Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › Section 182-538D-0200 - Behavioral health services- Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions and those found in chapters
				  182-500, 182-538, and 182-538C WAC apply to this chapter. If conflict exists,
				  this chapter takes precedence.
"Adult"
means a person age eighteen or older.
				  For purposes of the medicaid program, people age eighteen through age twenty
				  have the early and periodic screening, diagnostic and treatment (EPSDT) benefit
				  described in chapter 182-534 WAC. In the medicaid program, EPSDT is available
				  until a person reaches age twenty-one.
"Assessment"
means the process of obtaining all
				  pertinent bio-psychosocial information, as identified by the person, and family
				  and collateral sources, for determining a diagnosis and to plan individualized
				  services and supports.
"Behavioral health"
means the prevention,
				  treatment of, and recovery from substance use disorders, mental health
				  disorders or problem and pathological gambling disorders.
"Behavioral health administrative service organization
				  (BH-ASO)"
See WAC
				  182-538-050.
"Behavioral health agency"
means an entity
				  licensed by the department of health to provide behavioral health services,
				  including services for mental health disorders and substance use
				  disorders.
"Chemical dependency professional"
or
"CDP"
means a person credentialed by the department of health as a
				  chemical dependency professional (CDP) with primary responsibility for
				  implementing an individualized service plan for substance use disorder
				  services.
"Child"
means a person under the age of
				  eighteen. For the purposes of the medicaid program, people age eighteen through
				  age twenty have the early and periodic screening, diagnostic and treatment
				  (EPSDT) benefit described in chapter 182-534 WAC. In the medicaid program,
				  EPSDT is available until a person reaches age twenty-one.
"Clinical record"
means a paper or electronic
				  file that is maintained by the provider and contains pertinent psychological,
				  medical, and clinical information for each person served.
"Community support services"
means services
				  authorized, planned, and coordinated through resource management services
				  including, at a minimum, assessment, diagnosis, emergency crisis intervention
				  available twenty-four hours, seven days a week; prescreening determinations for
				  people who are mentally ill being considered for placement in nursing homes as
				  required by federal law; screening for patients being considered for admission
				  to residential services; 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; investigation, legal, and other nonresidential services under
				  chapter 71.05 RCW; case management services; psychiatric treatment including
				  medication supervision; counseling; psychotherapy; assuring transfer of
				  relevant patient information between service providers; recovery services; and
				  other services determined by behavioral health administrative service
				  organizations and managed care organizations.
"Complaint"
See "grievance" in WAC
				  182-538-050.
"Consent"
means agreement given by a person
				  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. Informed consent must be provided in a terminology that the
				  person can reasonably be expected to understand.
"Consultation"
means the clinical review and
				  development of recommendations regarding activities, or decisions of, clinical
				  staff, contracted employees, volunteers, or students by people with appropriate
				  knowledge and experience to make recommendations.
"Crisis"
means an actual or perceived urgent or
				  emergent situation that occurs when a person's stability or functioning is
				  disrupted and there is an immediate need to resolve the situation to prevent a
				  serious deterioration in the person's mental or physical health, or to prevent
				  the need for referral to a significantly higher level of care.
"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 people from diverse cultural backgrounds feel comfortable discussing
				  their cultural health beliefs and practices in the context of negotiating
				  treatment options, encouraging people 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.
"Designated crisis responder (DCR)"
means a
				  mental health professional appointed by the county, or an entity appointed by
				  the county, to perform the duties described in chapter 71.05 RCW.
"Disability"
means a physical or mental
				  impairment that substantially limits one or more major life activities of a
				  person and the person:
(a) Has a record of such an impairment; or
(b) Is regarded as having such impairment.
"Ethnic minority"
or
"racial/ethnic
				  groups"
means, for the purposes of this chapter, any of the following
				  general population groups:
(a) African American;
(b) An American Indian or Alaskan native, which
				  includes:
(i) A person who is a member or considered to be a member in
				  a federally recognized tribe;
(ii) A person determined eligible to be found Indian by the
				  secretary of interior;
(iii) An Eskimo, Aleut, or other Alaskan native; and
(iv) An unenrolled Indian meaning a person considered Indian
				  by a federally or nonfederally recognized Indian tribe or off-reservation
				  Indian/Alaskan native community organization.
(c) Asian/Pacific Islander; or
(d) Hispanic.
"Housing services"
means the active search and
				  promotion of individual access to, and choice in, safe and affordable housing
				  that is appropriate to the person's age, culture, and needs.
"Integrated managed care (IMC)"
See WAC
				  182-538-050.
