RCW 71.24.380
Purchase of behavioral health services—Managed care contracting—Requirements. (Effective until October 1, 2022.)
(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.
(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) 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.
(5) 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.
(6) 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.
[ 2019 c 325 § 1022; 2018 c 201 § 4022; 2014 c 225 § 5.]
NOTES:
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.
(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.
(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) A managed care organization must contract with the contracting advocacy organization selected by the state office of behavioral health consumer advocacy established in RCW 71.40.030 for the provision of behavioral health consumer advocacy services delivered to individuals enrolled in the managed care organization. The contract shall require the managed care organization to reimburse the office of behavioral health consumer advocacy for behavioral health consumer advocacy services delivered to individuals enrolled in the 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.
[ 2021 c 202 § 16; 2019 c 325 § 1022; 2018 c 201 § 4022; 2014 c 225 § 5.]
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.
Structure Revised Code of Washington
Chapter 71.24 - Community Behavioral Health Services Act.
71.24.015 - Legislative intent—Community behavioral health system.
71.24.030 - Grants, purchasing of services, for community behavioral health programs.
71.24.035 - Director's powers and duties as state behavioral health authority.
71.24.045 - Behavioral health administrative services organization powers and duties.
71.24.062 - Psychiatry consultation line—Implementation.
71.24.063 - Partnership access lines—Psychiatric consultation lines—Data collection.
71.24.064 - Partnership access lines—Psychiatric consultation lines—Funding—Performance measures.
71.24.067 - Partnership access lines—Psychiatric consultation lines—Review.
71.24.068 - Telebehavioral health access account.
71.24.115 - Recovery navigator programs—Reports.
71.24.125 - Grant program—Treatment services—Regional access standards.
71.24.135 - Expanded recovery support services program—Regional expanded recovery plans.
71.24.160 - Proof as to uses made of state funds—Use of maintenance of effort funds.
71.24.200 - Expenditures of county funds subject to county fiscal laws.
71.24.215 - Sliding-scale fee schedules for clients receiving behavioral health services.
71.24.220 - State grants may be withheld for noncompliance with chapter or related rules.
71.24.250 - Behavioral health administrative services organizations—Receipt of gifts and grants.
71.24.260 - Waiver of postgraduate educational requirements—Mental health professionals.
71.24.350 - Behavioral health ombuds office.
71.24.370 - Behavioral health services contracts—Limitation on state liability.
71.24.380 - Purchase of behavioral health services—Managed care contracting—Requirements.
71.24.383 - Managed care organization contracting—Requirements.
71.24.400 - Streamlining delivery system—Finding.
71.24.405 - Streamlining delivery system.
71.24.415 - Streamlining delivery system—Authority duties to achieve outcomes.
71.24.430 - Coordination of services for behavioral health clients—Collaborative service delivery.
71.24.435 - Behavioral health system—Improvement strategy.
71.24.450 - Offenders with mental illnesses—Findings and intent.
71.24.455 - Offenders with mental illnesses—Contracts for specialized access and services.
71.24.460 - Offenders with mental illnesses—Report to legislature.
71.24.510 - Integrated comprehensive screening and assessment process—Implementation.
71.24.520 - Substance use disorder program authority.
71.24.525 - Agreements authorized under the interlocal cooperation act.
71.24.530 - Local funding and donative funding requirements—Facilities, plans, programs.
71.24.535 - Duties of authority.
71.24.545 - Comprehensive program for treatment—Regional facilities.
71.24.555 - Liquor taxes and profits—City and county eligibility conditioned.
71.24.560 - Opioid treatment programs—Pregnant individuals—Information and education.
71.24.565 - Acceptance for approved treatment—Rules.
71.24.570 - Emergency service patrol—Establishment—Rules.
71.24.575 - Criminal laws limitations.
71.24.580 - Criminal justice treatment account.
71.24.585 - Opioid and substance use disorder treatment—State response.
71.24.589 - Substance use disorders—Law enforcement assisted diversion—Pilot project.
71.24.594 - Opioid overdose reversal medications—Education—Distribution—Labeling—Liability.
71.24.597 - Opioid overdose reversal medication—Coordinated purchasing and distribution.
71.24.598 - Drug overdose response team.
71.24.599 - Opioid use disorder—City and county jails—Funding.
71.24.605 - Fetal alcohol screening and assessment services.
71.24.610 - Interagency agreement on fetal alcohol exposure programs.
71.24.615 - Chemical dependency treatment expenditures—Prioritization.
71.24.625 - Uniform application of chapter—Training for designated crisis responders.
71.24.640 - Standards for certification or licensure of evaluation and treatment facilities.
71.24.645 - Standards for certification or licensure of crisis stabilization units.
71.24.647 - Standards for certification or licensure of triage facilities.
71.24.649 - Standards for certification or licensure of mental health peer-run respite centers.
71.24.650 - Standards for certification or licensure of a clubhouse.
71.24.660 - Recovery residences—Referrals by licensed or certified service providers.
71.24.710 - Reentry services—Work group.
71.24.715 - Reentry services—Waiver application.
71.24.720 - Less restrictive alternative treatment—Transition teams.
71.24.850 - Regional service areas—Report—Managed care integration.
71.24.855 - Finding—Intent—State hospitals.
71.24.861 - Behavioral health system coordination committee.
71.24.870 - Behavioral health services—Adoption of rules—Audit.
71.24.885 - Medicaid rate increases—Review authority—Reporting.
71.24.893 - National 988 system—Crisis response improvement strategy steering committee.
71.24.894 - National 988 system—Department reporting—Audit.
71.24.896 - National 988 system—Duties owed to public—Independent contractors.
71.24.898 - National 988 system—Technical and operational plan.