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Association of Advanced Practice Psychiatric Nurses
Advancing your practice, your career, and our community.

Legislative Update: June 2017

  • The Legislature is in its third special session to finalize the budget.
  • Bills still in committee will be reintroduced next year since 2018 is the second year of the two-year biennium.

AAPPN Priority Issues

The Volk v Demeerleer decision (HB 1810 and SB 5800) – Support

  • Background:
    • In its Volk decision, the state Supreme Court established a new standard for circumstances in which mental health professionals have a duty to warn potential victims based on statements made by patients.
    • Under this new duty, providers treating patients in an outpatient setting would be required to meet a new “foreseeability” standard in trying to determine when a duty to warn exists.
  • HB 1810 and SB 5800 reestablish that a health care professional providing mental health services has a duty to warn identifiable victims.
  • Neither bill passed the Legislature, but will be reintroduced in 2018.
  • To help pave the way for passage in 2018, AAPPN and other mental health allies are advocating that language be included in this year’s final budget authorizing a study on the Volk Decision and its impact on access to mental health services in Washington State. The University of Washington School of Law will conduct the study should it be included in the final budget.

Disclosure of mental health information and records (HB 1413 and SB 5435) – Monitor/Support

  • Under these bills, protected health information may be disclosed to a health care provider who is providing care to a patient or to whom the patient has been referred. Protected health information may also be disclosed to any person who is working in a care coordinator role.
  • SB 5435 passed the Legislature and was signed into law by Governor Inslee. It becomes effective July 23, 2017.

Opioid epidemic (HB 1427) – Support

  • This legislation requires disciplining authorities, including the Nursing Care Quality Assurance Commission, to adopt rules establishing requirements for prescribing opioid drugs by January 1, 2019.
  • It expands access to data in the state’s Prescription Monitoring Program, allowing health care facilities to receive information on provider prescribing.
  • It eases requirements for opioid treatment facilities located in local communities.
  • HB 1427 passed the Legislature and was signed into law by Governor Inslee. It becomes effective July 23, 2017.

Behavioral health system reform legislation (SB 5894)

  • This broad legislation addresses capacity for long-term involuntary treatment and community behavioral health.
  • It also addresses the provision of psychiatric treatment at state hospitals by psychiatric nurse practitioners.
  • AAPPN and ARNPs United is asking that the current bill language to be amended to ensure psychiatric nurse practitioners can practice at the top of their scope, education, training, and license.
  • While SB 5894 did not pass the Legislature, it could still be considered during the special session.

Involuntary Treatment Act (SB 5106)

  • This legislation revises the procedures for petition for court review of initial detention decision under the ITA.
  • It also revises the provisions requiring a DMHP to consult with an ER physician during an initial commitment evaluation.
  • It allows designated chemical dependency specialists to evaluate and sign a petition for involuntary commitment for substance use disorder treatment.
  • While SB 5106 did not pass the Legislature, it could still be considered during the special session.

Health Information Disclosure (SHB 1477)

  • SHB 1477 authorizes health care providers and health care facilities to use or disclose the health-related information of a patient without obtaining an authorization from the patient if certain conditions are met. The bill permits health care information to be disclosed to a family member or close relation of the patient if the disclosure is related to the person’s involvement with the patient’s health care or health care payments – or to prevent or lessen a serious and imminent threat.
  • This bill was signed into law by Governor Inslee on May 16, and takes effect July 23, 2017.

Certificate of Need/Psychiatric Beds (ESHB 1547)

  • ESHB 1547 exempts certain hospitals from certificate of need requirements for the addition of psychiatric beds. This bill suspends certificate of need requirements through June 30, 2019, for hospitals and establishments that add new psychiatric beds and entities that construct psychiatric hospitals of no more than 16 beds.
  • It was signed into law by Governor Inslee on May 5, and was effective immediately.
  • Background: For FY 2015, certificate of need requirements were suspended for hospitals that changed the use of licensed beds to increase the number of beds used to provide psychiatric services. In the 2015-17 biennial capital budget, $32 million was appropriated to the Department of Commerce to support grants to hospitals to add new psychiatric beds to their facilities. The certificate of need requirements were suspended in FY 2016 and FY 2017 for hospitals adding beds through the grant program.

Long-term Care Curricula (ESHB 1548)

  • ESHB 1548 requires the Department of Social and Health Services to establish standards for approving curricula for facility-based caregivers serving persons with behavioral needs and for geriatric behavioral health workers. The bill allows completion of the behavioral health curriculum to substitute for the experience requirement for becoming a geriatric behavioral health worker at a nursing home – and it removes the requirement that a geriatric behavioral health worker have either a bachelor’s or master’s degree in social work.
  • This bill was signed into law by Governor Inslee on May 5, and takes effect on July 23, 2017.

Children’s Mental Health (E2SHB 1713)

  • E2SHB 1713 implements recommendations from the Children’s Mental Health Work Group. This bill requires the Washington State Health Care Authority to:

1. Oversee the coordination of resources and services through the managed health care system and tribal organizations providing health care services for children who are eligible for medical assistance and have been identified as requiring mental health treatment.

