WAC Integration Overview Chapter 388-877 WAC Changes Specific to Mental Health Providers WAC 388-877-0200 388-877-0300 388-877-0305 388-877-0320 388-877-0335 388-877-0340 388-877-0350 388-877-0355 388-877-0360 388-877-0400

388-877-0410 388-877-0420 388-877-0500 388-877-0510 388-877-0520 388-877-0530 388-877-0600 388-877-0610 388-877-0630 388-877-0640 388-877-0650 Category Definitions Agency Licensure- General information Agency Licensure Application Agency Licensure On-site reviews and plan of correction Agency Licensure and Program-specific Certification Agency Licensure - Adding a branch Agency Licensure - Change in ownership Agency Licensure - Change in location Agency Licensure and Program-specific Certification- Facility remodel Agency Administration - Governing body Agency Administration - Administrator key responsibilities Agency Administration Policies and procedures Personnel Agency policies and procedures Personnel Agency record requirements Personnel Agency requirements for supervision of trainees and interns

Personnel Agency requirements for volunteers and student practicum Clinical Individual rights Clinical Initial assessment Clinical Individual clinical record system Clinical Record content Clinical Access to clinical records Change Additions and changes (3) and (5) (1) (a) (e) (g) (h) (1) (b) (i) (ii) All new All new All new All new All new All new All new Some new (3) and (6) (b) Some changes; some new All new Some new All new (2) (h) Electronic record addition (1)

Some new Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 6 WAC Integration Overview Chapter 388-877 WAC Changes Specific to Chemical Dependency Providers WAC Category PersonnelAgency policies and 388-877-0500 (1)(b) procedures Clinical Initial assessment 388-877-0610 388-877-0620 Clinical Individual service plan Change Ensures the requirements of WAC 388060170 are met if the agency provides services to youths. (2)(g) - Addition of tobacco to brief substance use history. (2)(h) - A brief problem and pathological gambling history is required.

Treatment Plan now is referred to as Individual Service Plan Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 7 WAC Integration Overview WAC Changes Definitions 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 8 WAC Integration Overview 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 programspecific 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 9 WAC Integration Overview 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 10 WAC Integration Overview 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). Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 11 WAC Integration Overview Governing Body WAC 388-877-0400 An agencys 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 administrators authority and duties. Approve the mission statement and quality management plan. Notify DBHR within 30 days of a change in administrator. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 12

WAC Integration Overview Administrator Key Responsibilities WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 13 WAC Integration Overview Administrator Key Responsibilities WAC 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 Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 14 WAC Integration Overview Agency Administration of Policies and Procedures WAC 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 Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 15 WAC Integration Overview Agency Administration of Policies and Procedures WAC 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

Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 16 WAC Integration Overview Agency Personnel Requirements WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 17 WAC Integration Overview Agency Personnel Requirements

WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 18 WAC Integration Overview Agency Personnel Requirements for Supervision of Trainees and Interns and Requirements for Volunteers and Student Practicum WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 19 WAC Integration Overview Agency Personnel Requirements for Supervision of Trainees and Interns and Requirements for Volunteers and Student Practicum WAC 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.

Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 20 WAC Integration Overview Background Check Requirements for Childrens Administration & Division of Developmental Disabilities WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 21 WAC Integration Overview

Background Check Requirements for Childrens Administration & Division of Developmental Disabilities WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 22 WAC Integration Overview Background Check Requirements for Childrens Administration & Division of Developmental Disabilities WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 23 WAC Integration Overview 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 individuals 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 388-8770600. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 24 WAC Integration Overview Clinical Initial Assessment WAC 388-877-0610 Initial Assessment An agency is responsible for an individuals 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.

Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 25 WAC Integration Overview Clinical Initial Assessment WAC 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; Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 26 WAC Integration Overview Clinical Initial Assessment WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 27 WAC Integration Overview Clinical Individual Service Plan formerly 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 individuals 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 28 WAC Integration Overview Clinical Individual Service Plan formerly 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 individuals 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.

Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 29 WAC Integration Overview Clinical Individual Service Plan formerly 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 30 WAC Integration Overview Clinical Individual Record System & Record Content WAC 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 31 WAC Integration Overview 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. Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 32

WAC Integration Overview What Is To Come? Meetings Trainings Email Email Websites Education FAQs Behavioral Health WAC Implementation Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 33 WAC Integration Overview Implementation

When an agencys license is scheduled for renewal, the agency will be required to submit a copy of their Quality Plan/Process and the agencys 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. 34 Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 34 WAC Integration Overview 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 388-877C WAC . 35 Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 35 WAC Integration Overview Whats 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. 36 Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery

36 WAC Integration Overview Questions? Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 37 WAC Integration Overview 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: [email protected] WAC Implementation Website: http://www.dshs.wa.gov/DBHR/ Washington State Department of Social & Health Services, Division of Behavioral Health and Recovery 38

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