Behavioral Health Client Rights

Details

Type: Legislative Rule
Agency: Health
CSR Number: 64-59
Effective Date: May 1, 1995

Summary

Behavioral Health and Health Facilities
The Bureau for Behavioral Health and Health Facilities has two rules that have a federal counterpart, WV CSR 64-59 and 64-74, which both deal with patient rights. The federal counterparts are 42 CFR 482, Subparts A through E, and 42 CFR Part 483, Subpart I. Both West Virginia rules are more stringent than their federal counterparts in certain areas. Also incorporated by reference in CSR 64-59 are standards that are set by the “1993 Accreditation Manual for Hospitals of the Joint Commission…” and the “1993 edition of the Outcome Based Performance Measures of the Accreditation Council on Services for People with Disabilities….”
CSR 64-59 Behavioral Health Client Rights
West Virginia CSR 64-59 has 21 sections and only addresses patient treatment at state-owned and operated mental health facilities, i.e. William R. Sharpe, Jr. Hospital and Mildred Mitchell-Bateman Hospital. There are far more requirements in CSR 64-59 than in the federal counterparts 42 CFR 482, Subparts A through E, and 42 CFR Part 483, Subpart I. However, the state rules and the federal regulations can be read together except for WV CSR § 64-59-10, which is more stringent than 42 CFR 482.13(f). These sections outline the standards for restraint and seclusion of a patient. The state law is more stringent where it states that a person may not be restrained for more than two hours; the federal law allows for up to three hours.
Section 64-59-20 is also more stringent than its federal counterpart at 42 CFR 483.420(d)(4), which requires that “the results of all investigations must be reported to the administrator or designated representative or to other officials in accordance with State law within five working days of [an abuse or neglect incident]…. The state rule has a more detailed procedure of requiring advocates to be notified within an hour of the complaint and for the advocate investigation being completed and written report provided to the administrator within eight working hours. From there, the administrator has until the next work day to answer the abuse or neglect complaint. This is a shorter time frame than the five-day federal requirement.
Section 64-59-6, for the most part, can be read together with 42 CFR 483.440(c). However, the federal regulation requires that an individual program plan be completed within 30 days of admission, whereas, the state rule requires that an initial program plan be completed within 72 hours of admission, an interim program plan be completed after seven days, and then does not specify when the individualized program plan is supposed to be completed, but states that the client must have one. It is worth noting that the state rule requires more information sooner than the federal regulation.
Section 64-59-10.17 also appears to be more stringent than its federal counterpart at 42 CFR 483.450(d)(6), which requires that a client placed in mechanical restraints be checked every 30 minutes. In section 10 of 64-59, it states that “supervision of clients in mechanical restraints shall be on a one-on-one basis for the duration of the time the restraints are in place.” This seems to indicate that the person supervising the restraints stays with the patient the whole time, which is more stringent than the federal law.
Section 64-59-15 is more stringent than the federal regulation at 42 CFR 483.470, which states, among other things, that rooms can have up to four people in a room and must measure 60 square feet per client in multiple client rooms and at least 80 square feet in single client rooms. Section 15 of the state rule requires that two people, at most, be in a room and that the room provide 100 feet for each client in the room. This is more stringent than the federal regulation. While the state rules may not contradict the federal regulations anywhere else, thus requiring a stringency analysis, much of the state rule as pertaining to client living space is more burdensome than the federal regulation.
CSR 64-74 Behavioral Health Consumer Rights
West Virginia CSR 64-74 is the companion to 64-59, but addresses the rights of all individuals with behavioral health needs that are not at Sharpe and Bateman. For the most part, this rule is a lot less specific than 64-59 and has no parts that are more stringent that the federal patient rights regulation that is not also at issue in 64-59.
Public Comment
During the comment period on these two rules, the Department received one comment from Disability Rights of West Virginia, which is attached.

Submitter Details

Name: Heather McDaniel
Email: Heather.J.McDaniel@wv.gov
Phone: 304-558-5965

Uploaded Files

Filename: Disability Rights of WV comment.pdf
Filesize: 392750
Uploaded: 2017-11-01 14:31:05