SB 5779 requires the Health Care Authority (HCA) to review payment codes related to behavioral health by August 1, 2017, and adjust payment rules to facilitate integration of behavioral health into primary care. It also requires HCA to communicate with health care providers to increase awareness of behavioral health reimbursement options, standardize billing practices, and reduce billing errors. Additionally, the authority and department are directed to establish a performance measure to be integrated into the statewide common measure set which tracks effective integration practices of behavioral health services in primary care settings. And subject to appropriation, it requires HCA to provide increased reimbursement for behavioral health services provided to patients up to 18 years of age in primary care settings.
EFFECT OF CHANGES MADE BY HUMAN SERVICES, MENTAL HEALTH & HOUSING COMMITTEE (First Substitute): Expands requirement for HCA to provide increased reimbursement to health care providers for behavioral health services provided in primary care settings to all patients, not just patients 18 years old and under. The substitute bill also changes the term Osteopath to Osteopathic Physician.
Amendments in House Appropriations:
-Requires the Health Care Authority (HCA), until June 30, 2020, to: (1) Oversee the coordination of mental health resources and services for Medicaid-eligible children to ensure children receive treatment and appropriate care based on their assessed needs, regardless of whether the referral occurred through primary care, school-based services, or another practitioner; (2) Require each managed care organization and behavioral health organization to develop and maintain adequate capacity to facilitate children’s mental health treatment services in the community or transfers to a behavioral health organization; and (3) Report to the Legislature on the number of children’s mental health providers available in the previous year, the languages spoken by those providers, and the overall percentage of children’s mental health providers who were actively accepting new patients.
-Requires managed care organizations and behavioral health organizations to: (1) follow up with individuals to ensure that an appointment has been secured; (2) coordinate with and report back to the primary care provider on individual treatment plans and medication management; (3) provide information to health plan members and primary care providers about the behavioral health resource line; and (4) maintain an accurate list of providers contracted to provide mental health services to children and youth, which must contain current information regarding providers’ availability and must be made available to health plan members and primary care providers.
-Requires the HCA to report to the Legislature on the number of children’s mental health providers available in the previous year, the languages spoken by those providers, and the overall percentage of children’s mental health providers who were actively accepting new patients.
Adopted in Appropriations as Amended:
States legislative findings related to bidirectional integration, whole-person care in behavioral health, and access to primary care for individuals with complex behavioral health disorders. Requires the review of payment codes by the Health Care Authority (HCA) to include review of primary care codes, and requires adjustments to payment rules to facilitate bidirectional integration. Provides that payment rules should allow medically necessary primary care services to be provided in any setting and should allow health and behavior codes to be reimbursed in behavioral health settings as provided by any licensed health care provider acting within his or her scope of practice. Requires the HCA to develop a matrix of all physical health related codes available for provider payment when provided in licensed behavioral health agencies. Requires the HCA and the Department of Social and Health Services to establish a performance measure that tracks effective integration practices of primary care services in behavioral health settings. References “substance use disorder professionals” and “substance use disorder professional trainees” (instead of “chemical dependency professionals” and “chemical dependency professional trainees”) if ESHB 1340 is enacted. Defines “bidirectional integration” as integrating behavioral health services into primary care settings and integrating primary care services into behavioral health settings. Defines “whole-person care in behavioral health” as a health care integration model in which primary care services are integrated into a behavioral health setting either through colocation or community-based care management. Removes the provision naming the act the Youth Behavioral Health Protection Act.
