Washington Administrative Code › Title 388 - Social and Health Services, Department of › BEHAVIORAL HEALTH SERVICES › Chapter 388-877 - Behavioral health services administrative requirements › Section SECTION TWO - BEHAVIORAL HEALTH SERVICES-DEFINITIONS › Section 388-877-0200 - Behavioral health services-Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions in this section contain words and phrases
					 used for behavioral health organizations (BHOs), the BHO managed care plan,
					 and behavioral health services . For terms and definitions that apply to the
					 behavioral health organization (BHO) grievance and appeal system and
					 administrative hearings, see WAC
					 388-877-0655.
"Absentee coverage"
means the temporary
					 replacement a clubhouse provides for the clubhouse member who is currently
					 employed in a time-limited, part-time community job managed by the
					 clubhouse.
"Administrative hearing"
means a proceeding
					 before an administrative law judge that gives a party an opportunity to be
					 heard in disputes about DSHS programs and services.
"Administrator"
means the designated person
					 responsible for the operation of either the licensed treatment agency, or
					 certified treatment service, or both.
"Adult"
means an individual eighteen years of
					 age or older. For purposes of the medicaid program, adult means an individual
					 twenty-one years of age or older.
"ASAM criteria"
means admission, continued
					 service, and discharge criteria for the treatment of substance use disorders as
					 published by the American Society of Addiction Medicine (ASAM).
"Assessment"
means the process of obtaining
					 all pertinent bio-psychosocial information, as identified by the individual,
					 and family and collateral sources, for determining a diagnosis and to plan
					 individualized services and supports.
"Background check"
means a search for any
					 record of an individual's conviction or civil adjudication related to crimes
					 against children or other persons, including develop-mentally disabled and
					 vulnerable adults. A background check includes a search and review of current
					 and past background check applicant self-disclosures, Washington state patrol
					 criminal history data, Washington courts criminal history data, civil
					 adjudication proceedings, department of health disciplinary board final
					 decisions, out-of-state court or law enforcement records, and department of
					 corrections information. A background check may include a national
					 fingerprint-based background check, including a Federal Bureau of Investigation
					 criminal history search.
"Behavioral health"
means the prevention,
					 treatment of, and recovery from any or all of the following disorders:
					 substance use disorders, mental health disorders, or problem and pathological
					 gambling disorders.
"Behavioral health agency" or "agency"
means
					 an entity licensed by the department to provide behavioral health
					 services.
"Behavioral health organization"
or
"BHO"
means any county authority or group of county authorities or
					 other entity recognized by the secretary in contract in a defined
					 region.
"Behavioral health organization (BHO) managed care
					 plan"
is the entity that operates the prepaid inpatient health plan
					 (PIHP) for medicaid behavioral health services.
"Branch site"
means a physically separate
					 licensed site, governed by a parent organization, where qualified staff
					 provides certified treatment services.
"Care coordination"
means a process-oriented
					 activity to facilitate ongoing communication and collaboration to meet multiple
					 needs of an individual. Care coordination includes facilitating communication
					 between the family, natural supports, community resources, and involved
					 providers and agencies, organizing, facilitating and participating in team
					 meetings, and providing for continuity of care by creating linkages to and
					 managing transitions between levels of care.
"Certified"
or
"certification"
means the status given by the department to substance use disorder, mental
					 health, and problem and pathological gambling program-specific services.
"Certified problem gambling counselor"
is an
					 individual certified gambling counselor (WSCGC) or a nationally certified
					 gambling counselor (NCGC), certified by the Washington State Gambling Counselor
					 Certification Committee or the International Gambling Counselor Certification
					 Board to provide problem and pathological gambling treatment services.
"Change in ownership"
means one of the
					 following:
(a) The ownership of a
				  licensed behavioral health agency changes from one distinct legal owner to
				  another distinct legal owner;
(b)
				  The type of business changes from one type to another, such as, from a sole
				  proprietorship to a corporation; or
(c) The current ownership takes on a new
				  owner of five per cent or more of the organizational assets.
"Chemical dependency professional"
or
"CDP"
means a person credentialed by the department of health as a
					 chemical dependency professional (CDP) under chapter 246-811 WAC.
"Child," "minor,"
and
"youth"
mean:
(a) An individual under the age
				  of eighteen years; or
(b) An
				  individual age eighteen to twenty-one years who is eligible to receive and who
				  elects to receive an early and periodic screening, diagnostic, and treatment
				  (EPSDT) medicaid service. An individual age eighteen to twenty-one years who
				  receives EPSDT services is not considered a "child" for any other
				  purpose.
