ESSB 6656 Overview and Scope of the Select Committee on Quality Improvement in State Hospitals April 29, 2016 Kevin Black, Senate Committee Services Andy Toulon, House Office of Program Research

Key Elements of ESSB 6656 Governor’s Behavioral Health Innovation Fund Fund created to improve the quality of care, patient outcomes, patient and staff safety, and efficiency of operations at the state hospitals. Expenditures must be authorized by the Director of OFM or their designee. Recommendations on the use of funds must be informed by consultants. Select committee charged with making recommendations for the use of funds, taking into consideration the information and recommendations provided by consultants. Partial veto eliminated additional provisions establishing a process for DSHS to apply for funds, restrictions on the use of the funds, and a requirement for OFM to consider input from the Select Committee when awarding funding. April 29, 2016 Select Committee on Quality Improvement in State Hospitals 2

Key Elements of ESSB 6656 Consultants Two external consultants must be contracted to make recommendations on long-term planning for the state hospitals and the use of moneys in the Fund. The Select Committee must review the selection and provide input into the prioritization of tasks. OFM must engage an external consultant on the configuration and financing of the state hospital system. Responsibilities include: – Working with DSHS to develop a transition plan relating to state hospital financing by November 2016 (Governor’s partial veto message); – Identification of appropriate populations to be served; – Review barriers to admission and discharge, including opportunities for transitional facilities and diversion; – Improving oversight of community networks and planning for long-term integration. DSHS must engage an academic or independent consultant to examine clinical care models and state hospital staffing roles, including issues of ward size, safety concerns, sustaining a culture of wellness and recovery, and increasing responsiveness to patient needs. Recommendations are due October 1, April 29, 2016 Select Committee on Quality Improvement in State Hospitals 3

Key Elements of ESSB 6656 DSHS Obligations DSHS must report quarterly data to the Select Committee on all performance measures and outcomes for which data is currently being collected, and any additional data requested by the Committee. DSHS must report the status of key activities, critical milestones, and deliverables, including specific barriers completion and strategies that will be used to address challenges. DSHS must identify patients with long-term care needs who can safely be served in alternative community placements and reduce the demand for state hospital beds among this population by 20 beds by July 1, 2016, and 10 additional beds by January 1, Partial veto eliminated specific activities which DSHS would have been charged with implementing, including creation of: – a standardized, acuity-based staffing model; – a strategy for reducing utilization of state hospital beds; – a safety training program; and – a process to appeal disputes between the state hospital and community over a patient’s readiness for discharge to the Secretary of DSHS. April 29, 2016 Select Committee on Quality Improvement in State Hospitals 4

Key Elements of ESSB 6656 Select Committee Charge and Scope Planning related to: – The role of the state hospitals in the state's mental health system; – State hospital structure, financing, staff composition, and workforce development needs. Recommend uses of the Governor’s Behavioral Health Innovation Fund Monitor process and outcome measures. Review findings from DOH and L&I surveys at the state hospitals and compliance with recommended corrective action. Review selection of consultants, provide input into prioritization of tasks, and receive and review consultant reports. Receive and review quarterly implementation progress reports and additional data as requested from DSHS. Receive DSHS requests for extensions to timelines in the act that conflict with other improvement timelines set by federal or state regulatory bodies. Provide open public meetings with an opportunity for public comment April 29, 2016 Select Committee on Quality Improvement in State Hospitals 5

Key Elements of ESSB 6656 Key Timelines and Milestones Quarterly (Ongoing): – DSHS progress reports – DOH and L&I reports regarding safety and compliance – Meetings of Select Committee Other Key Dates – April, 2016: Select Committee begins meeting – July 1, 2016: Twenty bed reduction for patients needing long-term care (DSHS) – October 1, 2016: Consultant reports due – December 1, 2016: Progress report for thirty bed reduction due (DSHS) – January 1, 2017: Additional ten bed reduction for patients needing long-term care (DSHS) – August 1, 2017: Final report due for thirty bed reduction, including outcomes for patients through June 30, 2017 (DSHS) – July 1, 2019: Expiration of enabling statute. April 29, 2016 Select Committee on Quality Improvement in State Hospitals 6