wa-law.org > bill > 2025-26 > HB 1813 > Engrossed Second Substitute
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The authority, in consultation with the office of the insurance commissioner, the department of health, and relevant stakeholders, shall develop a base model of crisis service delivery that should exist in every region. The authority must include in the model the minimum number and type of crisis services, regardless of population size, and recommendations for how to scale the service delivery model for regions with larger populations.
The authority shall consult with the department of commerce and the department of health quarterly for all agencies to plan and prepare for new or expanded services in each regional service area, which must include, but are not limited to, incorporating regional capacity changes reported to the authority by managed care organizations, behavioral health administrative services organizations, providers, or provider networks. When programs or facilities including, but not limited to, those programs and facilities described in RCW 71.24.045(1)(e) are newly established or closed or existing services are expanded or reduced in a region:
The authority shall direct the state's medicaid contractor for actuarial services to promptly and prospectively adjust medicaid managed care rates to include a programmatic adjustment related to the new or expanded service prior to the facility opening or the service expansion, consistent with the rate-setting cycles directed by the authority. If a facility closes or services are reduced, managed care and fee-for-service rates must be adjusted accordingly in the rate-setting cycle following the facility closure; and
Subject to appropriations, the state contracted nonmedicaid budget and reserve maximum and minimum limits with each regional behavioral health administrative services organization must be promptly and prospectively adjusted to reflect the projected increase or decrease in service facilities and capacity. Adjustments must be based on the reasonable and appropriate 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 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 July 1, 2026, and include:
The full participation and inclusion of the interests of tribes and Indian health care providers in the contract development process to assure that there is no disruption to the Indian health care delivery system and that opportunities to promote the health of American Indians and Alaska Natives 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.
By January 1, 2026, 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 negotiate with behavioral health administrative services organizations on a structure to reimburse delegated network providers for medical services offered at crisis facilities.
Managed care organizations shall maintain standards of delegation consistent with their required national committee for quality assurance accreditation. If a managed care organization finds that a behavioral health administrative services organization is unable to meet delegation standards for certain facility-based crisis stabilization services, the authority, in partnership with the managed care organization, shall provide technical assistance for up to 12 months to the behavioral health administrative services organization to develop its ability to comply with the full scope of delegated services. If, upon conclusion of the technical assistance period, the behavioral health administrative services organization remains unable to comply with the delegation standards, the delegation shall be terminated and the responsibility for the provision of facility-based crisis stabilization services shall revert to the managed care organization.
Under managed care delegation arrangements, behavioral health administrative services organizations are subject to audits of their performance to assure the quality of services being provided to their enrollees. If, at any time, a behavioral health administrative services organization fails the audit, the managed care organization shall proceed with findings or corrective action plans according to their requirements as a national committee for quality assurance accreditation entity. The managed care organization shall notify the authority of these findings and corrective actions within 72 hours. The authority, in partnership with the managed care organization, shall provide technical assistance to behavioral health administrative services organizations to address any deficiencies identified in the audit.
Managed care organizations and behavioral health administrative services organizations shall collectively, and in contract, establish defined roles, responsibilities, and protocols for care coordination of managed care enrollees that have engagement with the crisis system of 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.