SB 6312 addresses a variety of issues related to the purchase and provision of mental health and chemical dependency treatment services. Among other things, the bill:
Adds to the responsibilities of the task force, established to address issues related to the adult behavioral health system, the requirement to make recommendations regarding how services are purchased through DSHS; guidance for the creation of common regional service areas for purchasing behavioral health and medical care services; the design and requirements of future Medicaid behavioral health and health care delivery systems and purchasing; and state interactions with the federal centers for Medicare and Medicaid services related to the State’s method of purchasing Medicaid mental health services.
Directs DSHS and the Health Care Authority to jointly establish regional service areas by Sept. 1, 2014.
Identifies stipulations that must be included in agreements or contracts by DSHS or the Health Care Authority for the provision of behavioral health services.
Includes language assuring that any regional support network (or county community mental health program provides medically necessary services to Medicaid recipients consistent with the state’s Medicaid state plan or federal waiver authorities, and Non-Medicaid services consistent with priorities established by DSHS.
Allows the secretary of DSHS to use resources to incentivize improved performance with respect to client outcomes, integration of behavioral health and primary care services at the clinical level, and improved care coordination for individuals with complex care needs.
Allows the boundaries for the regional service areas to be consistent with those of the regional support networks.
Changes made by the Human Services and Corrections Committee: The dates by which DSHS and HCA must jointly establish regional services areas and the date by which WSAC must submit a proposal for regional service areas are extended. Language requiring WSAC to propose no more than nine regional service areas is deleted. The starting date for the Behavioral Health Task Force is extended to April 1, 2014, and certain reporting dates are extended. The taskforce must study whether a statewide ombuds office should be created and need only provide recommendations concerning negotiations with CMS if CMS provides written guidance to Washington concerning its rationale for changing state purchasing.
As amended in Senate Ways and Means: The authority for DSHS and HCA to establish new regional service areas for managed care and behavioral health service contracting is contingent on a positive recommendation to do so by the Adult Behavioral Health System Task Force.
As amended on the House Floor: The amendment specifies that the Adult Behavioral Health Task Force must consider incentives for behavioral health care providers, in addition to physical health care providers, to use community resources to reduce utilization of the criminal justice system. It also specifies that behavioral health and recovery organization contracts with Medicaid managed care systems must promote access, rather than provide access, to certified chemical dependency professionals and mental health professionals, as determined by the Department of Social and Health Services in rule.
The amendment also limits the flexibility of behavioral health and recovery organizations to design their mix of services to require that they include coverage of services funded by Medicaid and prohibits an entity from operating a behavioral health services organization without a contract, in addition to the prohibition on operating an organization without a certification or license.
Another amendment directs the Department of Social and Health Services and the Health Care Authority to develop a plan to provide integrated managed health and mental health care for foster children enrolled in Medicaid. It requires the plan to address the necessary steps to implement and operate an integrated program for foster children. The amendment requires the plan to meet the requirements for providing mental health services to children under the T.R. v. Dreyfus and Porter settlement and requires the plan to be submitted to the Legislature by December 1, 2014.
Final Bill: As amended by the House, and passed by the legislature, the bill does the following:
- Changes the name of regional support networks (RSN) to “behavioral health organizations” (BHO).
- Adds four more legislators to the Adult Behavioral Health Systems Task Force (Task Force) to serve as alternates. Adds stakeholder participants from Department of Commerce, chemical dependency advocates, and chemical dependency experts from drug courts.
- Eliminates the requirement that the Task Force make recommendations on the design of the future Medicaid behavioral health and health care delivery and purchasing system and interactions with the federal government.
- Adds to the Task Force’s requirements that it provide recommendations related to the means by which services are purchased and delivered for adults with mental illness and chemical dependency, including guidance for creating common regional service areas, key issues for accomplishing integration of chemical dependency into managed care contracts by April 1, 2016, strategies to move toward full integration of medical and behavioral health services by January 1, 2020, review of Department of Social and Health Services (DSHS) and Health Care Authority (HCA) performance measures and outcomes, review of criteria for detailed plans to become a BHO, the creation of a statewide behavioral health ombuds office, the services offered by the state chemical dependency program, obstacles to sharing health care information, and the extent to which there are variations in commitment rates in different jurisdictions. Requires a preliminary report of the Task Force by December 15, 2014, and a final report by December 15,2015.
- Requires DSHS and HCA to create regional service areas.
- Adds to the contract provisions for behavioral health services that medically necessary chemical dependency treatment services be available to clients.
- Directs DSHS to purchase mental health and chemical dependency services primarily through managed care contracting.
- Directs DSHS to request a detailed plan from counties, groups of counties, or private entities currently serving as a regional support network as to how they are able to provide behavioral health services within a regional service area.
- Allows counties to jointly purchase behavioral health services through an integrated medical and behavioral health services contract.
- Counties which adopt full integration by January 1, 2016,may receive an incentive payment equal to 10 percent of savings realized by the state within the regional service area.
- Requires DSHS and HCA chemical dependency programs to include withdrawal management.
- Allows the program to include peer support, supported housing, supported employment, crisis diversion, or recovery support services.
- Requires DSHS to purchase chemical dependency services primarily through managed care contracts, exempting the criminal justice treatment account, by April 1, 2016.
- Requires by April 1, 2016, that managed health care systems for Medicaid enrollees have contracts to provide access to primary care services integrated into behavioral health settings for clients with medical and behavioral health comorbidities.
- Requires DSHS and HCA to report to the Legislature and the Governor by December 1, 2018, as to the preparedness of each regional service area to provide mental health, chemical dependency, and physical health services to Medicaid clients under a fully integrated managed health care system.
- Requires that the community behavioral health program be fully integrated in a managed care health care system for mental health, chemical dependency, and physical health care by January 1, 2020.
- Allows a regional support network or BHO to establish reasonable limitations on the administrative costs charged by agencies that contract with the RSN or BHO.
- Allows the release of records of persons confined in jail to the Washington State Institute for Public Policy, DSHS, HCA, higher education institutions of Washington state, State Auditor’s Office, Caseload Forecast Council, or Office of Financial Management for the purpose of research in the public interest.
- Exempts hospitals from certificate of need requirements during fiscal year 2015 if they are changing the use of licensed beds to increase the number of beds to provide psychiatric services, including involuntary treatment services.
- Allows certified chemical dependency professionals and certified chemical dependency professional trainees who also hold a license to practice another specified health care profession to treat patients in settings other than programs approved by DSHS.
- Directs DSHS and HCA to develop a plan to provide integrated managed health and mental health care for foster children enrolled in Medicaid.
- Requires the plan to address the necessary steps to implement and operate an integrated program for foster children.
- Requires the plan to meet the requirements for providing mental health services to children under the T.R. v. Dreyfus and Porter settlement.
- Requires the plan to be submitted to the Legislature by December 1, 2014.
- Prohibits DSHS and HCA from releasing any public reports of client outcomes unless the data have been deidentified and aggregated so that client identities cannot be determined. Requires DSHS, HCA, and service contracting entities to establish record retention schedules for maintaining performance measure and outcome data reported by service contracting entities.
- Terminology in chapter 70.96A RCW is updated, including replacement of the terms “alcoholic” and “drug addict” with “person with a substance use disorder.”
- Makes technical and terminology corrections.
