To: Chief Executive Officers, Chief Financial Officers, Government Affairs staff
Please share with staff involved with behavioral health and strategic planning
From: Shirley S Prasad, JD | Policy Director, Government Affairs | ShirleyP@wsha.org
Lauren McDonald | Policy Director, Health Access | LaurenM@wsha.org
Subject: Behavioral Health Policy and Budget Changes, Including New Capital Funding Opportunities to Increase Behavioral Health Capacity
This bulletin is to inform hospitals and health systems about behavioral health policy bills and budget items that WSHA advocated for and the Legislature passed during the 2019 legislative session. The highlights include:
- New capital funding opportunities to increase behavioral health capacity (see below for details);
- The Certificate of Need (CN) exemption for psychiatric beds is extended through June 30, 2021;
- State law now authorizes the Health Care Authority (HCA) to contract with willing community hospitals to provide long-term psychiatric care;
- Other state funding to expand long-term psychiatric bed capacity;
- A reciprocity program for certain behavioral health professionals;
- Steps to modernize the substance use disorder professional practice; and
- Examine new behavioral health credentials.
Recommendation / Next Steps
- Review the available categories of capital funding aimed to expand behavioral health capacity and determine if your hospital or health system or a community partner could benefit from these opportunities.The Department of Commerce (DOC) is administering the 2019-21 Behavioral Health Capacity Grant Program. There is $47 million available, for nine categories of projects to expand behavioral health capacity. The DOC will stagger the application dates for each project category.Currently, the DOC is accepting applications for the following:
- Projects to increase behavioral health services for children and minor youth, with a priority on outreach and treatment for youth dealing with mental health and social isolation issues. The maximum funds an applicant can receive is $2 million per project ($2 million total is available).
- For enhanced adult residential care facilities for long-term placements of dementia patients discharged or diverted from the state psychiatric hospitals and are not subject to federal funding restrictions that apply to institutions of mental diseases. The maximum funds an applicant can receive is $2 million per project ($10 million total is available).
- For at least two enhanced service facilities for long-term placement of patients discharged or diverted from the state psychiatric hospitals and that are not subject to federal funding restrictions that apply to institutions of mental diseases. The maximum funds an applicant can receive is $2 million per project ($4 million total is available).
- For at least two facilities with secure withdrawal management and stabilization treatment beds that are not subject to federal funding restrictions that apply to institutions of mental diseases. The maximum funds an applicant can receive is $2 million per project ($4 million total is available).
Applications for the above categories of projects are due on November 6, 2020. More information can be found on the DOC website.
The remaining categories of projects, including $8 million for community hospitals and evaluation and treatment facilities to increase capacity for long-term psychiatric patients (those patients on 90- and 180-day civil commitment orders) will open in the coming weeks. WSHA will issue another bulletin with updated information.
- Review the other topics in this bulletin and share with staff, as appropriate.
The Certificate of Need Exemption for Psychiatric Beds Is Extended Through June 30, 2021
Recognizing the need to increase behavioral health capacity for both short-term and long-term psychiatric patients in the community, the Legislature passed House Bill 1394. The bill extends the CN exemption for new psychiatric beds for two more years – from June 30, 2019, to June 30, 2021.
For acute care hospitals, this means they can continue to add new psychiatric beds (short-term, long-term, voluntary, and involuntary) without a CN for two additional years (see RCW 70.38.111(11) and RCW 70.38.260(2)(a) for details). For freestanding psychiatric hospitals, this means if they have not already taken advantage of the CN exemption for the one-time addition of up to 30 new psychiatric beds, they have an additional two years to do so (see RCW 70.38.260(3)(a) for details).
State Law Now Authorizes the HCA to Contract with Willing Community Hospitals to Provide Long-Term Psychiatric Care
The Legislature understands that concentrating all long-term mental health placements at Eastern and Western State Hospital is not working. These patients will be better served in community hospitals closer to their home and support networks. To help accommodate this transition, House Bill 1394 amends the Community Mental Health Services Act to authorize the HCA to contract with willing acute care hospitals, freestanding psychiatric hospitals, and evaluation and treatment (E&T) facilities to provide long-term psychiatric services. A community hospital or E&T facility cannot be compelled to provide these services.