2. Require provider payment for annual depression screening for certain youth.

3. Require provider payment for maternal depression screening for mothers of children ages birth to six months.

  • The bill also requires the Department of Early Learning to establish a child care consultation program linking child care providers with evidence-based, trauma informed, and best practice resources regarding caring for infants and young children who present behavioral concerns or symptoms of trauma. It requires the Office of the Superintendent for Public Instruction to establish a competitive application process to designate two educational service districts in which to pilot one lead staff person for children’s mental health and substance use disorder services.
  • The bill also requires Washington State University to offer one 24-month residency position that is approved by the accreditation council for graduate medical education to one resident specializing in child and adolescent psychiatry.
  • Finally, the bill requires a behavioral health organization to (upon initiation or renewal of a contract with DSHS or the State Health Care Authority) reimburse a provider for a behavioral health service provided to a covered person who is under 18 years old through telemedicine or store and forward technology.
  • This bill was signed into law by Governor Inslee on May 5, and takes effect July 23, 2017.

Improving Children’s Mental Health & Safety (Documentation Requirements)
(HB 1819)

  • HB 1819 is aimed at reducing certain documentation and paperwork requirements in order to improve children’s mental health and safety. This bill requires the Department of Social and Health Services and the State Health Care Authority to immediately perform a review of their rules, policies, and procedures related to the documentation requirements for behavioral health services. This review must be completed by November 1, 2017, and upon completion immediate steps must be taken to amend department rules and procedures accordingly.
  • This bill was signed into law by Governor Inslee on May 5, and takes effect on July 23, 2017.

Behavioral Health Agencies (SSB 5707)

  • SSB 5707 concerns inspection and review of state contracted behavioral health and recovery agencies. The bill prohibits the Department of Social and Health Services from reducing the number of license violations found by field inspectors for the purpose of allowing licensed behavioral health service providers to avoid liability in a manner that permits the violating service provider to continue to provide care at the risk of public safety.
  • It also recognizes the need to prohibit fraudulent transfers of licenses between licensed behavioral health service providers found in violation of the terms of their license agreement and their family members.
  • This bill was signed into law by Governor Inslee.

Behavioral Health/Primary Care Integration (SSB 5779 )

  • SSB 5779 concerns behavioral health integration in primary care. This bill requires the State Health Care Authority to:

1. Complete a review of payment codes available to health plans and providers related to primary care and behavioral health.

2. Concurrent with the review, create matrices listing the following codes available for provider payment through medical assistance programs: behavioral health-related codes and physical health-related codes available for payment when provided in licensed behavioral health agencies.

3. For children who are eligible for medical assistance and who have been identified as requiring mental health treatment, oversee the coordination of resources and services through the managed health care system and tribal organizations providing health care services.

4. Along with DSHS, establish a performance measure to be integrated into the statewide common measure set which tracks effective integration practices of behavioral health services in primary care settings.

  • This bill was signed into law by Governor Inslee on May 5. The Governor vetoed Section 7 of the bill, directing to the State Health Care Authority to implement a rate intended to increase the availability of behavioral health services; this section was vetoed on the basis that it was premature without a budget that identifies funding to implement that section of the bill. The rest of the bill takes effect on July 23, 2017.

Other bills that were reintroduced in the 2nd special session.

Senate Bill 5782 – Monitor/Support
Restricts the use of step therapy by public and private insurers for drugs used in mental health treatment. Sponsors: Rivers, Mullet

  • This bill appears to place limits on the insurance industry in Washington State in terms of what restrictions they can place on approval of medications that prescribers have ordered.
  • Its current version, 1st Substitute – SSB 5782, is in the Senate Ways and Means Committee.
  • By resolution, reintroduced and retained in present status.

House Bill 1259 – Support
Concerning standards for detention of persons with mental disorders or chemical dependency. Sponsors: Klippert, Goodman, Rodne, Hayes

  • This bill concerns the standard used for detaining people on an emergency basis for the purpose of treatment of a mental illness. It would change the threshold from “imminent risk” to “substantial likelihood.” This is a significant change and will allow many more of our patients who need hospitalization to receive it.
  • It has been referred to the House Judiciary Committee.
  • By resolution, reintroduced and retained in present status.

House Bill 1546 – Support, with concerns
Concerning the addition of services for long-term placement of mental health patients in community hospitals that voluntarily contract and are certified by the department of social and health services. Sponsors: Schmick, Cody

  • This bill seeks to shift long-term care of severely/chronically mentally ill individuals out of the centralized state-run hospitals and into community-based hospitals. While this sounds like an acceptable idea, we are concerned about the ability of smaller, community-based hospitals to appropriately manage the needs of this difficult population. There are also concerns about whether this is cost-effective and whether it would actually result in any improvement in care over simply improving the care already provided at our state hospitals.
  • It is currently in the House Health Care & Wellness Committee.
  • By resolution, reintroduced and retained in present status.
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