"Child mental health specialist"
means a
					 mental health professional with the following education and experience:
(a) A minimum of one hundred actual hours
				  (not quarter or semester hours) of special training in child development and
				  the treatment of children with serious emotional disturbance and their
				  families; and
(b) The equivalent of
				  one year of full-time experience in the treatment of seriously emotionally
				  disturbed children and their families under the supervision of a child mental
				  health specialist.
"Clinical record"
means either a paper, or
					 electronic file, or both that is maintained by the behavioral health agency and
					 contains pertinent psychological, medical, and clinical information for each
					 individual served.
"Clinical supervision"
means regular and
					 periodic activities performed by an appropriate level of professional for
					 clinical staff. Clinical supervision includes review of assessment, diagnostic
					 formulation, treatment planning, progress toward completion of care,
					 identification of barriers to care, continuation of services, authorization of
					 care, and the direct observation of the delivery of clinical care.
"Clubhouse"
means a community-based,
					 recovery-focused program designed to support individuals living with the
					 effects of mental illness, through employment, shared contributions, and
					 relationship building. A clubhouse operates under the fundamental principle
					 that everyone has the potential to make productive contributions by focusing on
					 the strengths, talents, and abilities of all members and fostering a sense of
					 community and partnership.
"Community mental health agency "
means the
					 same as "behavioral health agency ."
"Community relations plan"
means a plan to
					 minimize the impact of an opioid treatment program as defined by the Center for
					 Substance Abuse Guidelines for the Accreditation of Opioid Treatment Programs,
					 section 2.C.(4).
"Community support services"
means services
					 authorized, planned, and coordinated through resource management services
					 including, at a minimum:
(a)
				  Assessment, diagnosis, emergency crisis intervention available twenty-four
				  hours, seven days a week;
(b)
				  Prescreening determinations for persons who are mentally ill being considered
				  for placement in nursing homes as required by federal law;
(c) Screening for patients being considered
				  for admission to residential services;
(d) Diagnosis and treatment for children who
				  are mentally or severely emotionally disturbed discovered under screening
				  through the federal Title XIX early and periodic screening, diagnosis, and
				  treatment (EPSDT) program;
(e)
				  Investigation, legal, and other nonresidential services under chapter 71.05
				  RCW;
(f) Case management
				  services;
(g) Psychiatric treatment
				  including medication supervision;
(h) Counseling;
(i) Psychotherapy;
(j) Assuring transfer of relevant patient
				  information between service providers;
(k) Recovery services; and
(l) Other services determined by behavioral
				  health organizations.
"Complaint"
means the expression of a
					 dissatisfaction with a service or program which may be investigated by the
					 department.
"Consent"
means agreement given by an
					 individual after the person is provided with a description of the nature,
					 character, anticipated results of proposed treatments and the recognized
					 serious possible risks, complications, and anticipated benefits, including
					 alternatives and nontreatment, that must be provided in a terminology that the
					 person can reasonably be expected to understand.
"Consultation"
means the clinical review and
					 development of recommendations by persons with appropriate knowledge and
					 experience regarding activities or decisions of clinical staff, contracted
					 employees, volunteers, or students.
"Co-occurring disorder"
means the co-existence
					 of both a mental health and a substance use disorder. Co-occurring treatment is
					 a unified treatment approach intended to treat both disorders within the
					 context of a primary treatment relationship or treatment setting.
"Crisis"
means an actual or perceived urgent
					 or emergent situation that occurs when an individual's stability or functioning
					 is disrupted and there is an immediate need to resolve the situation to prevent
					 a serious deterioration in the individual's mental or physical health, or to
					 prevent the need for referral to a significantly higher level of care.
"Critical incident"
means any one of the
					 following events:
(a) Any death,
				  serious injury, or sexual assault that occurs at an agency that is licensed by
				  the department;
(b) Alleged abuse
				  or neglect of an individual receiving services, that is of a serious or
				  emergency nature, by an employee, volunteer, licensee, contractor, or another
				  individual receiving services;
(c)
				  A natural disaster, such as an earthquake, volcanic eruption, tsunami, urban
				  fire, flood, or outbreak of communicable disease that presents substantial
				  threat to facility operation or client safety;
(d) A bomb threat;
(e) Theft or loss of data in any form
				  regarding an individual receiving services, such as a missing or stolen
				  computer, or a missing or stolen computer disc or flash drive;
(f) Suicide attempt at the
				  facility;
(g) An error in
				  program-administered medication at an outpatient facility that results in
				  adverse effects for the individual and requires urgent medical intervention;
				  and
(h) Any media event regarding
				  an individual receiving services, or regarding a staff member or owner(s) of
				  the agency.
