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.
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.
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.
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.”
Content Disclaimer: Parity Track is a collaborative forum that works to aggregate and elevate the parity implementation work taking place across the country. The content of this website is always evolving. If you are aware of other parity-related work that is not represented on this website, please contact us so that we can continue to improve this website.