246-341-1152  <<  246-341-1154 >>   246-341-1156

WAC 246-341-1154

Mental health inpatient servicesCompetency evaluation and restoration.

A behavioral health agency may provide competency evaluation and restoration treatment services to individuals under chapter 10.77 RCW when the department certifies the services.
(1) In addition to meeting the agency licensure, certification, administration, personnel, and clinical requirements in WAC 246-341-0100 through 246-341-0650 and the inpatient services requirements in WAC 246-341-1118 through 246-341-1132, an agency providing competency evaluation and restoration services must be licensed by the department as:
(a) A residential treatment facility consistent with chapter 246-337 WAC;
(b) A hospital consistent with chapter 246-320 WAC;
(c) A private psychiatric hospital consistent with chapter 246-322 WAC; or
(d) An inpatient evaluation and treatment facility as provided in WAC 246-341-1134 and consistent with chapter 246-337 WAC.
(2) The administrative policies and procedures must include:
(a) Designation of a psychiatrist as the professional person in charge of clinical services at the agency;
(b) Procedures to assure the protection of individual participant rights in WAC 246-341-1156; and
(c) Procedures to assure that seclusion and restraint are used only to the extent necessary to ensure the safety of the individual see WAC 246-341-1158.
(3) The clinical record must include all of the following:
(a) A copy of the court order and charging documents. If the order is for competency restoration treatment and the competency evaluation was provided by a qualified expert or professional person who was not designated by the secretary, a copy of all previous court orders related to competency or criminal insanity provided by the state and a copy of any evaluation reports must be included.
(b) A copy of the discovery materials, including, at a minimum, a statement of the individual's criminal history.
(c) A copy of the individual's medical clearance information.
(d) All diagnostic and therapeutic services prescribed by the attending clinical staff members.
(e) Specific targets and strategies for restoring competency to include periodic assessments of gains on these targets.
(f) Participation of a multidisciplinary team that includes at a minimum:
(i) A physician, advanced registered nurse practitioner (ARNP), or physician assistant certified (PA-C);
(ii) A nurse, if the person in (f)(i) of this subsection is not an ARNP; and
(iii) A mental health professional.
(g) Participation of other multidisciplinary team members, which may include a psychologist and chemical dependency professional.
(h) All assessments and justification for the use of seclusion or restraint.
(4) The initial assessment must include:
(a) The individual's:
(i) Identifying information;
(ii) Specific barriers to competence;
(iii) Medical provider's name or medical providers' names;
(iv) Medical concerns;
(v) Medications currently taken;
(vi) Brief mental health history; and
(vii) Brief substance use history, including tobacco use.
(b) The identification of any risk of harm to self and others, including suicide and homicide; and
(c) Treatment recommendations or recommendations for additional program-specific assessment.
(5) To determine the nature of the disorder and the treatment necessary, the agency must ensure that the individual receives the following assessments and document in the client's record the date provided:
(a) A health assessment of the individual's physical condition to determine if the individual needs to be transferred to an appropriate hospital for treatment;
(b) An examination and medical evaluation within twenty-four hours by a physician, advanced registered nurse practitioner, or physician assistant;
(c) A psychosocial evaluation by a mental health professional; and
(d) A competency to stand trial evaluation conducted by a licensed psychologist, or a copy of a competency to stand trial evaluation using the most recent competency evaluation, if an evaluation has already been conducted.
(6) If a state hospital transfers an individual to an agency for competency restoration treatment, the agency must review the individual's completed admission assessment from the state hospital to assure it meets the requirements of subsection (3) of this section for initial assessments. The agency must update the assessment as needed. If the state hospital has not completed or has only partially completed an assessment for the individual, the agency must complete the assessment according to the requirements in subsections (2) and (3) of this section.
(7) The agency must ensure the individual service plan is completed within seven days of admission and is updated every ninety days.
[Statutory Authority: 2018 c 201 and 2018 c 291. WSR 19-09-062, § 246-341-1154, filed 4/16/19, effective 5/17/19.]
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