Mental Health Resource Manual
Authored By: Northwest Justice Project
Northwest Justice Project - Everett
Legal Services – Snohomish AAA project
Revised: April 2013
MENTAL HEALTH ELECTRONIC RESOURCE MANUAL
for "Seniors" age 60 and older and other adults
- If you have Medicaid coverage, you have the best access to our state's public mental health system services.
Until January 2014, Medicaid eligibility is limited to people in certain categories who meet related requirements for low income and resources. These include:
Children are eligible for Medicaid under liberal rules for income and resources.
Parents of such children qualify for Medicaid only if they are very low-income.
Pregnant women, people over age 65, and people unable to work due to disability or blindness may qualify if they meet income and resource limits.
Seniors and people with disabilities who need, and receive, long-term care services, either in a nursing home, alternate facility, or at home, may qualify for Medicaid (including mental health coverage) even if their incomes are higher than the usual limits required.
Northwest HealthLaw Advocates' website has more information about current Medicaid eligibility programs: http://nohla.org/infoAnalysis/WAhpDSHS.php.
The "Medicaid Expansion" in 2014 will add many adults to Medicaid eligibility.
In January 2014, things should change greatly in Washington State. We will take part in the Medicaid Expansion allowed under the federal health reform law. The Expansion may add as many as 250,000 adults to Medicaid eligibility in Washington State.
With the Expansion, adults will no longer need to be over age 65, pregnant, parents of minor children, or prove that they have permanent disabilities, to get Medicaid. The main requirement for adult eligibility in the Expansion will be to have income below 138% of the Federal Poverty Level. People in the Medicaid Expansion will be eligible for Medicaid-funded mental health services through the public mental health service system.
- The Medicaid Expansion will NOT include seniors over age 65 or people under age 65 who already get Medicare. These groups can qualify for Medicaid or other health care assistance under other categories and programs that are already available.
Public Mental Health System in Washington State
Crisis and Involuntary treatment services
All state residents are eligible for crisis mental health services and involuntary treatment services. People who are on Medicaid receive free mental health services. If you are ineligible for Medicaid, you may have to pay for services. Example: regulations address patient share of costs for involuntary treatment in WAC Chapter 388-855.
- For an online directory of crisis line services, see: http://www.dshs.wa.gov/dbhr/mhcrisis.shtml
Medicaid-funded and state-funded services through DBHR
The State of Washington provides for mental health services through the Division of Behavioral Health and Recovery (DBHR). The DBHR's website is: http://www1.dshs.wa.gov/mentalhealth/index.shtml The DBHR answers questions about their programs here: http://www.dshs.wa.gov/dbhr/mhfaqs.shtml.
The DBHR funds "Regional Support Networks" ("RSNs") to administer public mental health services. The RSNs contract with licensed community mental health agencies to:
manage involuntary treatment services
provide services to people with serious mental illnesses
The state currently has 11 RSNs. The RSNs contract with mental health providers in their regions. Read more about the RSNs here: http://www.dshs.wa.gov/dbhr/rsn.shtml
Snohomish County Seniors and seniors in the counties north of Snohomish get services through the North Sound Mental Health Administration (formerly the "Northsound RSN"). Read more about NSMHA here: http://www1.dshs.wa.gov/mentalhealth/nsound.shtml
The type and level of Medicaid services made available to any client through the RSN is determined under the "Access to Care" guidelines. These guidelines focus on very serious conditions. Read the Access to Care guidelines here: http://www.dshs.wa.gov/pdf/dbhr/mh/PI/Access_to_Care_Standards20060101.pdf
The RSNs operate under a contract with the state whose terms are governed by the terms of a federal Medicaid "waiver." The federal Medicaid "waiver" requirements, state laws, and state regulations provide standards for programs for issues such as access, quality, grievances and appeals, and ombudsman services. See resources below.
In 2005, the federal Medicaid agency required the state to stop using federal Medicaid funds for service programs serving people ineligible for Medicaid. As a result, services provided through the RSN system for people ineligible for Medicaid are very limited compared to services available to Medicaid clients. The RSN system serves people ineligible for Medicaid who have serious or long-term mental illness only as resources allow.
Medicaid Managed care services
Medicaid clients also may get some mental health services through their regular Medicaid health coverage. Example: primary care providers may manage medications for mental health conditions.
Medicaid clients on "Healthy Options" managed care health plans also receive some mental health services through their plans. These include:
psychological testing, evaluation and diagnosis
up to 12 hours of treatment per calendar year for adults (more for children age 18 and younger)
*Page 13 of this Medicaid benefits booklet describes the mental health services available through the Medicaid managed care plans: http://www.hca.wa.gov/medicaid/publications/documents/22-542.pdf.
