SB 5432: Concerning fully implementing behavioral health integration for January 1, 2020, by removing behavioral health organizations from law…

*Companion to HB 1393

 SB 5432 includes a number of statutory changes related to implementation of behavioral health integration, such as:

 ·         changes Behavioral Health Organization to Behavioral Health Administrative Services Organization (BH-ASOs) and/or Managed Care Organization;

·         changes mental health to behavioral health;

·         rewords Children’s Metal Health Contracting to be more consistent with current purchasing;

·         adds new language to address BH-ASOs and counties directly delivering services to increase transparency of contracting and funding of services;

·         changes language from mental health professional to designated crisis responder; and

·         de-codifies and repeals outdated language.

Amendments:

Updated on 4.12.19:

1^st substitute:

• Added specified stakeholders to the work group to determine how to manage access to long-term inpatient care and specifies that the access management is until such time as the risk may be fully integrated into MCO contracts, and that the work group must provide advice to guide the integration process.
• Prohibited HCA and the Department of Health from creating initial documentation requirements for patients receiving care in a behavioral health agency which are substantially more time-consuming to complete than initial documentation requirements in primary care settings.
• Required a county-run provider in a county operated BH-ASO to have a clear separation of powers and duties from the BH-ASO and suitable accounting procedures to ensure funding is traceable and accounted for separately from other funds.
• Required HCA to establish a separate rate for dual diagnosis enhanced co-occurring treatment services that is greater than the rate for mental health services alone and require MCOs to provide sufficient access to fully integrated co-occurring treatment services.

2^nd substitute:

• Removes requirement for the HCA to create a separate reimbursement rate for providing dual diagnosis enhanced co-occurring disorder treatment services that is higher than the rate for providing mental health services alone.
• Expands work group by adding community behavioral health providers, including providers with experience providing co-occurring disorder services, and requires the work group to study how to expand bidirectional integration through increased support for co-occurring disorder services, including recommendations related to purchasing and rates.
• Narrows prohibition for HCA or the Department of Health to provide initial documentation requirements for behavioral health patients that are more administratively burdensome than requirements for primary care patients by adding “unless such documentation is required by federal law or to receive federal funds.”

House (Updated on 4.12.19):

The amended bill:

• Adds to the Health Care Authority work group the topic of managing access to the Children’s Long-Term Inpatient Program in the community and state hospitals.
• The Authority work group is required to include at least two representatives from managed care organizations, one with financial expertise and one with clinical expertise.
• Managed care organizations on the work group must represent the entire managed care sector.
• Restores the behavioral health advisory boards to provide local oversight of the behavioral health administrative service organizations (BHASOs).
• The behavioral health advisory boards must be maintained by the BHASOs, rather than the behavioral health organizations.
• Removes the requirement that the network include co-occurring treatment from providers that offer fully integrated co-occurring treatment services from the managed care organization network adequacy requirements.
• Changes a reference to the juvenile rehabilitation facilities being under contract with the Department of Social and Health Services or the Juvenile Rehabilitation Administration to the Department of Children, Youth, and Families.
• Removes the requirement that the Director of the Office of Forensic Mental Health Services be at least at the level of a deputy assistant secretary.
• The Office is authorized to:

(1) “coordinate” forensic evaluation services, rather than have “operational control;”

(2) liaison with courts, jails, and community mental health programs to coordinate care and transitions to community services, rather than coordinate logistical issues and solve complex problems;

(3) participate in statewide forensic data collection, rather than overseeing it; and

4) provide recommendations based on data for system changes.

The authority of the Office to promote congruence across state hospitals and interventions that flow smoothly into community interventions is removed.