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HB 1502 - Behavioral health teaching

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Section 1

  1. The legislature finds that:

    1. Licensed or certified behavioral health agencies are the essential safety net providers for adults, children, youth, and families experiencing mental health or substance use disorders in Washington;

    2. In addition to providing clinical services and care coordination, licensed or certified behavioral health agencies serve as the training ground for students and new graduates pursuing behavioral health careers across sectors and settings, bearing the cost for the essential training and supervision infrastructure that sustains this crucial workforce development pipeline. Although there are other health care settings that are compensated for their interdisciplinary training and workforce development programs, including teaching hospitals and federally qualified health centers, the training role in community behavioral health is an unofficial and uncompensated one, resulting in significant costs related to supervising interns and new graduates when clinicians would otherwise be providing billable direct services to patients; and

    3. Competition among agencies for employing behavioral health care workers is heightened and accelerating, and the compensation gap between community behavioral health care providers and other practice settings continues to grow. Because licensed or certified behavioral health agencies serve primarily medicaid enrollees and are reliant on inadequate medicaid reimbursement rates, they are unable to offer competitive compensation packages to their employees and they experience high turnover and vacancy rates as their workforce often leaves for other settings offering higher compensation, lower caseloads, and a less complex patient population.

  2. The legislature intends to establish the behavioral health teaching clinic designation and enhancement rate to recognize and compensate licensed or certified behavioral health agencies, regardless of geographic location or tribal affiliation, for training the broader behavioral health workforce in cutting edge, critical behavioral health treatment modalities.

Section 2

  1. The director shall designate licensed or certified behavioral health agencies that meet the state minimum standards described in this section as behavioral health teaching clinics. To be eligible for designation as a behavioral health teaching clinic, a licensed or certified behavioral health agency must:

    1. Be a licensed or certified behavioral health agency in good standing with the department;

    2. Train interns, trainees, or both;

    3. Attest that its organizational admissions policies and procedures make the clinic equitable and inclusive to the populations that it serves;

    4. Bill services rendered to clients by an intern or trainee and receive reimbursement only in accordance with payors' and the behavioral health agency's billing structures;

    5. Compensate interns with, at a minimum, a stipend or honorarium in accordance with the teaching clinic payment structure as described in subsection (4)(a) of this section and when not prohibited by educational institutions;

    6. Provide interns and trainees with physical or virtual space and resources similar to that of nonteaching clinic eligible staff functioning in a similar role;

    7. Assign each intern or trainee to an appropriately credentialed supervisor;

    8. Provide, at a minimum, the equivalent of one hour per week of clinical supervision using the methods and deliveries determined by the professional licensure standards of the profession that the intern or trainee is pursuing;

      1. Require access to and oversight of an intern or trainee during the internship or training to be provided by an assigned supervisor who is employed or contracted by the teaching clinic, either in person or virtually;

    9. Attest to having an active contract or agreement with each intern's educational institution or program, which must either be accredited or in the process of becoming accredited;

    10. Attest to having formal orientation, training, and observation processes and describe how the program ensures that practice opportunities are provided to interns or trainees; and

    11. Use continuous quality improvement strategies in the operational practices, clinical practices, and strategic planning.

  2. Behavioral health teaching clinics designated under subsection (1) of this section must be reimbursed at an enhanced rate as described in subsection (4)(a) of this section.

  3. Designation as a behavioral health teaching clinic is effective for three years from the date of issuance of the designation.

  4. The authority shall collaborate with a statewide organization representing licensed or certified behavioral health agencies to establish a stakeholder group comprised of licensed or certified behavioral health agencies and shall contract with an actuarial firm to:

    1. Finalize the rate methodology for an enhanced rate for designated behavioral health teaching clinics that builds upon previous rate estimates, including the behavioral health teaching clinic designation and enhancement rate demonstration project stakeholder report, prepared by the Washington council for behavioral health, December 2024; and

    2. Develop a plan for incremental implementation of statewide designation of behavioral health teaching clinics by June 30, 2026.

  5. Within its government-to-government relationship, the authority shall consult with tribes and tribal government behavioral health agencies to assure impacts of the teaching clinic designation and enhanced rate methodology on tribal providers are well understood and able to be implemented in a tribal behavioral health agency.

  6. By June 30, 2027, the authority shall seek approval from the federal centers for medicare and medicaid services to secure federal financial participation in the costs of the enhancement rate for operating a behavioral health teaching clinic.

  7. The authority shall submit a progress report to the governor and the appropriate committees of the legislature by December 31, 2025, and a final report by December 31, 2026.

Section 3

  1. Upon submission of its training program to the department, the department shall deem a licensed or certified behavioral health agency that is a designated behavioral health teaching clinic under section 2 of this act to have met all statutory and regulatory behavioral health agency training requirements.

  2. The department, in consultation with the authority, licensed or certified behavioral health agencies, and statewide organizations representing licensed or certified behavioral health agencies, shall adopt rules to implement this section by June 30, 2026.

Section 4

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

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