wa-law.org > bill > 2025-26 > HB 1813 > Second Substitute
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The authority, in consultation with the office of the insurance commissioner, shall conduct a review of service delivery models within each behavioral health administrative services organization region, including mobile crisis response, facility-based crisis stabilization services, and other crisis services.
When new programs or facilities including, but not limited to, those programs and facilities described in RCW 71.24.045(1)(e) are established or existing services are expanded in a region, the authority shall direct the state's medicaid actuaries to promptly adjust the region's medicaid rates to include a programmatic adjustment related to the new or expanded service. The state contract with the relevant behavioral health administrative services organization must be promptly adjusted to reflect the projected increase or decrease in service capacity. Adjustments must be based on the operational costs of the new or expanded facility or program, including staffing and resources required to support the delivery of services and the projected number of individuals served, assuring that both medicaid and nonmedicaid populations are served effectively.
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Within existing funds, the authority shall prepare for the reprocurement of services to enrollees of medical assistance programs authorized under this chapter, including by providing the opportunity for comment by key stakeholders, to the extent allowed by applicable state and federal procurement standards, including tribes, patient groups, health care providers and facilities, counties, and behavioral health administrative services organizations. Preparation for the reprocurement of services must be completed within existing resources by January 1, 2026, and include:
The full participation and inclusion of the interests of tribes, tribal health care providers, and urban Indian health care providers in the contract development process to assure that there is no disruption to the tribal health care delivery system and that opportunities to promote the health of American Indians are considered;
Contract standards to maximize care coordination between the managed care organizations and the behavioral health administrative services organizations;
The most effective methodologies for measuring network access and adequacy for each provider type subject to network access and adequacy standards and tailored to the particular needs of the regional service areas, to be implemented in the reprocurement to assure access to appropriate and timely behavioral health services in each region;
The optimal number of managed care organizations for each regional service area;
Appropriate outcome measures for inclusion in managed care contracts;
Timelines for new contracts to be executed and each step in the procurement process to reach the finalization of the new contracts;
Provisions for best practices regarding contract revisions and future reprocurement timelines;
Opportunities to amend managed care contract requirements to further streamline and standardize processes to reduce administrative burden for providers; and
ix. Exploration of contracting directly with behavioral health administrative services organizations, rather than managed care organizations, for the crisis services described in RCW 71.24.380(3)(b).
(1) The behavioral health administrative services organization contracted with the authority pursuant to RCW 71.24.381 shall:
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.
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.
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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.
The authority shall direct managed care organizations to establish, continue, or expand delegation arrangements with behavioral health administrative services organizations for crisis services for medicaid enrollees, including crisis phone interventions, mobile crisis teams, peer support services in crisis settings, and crisis stabilization services to include crisis stabilization facilities, in-home crisis stabilization services, and crisis relief centers. The authority shall direct managed care organizations to permit and enable behavioral health administrative services organizations to submit costs to managed care organizations for reimbursement for services delivered in crisis facilities in connection with behavioral health care.
The authority must contract with the department of commerce for the provision of behavioral health consumer advocacy services delivered to individuals enrolled in a managed care organization by the advocacy organization selected by the state office of behavioral health consumer advocacy established in RCW 71.40.030. The contract shall require the authority to reimburse the department of commerce for the behavioral health consumer advocacy services delivered to individuals enrolled in a managed care organization.
Managed care organizations and behavioral health administrative services organizations must collaborate with the authority 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.
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.
If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2025, in the omnibus appropriations act, this act is null and void.