| To: | Chief Nursing Officers, Government Affairs Leaders, Complex Discharge Workgroup and Behavioral Health Contacts |
| Staff Contact: | Cara Helmer, JD, RN, Policy Director, Legal Affairs carah@wsha.org| 206-577-1827 |
| Subject: | New Law Creating Legislatively Mandated State Rapid Care Team to Assist Children Stuck at Hospitals |
Purpose:
The purpose of this bulletin is to inform hospitals of recent changes found in Second Substitute House Bill 1580 relating to Children in Crisis. This law, codified at RCW 43.06.535, creates a rapid care team, led by a children and youth multisystem care coordinator within the governors office. The team will be responsible for supporting and identifying appropriate services and living arrangements for children (and their families) who, are staying in the hospital without medical necessity because they are unable or unsafe to return to the care of a parent or guardian. The state must establish the rapid care team no later than January 1, 2024.
Applicability/Scope
All hospitals should understand this new resource. The rapid care team can provide essential resources when a child, (person under the age of 18) is stuck at a hospital without medical necessity and cannot be discharged to their parents. The law is designed to provide help with “child(ren) in crisis” which is defined as “a person under the age of 18 who is (i) at risk of remaining in a hospital without medical necessity, without the ability to return to the care of a parent, and not dependent under chapter 13.34 RCW; (ii) staying in a hospital without medical necessity, and who is unable to return to the care of a parent, and not dependent under chapter 13.34 RCW; or (iii) Dependent under chapter 13.34 RCW, experiencing placement instability, and referred to the rapid care team by the department of children, youth, and families.”
Hospital is undefined in the law, but it is WSHA’s interpretation that these resources will be available for all hospitals including those licensed under 70.41 and 71.12 RCW.
Recommendations:
- Review this bulletin and consider how to respond if a child is abandoned, without medical necessity, at your hospital.
- Establish a policy for identifying and reporting children who are or may become stuck at your hospital to the rapid care team.
Overview:
Who does this law help?
The law is designed to provide help to “child(ren) in crisis,” and their families. A child in crisis is defined as “a person under the age of 18 who is (i) at risk of remaining in a hospital without medical necessity, without the ability to return to the care of a parent, and not dependent under chapter 13.34 RCW; (ii) staying in a hospital without medical necessity, and who is unable to return to the care of a parent, and not dependent under chapter 13.34 RCW; or (iii) Dependent under chapter 13.34 RCW, experiencing placement instability, and referred to the rapid care team by the department of children, youth, and families.” RCW 43.06.535(7)(a).
Who provides the help?
RCW 43.06.535 creates a new position in the governor’s office: that of a children and youth multisystem care coordinator (“care coordinator”). The care coordinator will be able to direct state and other resources to these children, as well as have access to flexible funds to support safe discharge of children in crisis and appropriate long-term placements of children who are dependents of the state.
Additionally, the care coordinator will manage and direct a rapid care team, whose purpose is to support and identify appropriate services and living arrangements for children in crisis. The rapid care team will be comprised of representatives of all the state agencies that are responsible for providing services to these children, including the health care authority, the department of social and health services, the office of financial management, the developmental disabilities administration of the department of social and health services, and DCYF. Additional members may be added at the discretion of the care coordinator.
What type of help can the rapid care team provide?
The rapid care team is tasked with using the expertise and resources from their respective agencies to support and identify appropriate services and living arrangements for a child in crisis, and the child’s family, if appropriate.
How are children referred to the rapid care team?
The care coordinator is tasked with creating a system in which children eligible for services may be identified by the rapid care team. Once the care coordinator is hired by the governor’s office, the specific system for making referrals should be established.
Under the law, the following individuals may refer a child in crisis to the rapid care team:
(a) A child in crisis themselves;
(b) A family member of the child in crisis;
(c) An advocate for the child in crisis;
(d) An educator;
(e) A law enforcement officer;
(f) An employee of the department of children, youth, and families;
(g) An employee of the department of social and health services;
(h) An employee of the health care authority;
(i) A service provider contracting with the department of children, youth, and families;
(j) A service provider contracting with the department of social and health services;
(k) A behavioral health service provider;
(l) A representative of a managed care organization;
(m) A representative from a youth behavioral health or inpatient navigator team;
(n) A person providing health care services to the child in crisis; or
(o) A hospital employee.
When can children be referred to the rapid care team?
The rapid care team must be implemented by January 1, 2024. The governor’s office has posted the care coordinator job. It opened on October 6 and closed October 29.
Will the governor’s office provide any updates on the status of this new law implementation and the multisystem care coordinator?
The governor was due to report on the implementation and development of the rapid care team by November 1, 2023. The report, when complete will likely be posted here. It must provide a final report, including data and recommendations, relating to the work of the rapid care team by November 1, 2024. The legislation is set to sunset June 30, 2025.
Background:
Due to policy changes and lack of capacity at the Department of Children, Youth and Families (DCYF), increasing numbers of children have been stuck in hospitals for extended periods of time, without medical necessity. These children often have high behavioral health needs, and the wraparound services and long-term therapeutic beds they need aren’t available or accessible. Parents are often unwilling to take their children home, feeling that they cannot keep their children or families safe. When this happens, these children can stay in hospitals for months or even years.
To address this issue, a coalition of stakeholders, including impacted hospitals, governmental agencies, and WSHA came together to develop a legislative solution. WSHA was engaged throughout the process to ensure the legislation provided a meaningful change to help alleviate the burden hospitals face caring for these children. The result, 2SHB 1580, codified at RCW 43.06.535, is a helpful first step towards providing collaborative effective care for families and children in this challenging situation.
WSHA’s 2023 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2023 to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
References:
- 2SHB 1580
- RCW 43.06.535
- Children and Youth Multisystem Care Coordinator job posting
- Reports published by The Office of the Governor