"Less restrictive alternative (LRA)"
See WAC
				  182-538C-050.
"Mental health professional"
means a person who
				  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, mental health counselor associate, marriage and family
				  therapist, or marriage and family therapist associate; or
(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
				  people with mental illness or emotional disturbance, experience that was gained
				  under the supervision of a mental health professional recognized by the
				  department of health or attested to by the licensed behavioral health agency.
"Mental health specialist"
means:
(a) A
"child mental health specialist"
is
				  defined as a mental health professional with the following education and
				  experience:
(i) A minimum of one hundred actual hours (not quarter or
				  semester hours) of special training in child development and the treatment of
				  children and youth with serious emotional disturbance and their families;
				  and
(ii) The equivalent of one year of full-time experience in
				  the treatment of seriously emotionally disturbed children and youth and their
				  families under the supervision of a child mental health specialist.
(b) A
"geriatric mental health specialist"
is
				  defined as a mental health professional who has the following education and
				  experience:
(i) A minimum of one hundred actual hours (not quarter or
				  semester hours) of specialized training devoted to the mental health problems
				  and treatment of people age sixty and older; and
(ii) The equivalent of one year of full-time experience in
				  the treatment of people age sixty and older, under the supervision of a
				  geriatric mental health specialist.
(c) An
"ethnic minority mental health
				  specialist"
is defined as a mental health professional who has
				  demonstrated cultural competence attained through major commitment, ongoing
				  training, experience and/or specialization in serving ethnic minorities,
				  including evidence of one year of service specializing in serving the ethnic
				  minority group under the supervision of an ethnic minority mental health
				  specialist; and
(i) Evidence of support from the ethnic minority community
				  attesting to the person's commitment to that community; or
(ii) A minimum of one hundred actual hours (not quarter or
				  semester hours) of specialized training devoted to ethnic minority issues and
				  treatment of ethnic minorities.
(d) A
"disability mental health specialist"
is
				  defined as a mental health professional with special expertise in working with
				  an identified disability group. For purposes of this chapter only, "disabled"
				  means a person with a disability other than a mental illness, including a
				  developmental disability, serious physical handicap, or sensory
				  impairment.
(i) If the consumer is deaf, the specialist must be a mental
				  health professional with:
(A) Knowledge about the deaf culture and psychosocial
				  problems faced by people who are deaf; and
(B) Ability to communicate fluently in the preferred language
				  system of the consumer.
(ii) The specialist for people with developmental
				  disabilities must be a mental health professional who:
(A) Has at least one year experience working with people with
				  developmental disabilities; or
(B) Is a developmental disabilities professional as defined
				  in
				  RCW
				  71.05.020.
"Peer counselor"
means a person recognized by
				  medic-aid agency as a person who:
(a) Is a self-identified consumer of behavioral health
				  services who:
(i) Has applied for, is eligible for, or has received
				  behavioral health services; or
(ii) Is the parent or legal guardian of a person who has
				  applied for, is eligible for, or has received behavioral health
				  services;
(b) Is a counselor credentialed under chapter 18.19
				  RCW;
(c) Has completed specialized training provided by or
				  contracted through the medicaid agency. If the person was trained by trainers
				  approved by the department of social and health services 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
				  the medicaid agency or an authorized contractor; and
(e) Has received a written notification letter from the
				  medicaid agency stating that the medicaid agency recognizes the person as a
				  "peer counselor."
"Quality plan"
means an overarching system
				  and/or process whereby quality assurance and quality improvement activities are
				  incorporated and infused into all aspects of a behavioral health administrative
				  service organization's (BH-ASO's) or managed care organization's (MCO's)
				  operations.
"Residential services"
means a complete range of
				  residences and supports authorized by resource management services and which
				  may involve a facility, a distinct part thereof, or services which support
				  community living, for people who are acutely mentally ill, adults who are
				  chronically mentally ill, children who are severely emotionally disturbed, or
				  adults who are seriously disturbed and determined by the behavioral health
				  organization to be at risk of becoming acutely or chronically mentally
				  ill.
"Resource management services"
means the
				  planning, coordination, and authorization of residential services and community
				  support services for people who are:
(a) Adults and children who are acutely mentally ill;
(b) Adults who are chronically mentally ill;
(c) Children who are severely emotionally disturbed;
				  or
(d) Adults who are seriously disturbed and determined solely
				  by a behavioral health organization to be at risk of becoming acutely or
				  chronically mentally ill.
"Substance use disorder"
means a cluster of
				  cognitive, behavioral, and physiological symptoms indicating that a person
				  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.
"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.
"Youth"
means a person who is age seventeen or
				  younger.