"Cultural competence"
or
"culturally
					 competent"
means the ability to recognize and respond to health-related
					 beliefs and cultural values, disease incidence and prevalence, and treatment
					 efficacy. Examples of culturally competent care include striving to overcome
					 cultural, language, and communications barriers, providing an environment in
					 which individuals from diverse cultural backgrounds feel comfortable discussing
					 their cultural health beliefs and practices in the context of negotiating
					 treatment options, encouraging individuals to express their spiritual beliefs
					 and cultural practices, and being familiar with and respectful of various
					 traditional healing systems and beliefs and, where appropriate, integrating
					 these approaches into treatment plans.
"Deemed"
means a status that may be given to a
					 licensed behavioral health agency as a result of the agency receiving
					 accreditation by a recognized behavioral health accrediting body which has a
					 current agreement with DBHR.
"Department"
means the Washington state
					 department of social and health services.
"Designated chemical dependency specialist"
means a person designated to perform involuntary substance use disorder
					 commitment duties . The duties of a designated chemical dependency specialist
					 and designated mental health professional are combined as of April 1, 2018,
					 into the role of designated crisis responder.
"Designated crisis responder"
or
"DCR"
means a mental health professional appointed by the county
					 or the BHO who is authorized to conduct investigations, detain persons up to
					 seventy-two hours at the proper facility, and carry out the other functions
					 identified in chapters 71.05 and 71.34 RCW. To qualify as a designated crisis
					 responder, a person must complete substance use disorder training specific to
					 the duties of a designated crisis responder.
"Designated mental health professional "
or
"DMHP"
means a mental health professional designated to perform
					 involuntary mental health commitment duties . The duties of a designated
					 chemical dependency specialist and designated mental health professional are
					 combined April 1, 2018, into the role of designated crisis responder.
"Detoxification"
has been replaced by the term
					 "withdrawal management."
"Disability"
means a physical or mental
					 impairment that substantially limits one or more major life activities of the
					 individual and the individual:
(a) Has
				  a record of such an impairment; or
(b) Is regarded as having such
				  impairment.
"Division of behavioral health and recovery "
or
"DBHR"
means the division within the department of social and
					 health services (formerly the mental health division and the division of
					 alcohol and substance abuse) that administers mental health, problem gambling
					 and substance use disorder programs authorized by chapters 43.20A, 71.05,
					 71.24, and 71.34 RCW.
"Early and periodic screening, diagnosis and
					 treatment"
or
"EPSDT"
means a comprehensive child health
					 medicaid program that entitles individuals age twenty and younger to preventive
					 care and treatment services. These services are outlined in chapter 182-534
					 WAC.
"Governing body"
means the entity with legal
					 authority and responsibility for the operation of the behavioral health agency,
					 to include its officers, board of directors or the trustees of a corporation or
					 limited liability company.
"HIV/AIDS brief risk intervention"
means a
					 face-to-face interview with an individual to help the individual assess
					 personal risk for HIV/AIDS infection and discuss methods to reduce infection
					 transmission.
"Individual"
means a person who applies for,
					 is eligible for, or receives behavioral health organization (BHO) authorized
					 behavioral health services from an agency licensed by the department as from a
					 behavioral health agency.
"Less restrictive alternative (LRA)"
means
					 court ordered outpatient treatment in a setting less restrictive than total
					 confinement.
"Licensed"
or
"licensure"
means
					 the status given to behavioral health agencies by the department under its
					 authority to license and certify mental health and substance use disorder
					 programs chapters 71.05, 71.34, and 71.24 RCW and its authority to certify
					 problem and pathological gambling treatment programs under
					 RCW
					  43.20A.890.
"Medical necessity"
or
"medically
					 necessary"
is a term for describing a required service that is
					 reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent
					 the worsening of conditions in the recipient that endanger life, or cause
					 suffering or pain, or result in illness or infirmity, or threaten to cause or
					 aggravate a handicap, or cause physical deformity or malfunction, and there is
					 no other equally effective, more conservative or substantially less costly
					 course of treatment available or suitable for the person requesting service.
