Washington Code 71.24.380 – Purchase of behavioral health services — Contracting — Requirements
Current as of: 2023 | Check for updates
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(1) The director shall purchase behavioral health services primarily through managed care contracting, but may continue to purchase behavioral health services directly from providers serving medicaid clients who are not enrolled in a managed care organization.
Terms Used In Washington Code 71.24.380
- Authority: means the Washington state health care authority. See Washington Code 71.24.025
- Behavioral health administrative services organization: means an entity contracted with the authority to administer behavioral health services and programs under RCW 71. See Washington Code 71.24.025
- Behavioral health services: means mental health services, substance use disorder treatment services, and co-occurring disorder treatment services as described in this chapter and chapter 71. See Washington Code 71.24.025
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the department of health. See Washington Code 71.24.025
- Director: means the director of the authority. See Washington Code 71.24.025
- Early adopter: means a regional service area for which all of the county authorities have requested that the authority purchase medical and behavioral health services through a managed care health system as defined under RCW 71. See Washington Code 71.24.025
- Managed care organization: means an organization, having a certificate of authority or certificate of registration from the office of the insurance commissioner, that contracts with the authority under a comprehensive risk contract to provide prepaid health care services to enrollees under the authority's managed care programs under chapter 74. See Washington Code 71.24.025
(2) The director shall require that contracted managed care organizations have a sufficient network of providers to provide adequate access to behavioral health services for residents of the regional service area that meet eligibility criteria for services, and for maintenance of quality assurance processes. Contracts with managed care organizations must comply with all federal medicaid and state law requirements related to managed health care contracting, including RCW 74.09.522.
(3) A managed care organization must contract with the authority‘s selected behavioral health administrative services organization for the assigned regional service area for the administration of crisis services. The contract shall require the managed care organization to reimburse the behavioral health administrative services organization for behavioral health crisis services delivered to individuals enrolled in the managed care organization.
(4) The authority must contract with the department of commerce for the provision of behavioral health consumer advocacy services delivered to individuals enrolled in a managed care organization by the advocacy organization selected by the state office of behavioral health consumer advocacy established in RCW 71.40.030. The contract shall require the authority to reimburse the department of commerce for the behavioral health consumer advocacy services delivered to individuals enrolled in a managed care organization.
(5) A managed care organization must collaborate with the authority and its contracted behavioral health administrative services organization to develop and implement strategies to coordinate care with tribes and community behavioral health providers for individuals with a history of frequent crisis system utilization.
(6) A managed care organization must work closely with designated crisis responders, behavioral health administrative services organizations, and behavioral health providers to maximize appropriate placement of persons into community services, ensuring the client receives the least restrictive level of care appropriate for their condition. Additionally, the managed care organization shall work with the authority to expedite the enrollment or reenrollment of eligible persons leaving state or local correctional facilities and institutions for mental diseases.
(7) As an incentive to county authorities to become early adopters of fully integrated purchasing of medical and behavioral health services, the standards adopted by the authority shall provide for an incentive payment to counties which elect to move to full integration by January 1, 2016. Subject to federal approval, the incentive payment shall be targeted at ten percent of savings realized by the state within the regional service area in which the fully integrated purchasing takes place. Savings shall be calculated in alignment with the outcome and performance measures established in RCW 71.24.435, 70.320.020, and 71.36.025, and incentive payments for early adopter counties shall be made available for up to a six-year period, or until full integration of medical and behavioral health services is accomplished statewide, whichever comes sooner, according to rules to be developed by the authority.
NOTES:
Effective date—2021 c 202 §§ 15-17: See note following RCW 71.24.045.
Effective date—2019 c 325: See note following RCW 71.24.011.
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.