Presented by The Kennedy Forum Scattergood Foundation

Menu Close

Legislation Signed into Law

2017-2018

SB 5779
Introduced: 2/2017
Sponsor: Brown and O’Ban
Status: Signed into law 5/2017
Summary:
This bill amended the section pertaining to the state Medicaid law to require the review and adjustment of payment rules so that payment rules:

  • Allow professionals to operate within their full scope of practice
  • Allow medically necessary behavioral health services and primary care services to be provided in any setting for covered individuals
  • Rules and provider communication related to payment facilitate integration of physical and behavioral health services
  • Are designed “liberally” to encourage innovation and transition to integrated models of payment and care
  • Allow health and behavior codes to be reimbursed for all patients in primary care settings and behavioral health settings as provided by any licensed behavioral health professional or licensed health care provider operating within their scope of practice
  • Allow the implementation of the following only when consistent with national coding conventions and best practices in the field:
    • Prior authorization for low level or routine behavioral health care,
    • Limits on same-day billing for providers using the same provider number, or
    • Prohibitions on payment when patient is not present

Additionally, the bill requires the state Medicaid agency to create and disseminate clear and understandable matrices that list codes available for provider payment through Medicaid.

Furthermore, for children eligible for Medicaid and identified as in need of mental health treatment, the bill requires the state Medicaid agency to oversee the coordination of resources and services through a managed health care system or tribal organization providing health care services. These managed health care systems and behavioral health organizations must:

  • Develop and maintain adequate capacity to facilitate mental health treatment services or transfers to behavioral health organizations
  • Follow up with individuals to ensure that appointments are secured
  • Coordinate with and report back to primary care provider offices on treatment plans and medication management
  • Provide information to health plan members and primary care providers about 24/7 behavioral health resource line
  • Make available to health plan members and primary care providers an accurate list of contracted children and youth mental health service providers and their availability to provide services

Finally, the bill requires the state Medicaid agency to include in established reports to the appropriate legislative committee the number of children’s health providers available in the year prior, the languages spoken by the providers, and the providers actively accepting patients.

2015-2016

SB 5317/HB 1365
Introduced: 1/2015
Sponsor: Many sponsors (listed near the top of page on hyperlinks)
Status: Signed into law 6/2015
Summary: This bill changed the state public assistance law so that Medicaid plans will cover universal autism screening in children according to the Bright Futures Guidelines.

2011

Primary Focus: Parity: General
Title/Description: Medical care services benefits — Mental health services
Citation: Rev. Code Wash. § 74.04.230
Summary: Persons eligible for medical care services benefits are eligible for mental health services to the extent that they meet the client definitions and priorities established by chapter 71.24 RCW.
Effective Date: June 15, 2011
Notes: Amended by Wa. HB 2082.

Washington Parity Law

There are multiple sections of the state insurance law relevant to parity for mental health coverage and substance use disorder coverage. Some of these sections are virtually identical and have no meaningful differences. For the sake of simplicity, they will all be listed and hyperlinked here, and summarized below in the “Mental Health Coverage” and “Substance Use Disorder Coverage” sections. Any other sections relevant
to parity are linked within the summaries below.

Identical mental health Sections: 41.05.600; 48.20.580; 48.21.241; 48.44.341; 48.46.291; 48.41.220; 70.47.200

Identical substance use disorder sections: 48.21.180; 48.44.240; 48.46.350

This section authorizes the Washington State Office of the Insurance Commissioner to issue regulations regarding the sections of the insurance law relevant to parity.

Mental Health Coverage

These sections (links are above) require individual plans, small employer fully-insured plans, large employer fully-insured, public employee plans, plans offered by the Washington State Health Insurance Pool, and the Washington Basic Health Plan (currently not active) to cover all mental health services in the DSM with the exception of V codes and substance use disorders (other sections do require coverage for substance use disorders; these sections are summarized below).

These sections require the following of plans:

  • Copayments and coinsurance must be the same for mental health services as what they are for other medical services
  • Patients’ out-of-pocket costs for mental health services and other medical services must all go towards the same deductible
  • Mental health services and other medical services must go towards the same out-of-pocket stop loss amount
  • Treatment limitations and any other financial requirements not listed above must be the same for mental health services as they are for other medical services
  • Prescription medication benefits for mental health treatment must be on “the same terms and conditions” as prescription medications for other medical treatment

Plans are allowed to use managed care, and there is no language saying that it must applied the same for mental health services as it is for other medical services.

Plans are exempted from covering residential treatment.

There is a section of the law and another identical section that forbid plans from requiring prior authorization for inpatient care if the patient is involuntarily committed.

Substance Use Disorder Coverage

These sections of the law (linked above) require plans to cover services for substance use disorders as long as the services are part of an “approved treatment plan.” Approved treatment plan is defined as a “discrete program of chemical dependency treatment provided by a treatment program certified by the department of social and health services.”

Get Support

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

Term Name


View in Glossary