					 Course of treatment may include mere observation or, where appropriate, no
					 treatment at all.
"Medical practitioner"
means a physician,
					 advance registered nurse practitioner (ARNP), or certified physician assistant.
					 An ARNP and a midwife with prescriptive authority may perform practitioner
					 functions related only to specific specialty services.
"Medication administration"
means the direct
					 application of a medication or device by ingestion, inhalation, injection or
					 any other means, whether self-administered by a resident, or administered by a
					 guardian (for a minor), or an authorized healthcare provider.
"Mental health disorder"
means any organic,
					 mental, or emotional impairment that has substantial adverse effects on a
					 person's cognitive or volitional functions.
"Mental health professional "
or
"MHP"
means a designation given by the department to an agency
					 staff member or an attestation by the licensed behavioral health agency that
					 the person meets the following:
(a) A
				  psychiatrist, psychologist, physician assistant working with a supervising
				  psychiatrist, psychiatric advanced registered nurse practitioner (ARNP),
				  psychiatric nurse, or social worker as defined in chapters 71.05 and 71.34
				  RCW;
(b) A person who is licensed
				  by the department of health as a mental health counselor or mental health
				  counselor associate, marriage and family therapist, or marriage and family
				  therapist associate;
(c) A person
				  with a master's degree or further advanced degree in counseling or one of the
				  social sciences from an accredited college or university who has at least two
				  years of experience in direct treatment of persons with mental illness or
				  emotional disturbance, experience that was gained under the supervision of a
				  mental health professional recognized by the department or attested to by the
				  licensed behavioral health agency;
(d) A person who meets the waiver criteria of
				  RCW
				   71.24.260, and the waiver was granted prior
				  to 1986; or
(e) A person who had an
				  approved waiver to perform the duties of a mental health professional (MHP),
				  that was requested by the behavioral health organization (BHO) and granted by
				  the mental health division prior to July 1, 2001.
"Minor"
means the same as "child."
"Off-site"
means the provision of services by
					 a provider from a licensed behavioral health agency at a location where the
					 assessment or treatment is not the primary purpose of the site, such as in
					 schools, hospitals, long term care facilities, correctional facilities, an
					 individual's residence, the community, or housing provided by or under an
					 agreement with the agency.
"Outpatient services"
means behavioral health
					 treatment services provided to an individual in a nonresidential setting. A
					 residential treatment facility (RTF) may become certified to provide outpatient
					 services.
"Peace officer"
means a law enforcement
					 official of a public agency or governmental unit, and includes persons
					 specifically given peace officer powers by any state law, local ordinance, or
					 judicial order of appointment.
"Peer counselor"
means a person recognized by
					 the division of behavioral health and recovery (DBHR) as a person who meets all
					 of the following:
(a) Is a
				  self-identified recipient of mental health services;
(b) Is a counselor registered under chapter
				  18.19 RCW;
(c) Has completed
				  specialized training provided by or contracted through DBHR. If the person was
				  trained by trainers approved by the mental health division (now DBHR) before
				  October 1, 2004, and has met the requirements in (a), (b), and (d) of this
				  subsection by January 31, 2005, the person is exempt from completing this
				  specialized training(;)
(d) Has
				  successfully passed an examination administered by DBHR or an authorized
				  contractor; and
(e) Has received a
				  notification letter from DBHR stating that DBHR recognizes the person as a
				  "peer counselor."
"Probation"
means a licensing or certification
					 status resulting from a finding of deficiencies that requires immediate
					 corrective action to maintain licensure or certification.
"Problem and pathological gambling"
means one
					 or more of the following disorders:
(a)
"Pathological gambling"
means a mental disorder characterized by loss of control over gambling,
				  progression in preoccupation with gambling and in obtaining money to gamble,
				  and continuation of gambling despite adverse consequences;
(b)
"Problem gambling"
is an
				  earlier stage of pathological gambling that compromises, disrupts, or damages
				  family or personal relationships or vocational pursuits.
"Progress notes"
means permanent written or
					 electronic record of services and supports provided to an individual
					 documenting the individual's participation in, and response to, treatment,
					 progress in recovery, and progress toward intended outcomes.
"Recovery"
means the process in which people
					 are able to live, work, learn, and participate fully in their
					 communities.
"Relocation"
means a physical change in
					 location from one address to another.
"Remodeling"
means expanding existing office
					 space to additional office space at the same address, or remodeling interior
					 walls and space within existing office space to a degree that accessibility to
					 or within the facility is impacted.
