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90- and 180-day civil commitment beds
In 2018, Governor Jay Inslee announced a plan to change how and where individuals with mental illness are treated in Washington State. Rather than receive treatment in a state hospital, individuals will receive treatment from a facility close to their home and community. The change will help people to get long-term psychiatric care in settings that are integrated in the community.
The Health Care Authority (HCA) contracts with community hospitals and freestanding evaluation and treatment facilities to maintain beds for 90-180-day involuntary, inpatient, psychiatric treatment. The facility assists with the discharge planning process and keeps the individuals’ friends and family members in close proximity.
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Individuals, mandated by a court process for civil commitment stays of 90-180 days, may receive long-term inpatient care from a community hospital or freestanding evaluation and treatment center contracted with HCA for this program, regardless of Medicaid managed care enrollment.
Enrollment into an eligible plan is encouraged for program participants to receive continuity of care post discharge from the psychiatric care facility.
A designated crisis responder may determine if an individual meets the criterion to be held for a 120-hour hold. The 120-hour hold can be increased to a 14, 90 or 80-day hold.
Contracted facilities with occupied beds receive reimbursement. Community hospital reimbursement rates are based on the current inpatient prospective payment system. Evaluation and treatment center reimbursement rates are based on the mental health service fee schedule. Both of the rate schedules can be found on the provider billing guides and fee schedules webpage.
Contracted providers will receive a start-up rate in order to help admit individuals into their programs. The rate will be determined according to ESSB 5092 215(66)(f)19 (page 224) beginning July 1, 2022 (fiscal year 2023).
As of January 1, 2022 the state has 140 contracted beds that are located in a community setting. The state continues to make efforts to expand 90-180-day treatment beds and anticipates adding 75+ beds within the next calendar year.
The Washington State Department of Commerce is assisting in the program expansion with their Behavioral Health Facilities Program The program will help to support community providers in creating more capacity for behavioral health services in local communities.
On July 1, 2021, contracted sites started tracking their bed availability. Sites input the number of available beds into a data collection survey each week on Tuesdays and Fridays. By collecting the number of available beds, the state will have an accurate representation of 90-and-180-day treatment beds, and it will make sure that available beds are available.
HCA partnered with Advocates for Human Potential, Inc., a national technical assistance provider, to develop a toolkit. The toolkit will help community hospitals and evaluation and treatment centers to provide the best possible treatment over 90- or 180-day periods.
The suggestions in this toolkit are based on best practices and discussions with individuals who have experienced inpatient commitments, and the guidance is not mandatory. Community hospitals evaluation and treatment centers may design their facilities, procedures, and protocols to best serve the individuals in their care.
The treatment and services necessary over the course of 90- and 180-days differ significantly from acute care, and the community hospital or E&T should offer a home-like feel to someone staying these longer periods. The toolkit includes:
- Treatment options.
- Safety and reduction of seclusion and restraint.
- Trauma-informed care.
- Physical environment conducive to 90-and 180-day treatment.
- How to engage individuals in person-centered planning.
- Individualizing care to an individual need.
- How to work with designated crisis responders and the courts on commitments and transitions of care.
- Community collaboration.