Clients on the "Medical Care Services" program receive their health services through a different managed care system. That system provides limited outpatient mental health services, which clients access through their assigned primary care provider.
Mental Health Services provided through "WMIP" instead of through RSNs –Snohomish County only
WMIP is a special managed care program for Medicaid clients who live in Snohomish County. It is open only to residents who get Medicaid based on disability, age (65 and older), or blindness.
WMIP is a pilot project, expected to end at the end of 2013. It is an "integration" project. It makes the managed care health plan responsible for managing:
mental health services
chemical dependency services
long-term care services
the usual medical services
WIMP enrollees get mental health services as part of their WMIP managed care services instead of through the RSN system. The current WMIP managed care contractor is Molina-WMIP. Molina-WMIP contracts for mental health services with many of the same providers serving clients through the RSN system. Molina currently contracts with the same Mental Health Ombudsman program that serves RSN clients after initially providing ombudsman services through Molina staff.
The WMIP website has more information: http://www.hca.wa.gov/medicaid/mip/pages/default.aspx. The details concerning client rights are in the state's WMIP contract with Molina. Contract information may be available through the state Health Care Authority (Medicaid agency) website: http://www.hca.wa.gov/medicaid/healthyoptions/pages/contracts.aspx
Other programs (not funded by Medicaid) for mental health services for seniors
Medicare covers some mental health services. In some communities, it is hard to find a provider that accepts Medicare. Other insurance coverage, such as through an employer or past employer, may provide mental health service coverage.
Some local communities in the state now have special programs funded by other sources to serve mental health needs of seniors. Local Area Agencies on Aging, sometimes using federal Older Americans Act funds, support some of these programs. In Snohomish County, the local AAA funds the Hope Options program to help seniors with mental illness having housing problems. The same AAA also funds peer support mental health programs for seniors.
Many Washington counties have voted for a small increase in county sales tax earmarked to fund additional mental health services. These programs may serve people ineligible for other services. Many include some programs designed for seniors.
Your local Senior Information and Referral program is the best resource for current information about these kinds of resources in local communities for seniors (age 60 and older). Senior I and R programs are funded through the Older Americans Act for every part of the state and the country through a local "Area Agency on Aging." To find your local Senior Information program or area agency on aging, go to http://www.aasa.dshs.wa.gov/Resources/clickmap.htm.
Requirements for "age competency" in serving seniors:
Many sections of the law and regulations require that programs or contractors have age and cultural competency in their services. See, for example, WAC 388-865-0229; -0225; -0405; -0300. To find these requirements, go to the link for the chapter you wish to review, load the full chapter text, and use "find" to locate the word "age" and "cultural."
Rights of senior clients with mental health-based disabilities
The Department of Social and Health Services (DSHS) requires accommodations for clients with disabilities who need them to access department services. This is how DSHS complies with federal and state laws protecting people with disabilities, including mental health conditions.
DSHS calls this "Needing Supplemental Accommodation" or "Equal Access." The manual DSHS office workers use for these accommodations is at http://www.dshs.wa.gov/manuals/eaz/sections/NSA.shtml.
The federal Americans with Disabilities Act protects people with disabilities. You can use ADA "reasonable accommodation" requests to address problems seniors with mental health disabilities may have in a variety of contexts.
Example: the law prohibits housing discrimination against people with disabilities. Discrimination may take place when a covered provider refuses to make reasonable accommodation in rules, policies, practices, or services, when doing so is necessary to provide an equal opportunity for a person with a disability to use and enjoy a dwelling.
The Washington LawHelp website, http://www.washingtonlawhelp.org/, has materials or links to materials regarding discrimination. Look for the section on "Civil and Other Individual Rights," and then under "Disability Rights," for more information. You can also search for "ADA," "discrimination," and "reasonable accommodation."
Research Tools for Service Standards, Access, Grievance and Appeals, Quality, and Client Rights
Federal Medicaid waiver requirements: http://www.dshs.wa.gov/dbhr/mhwaivers.shtml
The waiver addresses requirements for grievances and appeals.
