Washington Statutes

Amends RCW 71.24.045 and RCW 71.24.380, creates new Title 71 RWC

Introduction to new law highlights the need for MH/SUD expanded services, noting the need to create a new state office of behavioral health consumer advocacy that shall advocate for patients to promote their care and compliance with applicable state and federal laws.  Among other responsibilities, the new agency will promote access to MH/SUD services, offer a toll-free number, publish a website, establish a state-wide uniform reporting system, set up a system to investigate complaints and inform patients about their rights – among other functions.  Behavioral health providers and facilities must post contact information to the new agency, along with a brief description of the agency’s support services.  In addition, the agency will train and certify consumer advocates.  Managed care organizations must reimburse the agency for some of its services if used by plan enrollees.

Enacted through HB 1086; signed by the Governor on May 10, 2021

This bill amended the section pertaining to the state Medicaid law to require the review and adjustment of payment rules so that payment rules:

• Allow professionals to operate within their full scope of practice
• Allow medically necessary behavioral health services and primary care services to be provided in any setting for covered individuals
• Rules and provider communication related to payment facilitate integration of physical and behavioral health services
• Are designed “liberally” to encourage innovation and transition to integrated models of payment and care
• Allow health and behavior codes to be reimbursed for all patients in primary care settings and behavioral health settings as provided by any licensed behavioral health professional or licensed health care provider operating within their scope of practice
• Allow the implementation of the following only when consistent with national coding conventions and best practices in the field:
  • Prior authorization for low level or routine behavioral health care,
  • Limits on same-day billing for providers using the same provider number, or
  • Prohibitions on payment when patient is not present

Additionally, the bill requires the state Medicaid agency to create and disseminate clear and understandable matrices that list codes available for provider payment through Medicaid.

Furthermore, for children eligible for Medicaid and identified as in need of mental health treatment, the bill requires the state Medicaid agency to oversee the coordination of resources and services through a managed health care system or tribal organization providing health care services. These managed health care systems and behavioral health organizations must:

• Develop and maintain adequate capacity to facilitate mental health treatment services or transfers to behavioral health organizations
• Follow up with individuals to ensure that appointments are secured
• Coordinate with and report back to primary care provider offices on treatment plans and medication management
• Provide information to health plan members and primary care providers about 24/7 behavioral health resource line
• Make available to health plan members and primary care providers an accurate list of contracted children and youth mental health service providers and their availability to provide services

Finally, the bill requires the state Medicaid agency to include in established reports to the appropriate legislative committee the number of children’s health providers available in the year prior, the languages spoken by the providers, and the providers actively accepting patients.

This bill changed the state public assistance law so that Medicaid plans will cover universal autism screening in children according to the Bright Futures Guidelines.

Persons eligible for medical care services benefits are eligible for mental health services to the extent that they meet the client definitions and priorities established by chapter 71.24 RCW.

Amended by Wa. HB 2082.