"Service area"
means the geographic area
					 covered by each behavioral health organization (BHO) for which it is
					 responsible.
"Short-term facility"
means a facility
					 licensed by the department of health and certified by the department of social
					 and health services under
					 RCW
					  71.24.035 which has been designed to assess,
					 diagnose, and treat individuals experiencing an acute crisis without the use of
					 long-term hospitalization. Length of stay in a short-term facility is less than
					 fourteen days from the day of admission.
"State minimum standards"
means minimum
					 requirements established by rules adopted by the secretary of the department
					 and necessary to implement this chapter for delivery of behavioral health
					 services.
"Substance use disorder"
means a cluster of
					 cognitive, behavioral, and physiological symptoms indicating that an individual
					 continues using the substance despite significant substance-related problems.
					 The diagnosis of a substance use disorder is based on a pathological pattern of
					 behaviors related to the use of the substances.
"Summary suspension"
means the immediate
					 suspension of either a facility's license or program-specific certification or
					 both by the department pending administrative proceedings for suspension,
					 revocation, or other actions deemed necessary by the department.
"Supervision"
means the regular monitoring of
					 the administrative, clinical, or clerical work performance of a staff member,
					 trainee, student, volunteer, or employee on contract by a person with the
					 authority to give direction and require change.
"Suspend"
means termination of a behavioral
					 health agency's license or program specific certification to provide behavioral
					 health treatment program service for a specified period or until specific
					 conditions have been met and the department notifies the agency of the
					 program's reinstatement of license or certification.
"Triage facility"
means a short-term facility
					 or a portion of a facility licensed by the department of health and certified
					 by the department of social and health services under
					 RCW
					  71.24.035 that is designed as a facility to
					 assess and stabilize an individual or determine the need for involuntary
					 commitment of an individual. A triage facility must meet department of health
					 residential treatment facility standards and may be structured as either a
					 voluntary or involuntary placement facility or both.
"Triage involuntary placement facility"
means
					 a triage facility that has elected to operate as an involuntary facility and
					 may, at the direction of a peace officer, hold an individual for up to twelve
					 hours. A peace officer or designated crisis responder may take or cause the
					 person to be taken into custody and immediately delivered to the triage
					 facility. The facility may ask for an involuntarily admitted individual to be
					 assessed by a mental health professional for potential for voluntary admission.
					 The individual has to agree in writing to the conditions of the voluntary
					 admission.
"Triage voluntary placement facility"
means a
					 triage facility where the individual may elect to leave the facility of their
					 own accord, at anytime. A triage voluntary placement facility may only accept
					 voluntary admissions.
"Tribal authority"
means, for the purposes of
					 behavioral health organizations and
					 RCW
					  71.24.300 only, the federally recognized
					 Indian tribes and the major Indian organizations recognized by the secretary of
					 the department as long as these organizations do not have a financial
					 relationship with any behavioral health organization that would present a
					 conflict of interest.
"Vulnerable adult"
means an individual who
					 receives services from the department and has at least one of the following
					 characteristics:
(a) A vulnerable
				  adult as defined in chapter 74.34 RCW;
(b) An individual admitted for withdrawal
				  management or detained or committed to an involuntary treatment facility that
				  is certified by the division of behavioral health and recovery.
"Withdrawal management"
means services
					 provided during the initial period of care and treatment to an individual
					 intoxicated or incapacitated by substance use.
"Work-ordered day"
means a model used to
					 organize clubhouse activities during the clubhouse's normal working hours.
					 Members and staff are organized into one or more work units which provide
					 meaningful and engaging work essential to running the clubhouse. Activities
					 include unit meetings, planning, organizing the work of the day, and performing
					 the work that needs to be accomplished to keep the clubhouse functioning.
					 Members and staff work side-by-side as colleagues. Members participate as they
					 feel ready and according to their individual interests. While intended to
					 provide members with working experience, work in the clubhouse is not intended
					 to be job-specific training, and members are neither paid for clubhouse work
					 nor provided artificial rewards. Work-ordered day does not include medication
					 clinics, day treatment, or other therapy programs.
"Youth"
means the same as
					 "child."
Statutory Authority:
						Chapters
						70.02,
						70.96A,
						71.05,
						71.24,
						71.34,
						74.50 RCW,
						RCW
						 74.08.090,
						43.20A.890, and 42 C.F.R. Part 8.
						WSR 13-12-054, § 388-877-0200, filed 5/31/13, effective
						7/1/13.