The legislation also calls for the HCA to work with the Department of Health (DOH), WSHA and the Washington Behavioral Health Council to review statutes and regulations that may need to be amended as care for long-term psychiatric patients shifts to community hospitals and E&T facilities. A report to the Legislature is due in December 2019.
Other State Funding to Expand Long-Term Psychiatric Bed Capacity
Long-Term Psychiatric Services Payment Rates
In the 2019-21 operating budget, the Legislature continues to make significant investments in behavioral health. This includes appropriating $64 million to increase the number of long-term psychiatric beds (those serving patients on 90- and 180-day civil commitment orders) in acute care hospitals, freestanding psychiatric hospitals, and E&T facilities.
For fiscal year 2020, the Legislature establishes an interim per diem payment rate for all facilities at $1,171. For subsequent years, the HCA will work with WSHA and the E&T facilities to develop a per diem payment rate methodology for long-term psychiatric patients. WSHA’s goal is to establish a methodology that accurately reflects the cost of caring for this complex population. A report to the Legislature is due December 2019.
State Investments in Behavioral Health Facilities
In the 2019-21 capital budget, the Legislature continues to invest in behavioral health capacity. In addition to the capital funding projects noted above, other notable investments include:
- $26.9 million to three acute care hospitals to support increasing their capacity for 90- and 180-day civil commitment patients;
- $33.3 million to the University of Washington to support the predesign, siting and design costs of a new psychiatric teaching hospital. The facility must provide a minimum of 50 long-term civil commitment beds;
- Of the $129 million appropriated to the Housing Trust Fund Program, $35 million is for supportive housing and case-management services for individuals with behavioral or chronic mental illness; and
- $20 million to support the predesign, design, siting, and preliminary construction of a new 48-bed, state-owned, behavioral health facility. Of those beds, 16 beds must be for state-operated civil commitment patients.
A Reciprocity Program for Certain Behavioral Health Professionals
To help address the ongoing shortage of behavioral health professionals, the Legislature passed Senate Bill 5045, which establishes a reciprocity program to increase the portability of behavioral health professional licenses and certifications. This bill directs the DOH to establish a program for behavioral health professionals who already hold a valid license or credential within the last year in another state, are in good standing with that state, and want to practice in Washington. The DOH will include a probationary license for those meeting certain requirements and a process to determine whether additional training and education is needed for the individual to transition to a full license to practice in Washington.
This reciprocity program will apply to:
- Chemical dependency, now renamed substance use disorder professionals;
- Mental health counselors;
- Social workers; and
- Marriage and family therapists.
Steps to Modernize the Substance Use Disorder Professional Practice
The Legislature passed House Bill 1768, which modernizes the substance use disorder practice and better aligns services with integrated care. The bill:
- Creates a new certified health profession, “co-occurring disorder specialists,” as an enhancement to another qualifying behavioral health license; and
- Formally renames chemical dependency professionals to “substance use disorder professionals.”
Examine New Behavioral Health Credentials
The Legislature directs the DOH to examine the need for two new behavioral health credentials to support patient access to services. This includes:
- A Bachelor’s-level behavioral health credential (as directed in House Bill 1768); and
- An advanced peer support specialist credential (as directed in House Bill 1907)
Reports to the Legislature on both potential credentials are due in December 2019.
Background and References
In 2018, the state announced a five-year plan to modernize and transform Washington’s mental health system. A key part of the effort is to move most patients on 90- and 180-day civil commitment patients out of Eastern and Western State Hospitals and place them in smaller, community-based facilities. These facilities will include acute care hospitals, freestanding psychiatric hospitals, and residential E&T facilities. Eastern and Western State Hospitals will continue to focus on forensic patients and certain hard-to-place civil commitment patients. WSHA has continually raised concerns that the state hospitals need to maintain their beds until appropriate community resources are open and accepting patients.
As 2023 approaches, the Legislature will be focusing on making the financial investments and policy changes needed to accomplish this goal. In the 2019 Legislative session, legislators have taken the right steps, but more needs to be done. We must continue to ensure that community hospitals have the right resources to take on these services.
WSHA’s 2019 New Law Implementation Guide
Please visit WSHA’s 2019 implementation guide online, where you will find a list of the high priority laws that WSHA is preparing resources and information on 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.