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HB 2720 - Behavioral health services ¶

Source

Section 1 ¶

The legislature finds that:
1. Behavioral health crisis services are cost-effective and reduce burdens on other emergency systems. According to the all payer claims database from 2022 through 2024, aggregate health plan claims payments for hospital emergency department visits where patients have primary mental health diagnoses cost far more than behavioral health crisis services;
2. Behavioral health crisis services which include, but are not limited to, mobile crisis response, crisis relief centers, and crisis stabilization units, provide customized care specific to behavioral health conditions that support people to recover as a more effective alternative to hospital emergency departments;
3. By giving first responders, family members, and people with behavioral health conditions a place to go and someone to respond in a crisis, behavioral health crisis services help people avoid overburdened emergency departments, inpatient hospitals, and jails;
4. Behavioral health crisis services should be available to all regardless of insurance status, residency, age, or diagnosis, similar to medical emergency services;
5. The substance abuse and mental health services administration recommends a comprehensive, 24/7, community-based crisis system that is funded under a firehouse model rather than through traditional insurance reimbursement;
6. RCW 48.43.093 requires health carriers to cover behavioral health emergency services for people enrolled in their health plans. Federal and state mental health parity laws require private health insurance to provide comparable coverage of medical and behavioral health emergency services;
7. Despite ongoing efforts from the office of the insurance commissioner, behavioral health administrative services organizations, behavioral health agencies, and health carriers to implement this coverage requirement, payments for behavioral health emergency services by private health plans remain limited. This is due in part to the challenges of obtaining health insurance information when a client is experiencing a behavioral health crisis or its aftermath and to the complexity of billing private health insurers given limited administrative capacity and billing expertise of behavioral health crisis providers. Due to these structural barriers, there are not clear and consistent systems for payments for behavioral health crisis services by health carriers as required by RCW 48.43.093. As a result, Washington state taxpayers have been subsidizing this care;
8. Behavioral health administrative services organizations are best positioned to administer and implement the array of community-based behavioral health crisis services that a region needs and its providers can deliver, within their limited available resources, given their role as regional behavioral health crisis services authorities under RCW 71.24.045;
  1. A streamlined payment mechanism is needed to sustain access to behavioral health crisis services and to ensure that private health insurers provide the financial contribution for these services that RCW 48.43.093 and mental health parity laws are intended to result in; and
9. Communities throughout Washington are seeking to expand access to behavioral health crisis care by establishing new facilities, often with state capital funding, but neither state funding nor private health insurance funding is sufficient to support services in these facilities. Too many have been unable to start providing services in their community.
The legislature intends to create a broad-based, ongoing, dedicated funding source for behavioral health crisis services provided to people that are not eligible for medicaid reimbursement, and for people who are not enrolled in medicaid.

Section 2 ¶

The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

"Adjustment factor" means the sum of inflation change and population change for the biennium during which an adjustment increase, as provided in section 3(7) of this act, is being calculated.
"Commissioner" means the insurance commissioner or his or her designee.
"Covered entity" means any entity insuring or administering health coverage to covered lives.
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1. "Covered lives" means all persons residing in Washington state who are enrolled in health coverage offered by the following entities:
  1. A health plan offered by a health carrier, as defined in RCW 48.43.005;
  2. A self-funded multiple employer welfare arrangement, as defined in RCW 48.125.010; and
  3. An employer-sponsored self-funded group plan or a Taft-Hartley trust plan.
2. "Covered lives" does not include lives enrolled in medicaid managed care organizations under contract with the health care authority.
"Health plan" has the same meaning as defined in RCW 48.43.005 but does not include medicare advantage plans established under medicare part C, outpatient prescription drug plans established under medicare part D, or federal employee health benefit plans.
"Inflation change" means the percentage change in the consumer price index for all urban consumers for the Seattle-Tacoma-Bellevue area, or successor index, as published by the federal bureau of labor statistics, for the biennium during which an adjustment increase, as provided in section 3(7) of this act, is being calculated.
"Population change" means the percentage change in state population as reported by the office of financial management for the biennium during which an adjustment increase, as provided in section 3(7) of this act, is being calculated.