Public Mental Health System Benefits Booklet: http://www.dshs.wa.gov/pdf/Publications/22-661.pdf
This booklet is for clients. It has many details without citations to law or regulations. Info and links to version of the booklet in languages other than English are here: http://www.dshs.wa.gov/dbhr/mhmedicaidbenefit.shtml
RCW Chapter 71.05 -- Mental illness: http://apps.leg.wa.gov/RCW/default.aspx?cite=71.05
RCW Chapter 71.24 – Community Mental Services Act http://apps.leg.wa.gov/RCW/default.aspx?cite=71.24
WAC Chapter 388-865 – State regulations on Community Mental Health and Involuntary Treatment Programs:
WAC 388-865-0215-- Eligibility and payment for RSN services: http://apps.leg.wa.gov/WAC/default.aspx?cite=388-865&full=true#388-865-0215
WAC Chapter 388-855- -- liability for costs for hospitalizations for mental illness: http://apps.leg.wa.gov/WAC/default.aspx?cite=388-855
WAC 388-865-0410 -- Rights of consumers receiving Community Support services: http://apps.leg.wa.gov/WAC/default.aspx?cite=388-865&full=true#388-865-0410. The endnote below provides the list of rights from the WAC.[Endnote].
"Best practices" materials:
The subpart of this 2003 guide that addresses older clients is at this link: http://www.dshs.wa.gov/pdf/dbhr/mh/resourceguide/geriatricbestpract.pdf
Link to the Access to Care Standards document (which address conditions and services addressed by the RSNs and their contractors): http://www.dshs.wa.gov/pdf/dbhr/mh/PI/Access_to_Care_Standards20060101.pdf
DBHR's Mental health definitions:http://www.dshs.wa.gov/dbhr/mhdefinitions.shtml
Links to contracts between the North Sound Mental Health Administration (the RSN organization serving Snohomish County and counties north) and other entities (DSHS, providers, counties):http://nsmha.org/Contracts/Default.htm
Mental health for older adults website (state DBHR website materials) http://www.dshs.wa.gov/dbhr/olderadultmentalhealth.shtml
Footnote 1: This publication addresses services for adults. Read more about mental health services for children and youth at Disability Rights of Washington's website: http://www.disabilityrightswa.org/. This includes information about "EPSDT" and Medicaid coverage for treatment: http://www.disabilityrightswa.org/fact-sheet-mental-health-professionals-early-and-periodic-screening-diagnosis-and-treatment; and information about getting inpatient treatment for youth: http://www.disabilityrightswa.org/obtaining-inpatient-mental-health-treatment-youth.
Endnote: WAC 388-865-0410 Consumer rights
[link is: http://apps.leg.wa.gov/WAC/default.aspx?cite=388-865-0410 ](1) The provider must document that consumers, prospective consumers, or legally responsible others are informed of consumer rights at admission to community support services in a manner that is understandable to the individual. Consumer rights must be written in alternative format for consumers who are blind or deaf, and must also be translated to the most commonly used languages in the service area consistent with WAC 388-865-0260(3);
(2) The provider must post a written statement of consumer rights in public areas, with a copy available to consumers on request. Providers of telephone only services (e.g., crisis lines) must post the statement of consumer rights in a location visible to staff and volunteers during working hours;
(3) The provider must develop a statement of consumer rights that incorporates the following statement or a variation approved by the mental health division: "You have the right to:
(a) Be treated with respect, dignity and privacy;
(b) Develop a plan of care and services which meets your unique needs;
(c) The services of a certified language or sign language interpreter and written materials and alternate format to accommodate disability consistent with Title VI of the Civil Rights Act;
(d) Refuse any proposed treatment, consistent with the requirements in chapters 71.05 and 71.34 RCW;
(e) Receive care which does not discriminate against you, and is sensitive to your gender, race, national origin, language, age, disability, and sexual orientation;
(f) Be free of any sexual exploitation or harassment;
(g) Review your clinical record and be given an opportunity to make amendments or corrections;
(h) Receive an explanation of all medications prescribed, including expected effect and possible side effects;
(i) Confidentiality, as described in chapters 70.02, 71.05, and 71.34 RCW and regulations;
(j) All research concerning consumers whose cost of care is publicly funded must be done in accordance with all applicable laws, including DSHS rules on the protection of human research subjects as specified in chapter 388-04 WAC;
(k) Make an advance directive, stating your choices and preferences regarding your physical and mental health treatment if you are unable to make informed decisions;
(l) Appeal any denial, termination, suspension, or reduction of services and to continue to receive services at least until your appeal is heard by a fair hearing judge;
(m) If you are medicaid eligible, receive all services which are medically necessary to meet your care needs. In the event that there is a disagreement, you have the right to a second opinion from:
(i) A provider within the regional support network about what services are medically necessary; or
(ii) For consumers not enrolled in a prepaid health plan, a provider under contract with the mental health division.
(n) Lodge a complaint with the ombuds, regional support network, or provider if you believe your rights have been violated. If you lodge a complaint or grievance, you must be free of any act of retaliation. The ombuds may, at your request, assist you in filing a grievance. The ombuds' phone number is:__________;
(o) Ask for an administrative hearing if you believe that any rule in this chapter was incorrectly applied in your case."