Section 3 ¶

All covered entities shall pay an annual covered lives assessment beginning January 1, 2027.
The commissioner shall annually assess a per member per month assessment per covered life for covered entities. The per member per month assessment in calendar year 2027 shall be 58 cents per covered life. The assessment shall be updated every two years in accordance with the process established in subsection (7) of this section.
The commissioner shall annually notify, in writing, each covered entity of the total assessment and its payment obligation for the upcoming year. The commissioner shall determine a payment schedule for receipt of assessments under this section. Payment collections may be made no more frequently than quarterly.
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1. Covered entities shall provide the commissioner the information needed to calculate the covered entity's covered lives subject to the assessment in a form and manner determined by the commissioner.
2. The commissioner may contract with a third-party administrator to obtain information regarding each covered entity's covered lives and administer the collection of assessments under this section.
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1. Payments from covered entities are due to the commissioner within 45 days of the receipt of notice of their payment obligation determined under this section. The commissioner shall charge interest as detailed by RCW 43.17.240, which begins to accrue on the 46th day, on amounts received after the 45-day period.
2. The commissioner shall assess a civil penalty against any covered entity that fails to pay an assessment within 90 days of notification of the payment obligation under this section. The civil penalty under this subsection is 150 percent of such assessment. The commissioner is authorized to file liens and seek judgment to recover amounts in arrears and civil penalties, and recover reasonable collection costs, including reasonable attorneys' fees and costs.
3. The commissioner may allow each covered entity in arrears to submit a payment plan, subject to approval by the commissioner and initial payment under an approved payment plan.
The commissioner shall deposit annual assessments interest, and civil penalties collected under this section with the state treasurer to the credit of the behavioral health emergency services account created in section 4 of this act.
Each June of even numbered years, the commissioner shall calculate the assessment for the next two calendar years by increasing the current assessment by known changes in the adjustment factor, except that the increase shall not exceed 10 percent.

Section 4 ¶

The behavioral health emergency services account is created in the state treasury. All receipts from the assessments, interest, and penalties collected by the commissioner under section 3 of this act must be deposited into the account. Moneys in the account may be spent only after appropriation.
Expenditures from the account may be used only for:
1. Behavioral health emergency services administered through behavioral health administrative services organizations as defined in RCW 71.24.025 by the following behavioral health emergency services providers as defined in RCW 48.43.005:
  1. A crisis stabilization unit as defined in RCW 71.05.020;
  2. A 23-hour crisis relief center as defined in RCW 71.24.025;
  3. An agency certified by the department of health under chapter 71.24 RCW to provide outpatient crisis services; and
  4. A mobile rapid response crisis team as defined in RCW 71.24.025 that is contracted with a behavioral health administrative services organization operating under RCW 71.24.045 to provide crisis response services in the behavioral health administrative services organization's service area;
2. Administrative costs for the health care authority associated with implementation of this act; and
3. Disbursements to refund erroneous or excessive payments made by covered entities as determined by the commissioner.
Expenditures from the account are subject to the following limitations:
1. The account may not be used for reimbursement of services identified in subsection (2) of this section provided to individuals enrolled in medical assistance programs that include coverage for these services under Title XIX of the federal social security act or Title XXI of the federal social security act; and
2. The account may not be used for reimbursement of services identified in subsection (2) of this section that have been directly billed by a provider or on the provider's behalf and reimbursed by a covered entity or payer for the covered entity or payer's enrollee.

Section 5 ¶

The commissioner may adopt rules and undertake actions necessary to carry out section 3 of this act including, but not limited to, measures to enforce reporting of covered lives, audits of covered lives reporting, and payment of applicable assessments.

Section 6 ¶

The authority shall adopt rules and undertake actions necessary to ensure that behavioral health emergency services account funds appropriated to and expended by the authority are used in accordance with the conditions and limitations of chapter 48.--- RCW (the new chapter created in section 13 of this act).