HB 1515 — Concerning contracting and procurement requirements for behavioral health services in medical assistance programs.

H-1310.1H-0601.1 SUBSTITUTE HOUSE BILL 1515 State of Washington 68th Legislature 2023 Regular Session By House Health Care & Wellness (originally sponsored by Representatives Macri, Davis, Simmons, Orwall, Taylor, Leavitt, Riccelli, Callan, Farivar, Alvarado, Reed, Fosse, Doglio, Berg, Ryu, Peterson, Fitzgibbon, Bateman, Eslick, Ormsby, Stonier, and Tharinger)Tharinger READRead FIRSTfirst TIMEtime 02/16/23.01/23/23.

Referred to Committee on Health Care & Wellness.

amending RCW 74.09.87174.09.871; and 71.24.861;

(a) Medicaid enrollees in Washington arelack challengedsufficient withaccess accessingto needed behavioral health care.

1 SHBHB 1515 (b) As of December 2022, 1,953,153 Washington residents rely on apple health managed care organizations to provide for their physical and behavioral health needs.

The health care authority has begun consideringplanning when to conductopen a new procurement for managed care organizations, including an allowance for possible new entrants that do not currently serve Washington's medicaid population.

(c) Medicaid managed care procurement presents a need and an opportunity for the state to reset expectations for managed care organizations related to behavioral health services to ensureassure that Washington residents are being served by qualified and experienced health plans that can deliver on the access to care and quality of care that residents need and deserve.

to ensureassure that managed care organizations that serve Washington's medicaid enrollees have a track record of success in delivering a broad range of behavioral health care services to safety net populations;

2 SHBHB 1515 (b) Standards regarding the quality of services to be provided, including increased use of evidence-based, research-based, and promising practices, as defined in RCW 71.24.025;

(2) AtBefore least six months prior to releasing a medicaidprocurement integratedunder managedthis caresection, procurement,and but no later than JanuaryJuly 1, 2025,2024, the authority shall adopt regional standards p.

3 SHBHB 1515 authority shall adopt standards for the behavioral health provider networks maintained by managed care organizations pursuant to subsection (1)(d) of this section.

The standards shall ensureassure access to appropriate and timely behavioral health services for the enrollees of the managed care organization within the regional service area.

At a minimum, thesethe standards must address each behavioral health services type covered by thethese medicaidstandards integratedmust managedinclude: care contract.

ThisCertified includes,residential buttreatment isproviders; not limited to:

Outpatient,licensed inpatient,community and residential levels of care for adults and youth with a mental health disorder;agencies;

outpatient,certified inpatient, and residential levels of care for adults and youth with a substance use disorder;disorder provider agencies;

crisiscertified andmedication stabilizationassisted services;treatment providers;

providerscertified ofopiate medicationsubstitution forproviders; opioid use disorders;

specialtylicensed care;and certified free-standing facilities, hospitals, or psychiatric inpatient facilities that provide evaluation and treatment services;

facility-basedlicensed services;and certified withdrawal management and stabilization facilities, including secure withdrawal management and stabilization facilities;

licensed and othercertified providersresidential astreatment determinedfacilities byto theprovide authoritycrisis throughstabilization thisservices; process.

Theand authoritywraparound shall apply the standards regionally and shallintensive incorporateservices behavioralproviders healthrecognized systemby needsthe andauthority. considerations as follows:

The regional standards shall:

an assessment of the needs or gaps in the region;

and (d) Include a structure for monitoring compliance with provider network standardsstandards. and timely access to the services;

(e)(3) ConsiderBefore howreleasing statewidea services,procurement suchunder asthis residentialsection, treatmentthe facilities,authority areshall utilizedevaluate cross-regionally;the potential to reduce provider administrative burden by limiting the number of managed care organizations that operate in a regional service area.

and(4) (f)The Considerfollowing howfactors themust standardsbe wouldgiven impactsignificant requirementsweight forin behavioralany healthprocurement administrativeprocess serviceunder organizations.this section:

(3) Before releasing a medicaid integrated managed care procurement, the authority shall identify options that would minimize provider administrative burden, including the potential to limit the number of managed care organizations that operate in a regional service area.

p.

4 SHB 1515 (4) The following factors must be given significant weight in any medicaid integrated managed care procurement process under this section:

(b)p. Demonstrated commitment and experience serving persons who have mental illness, substance use disorders, or co-occurring disorders;

4 HB 1515 (b) Demonstrated commitment and experience serving persons who have mental illness, substance use disorders, or co-occurring disorders;

and (i) Demonstrated priorcommitment nationalby ormanaged in-statecare experienceorganizations withto the use of alternative pricing and payment structures between a fullmanaged continuumcare oforganization and its behavioral health services thatproviders, areincluding substantiallyprovider similarnetworks todescribed thein behavioral(h) healthof servicesthis coveredsubsection, underin theany Washingtonof medicaidtheir stateagreements plan,or includingcontracts evidenceunder throughthis pastsection, andwhich currentmay datainclude onbut performance,are quality,not andlimited outcomes;to:

and(i) p.Value-based purchasing efforts consistent with the authority's value-based purchasing road map, such as capitated payment arrangements or case rate arrangements;

5 SHB 1515 (j) Demonstrated commitment by managed care organizations to the use of alternative pricing and payment structures between a managed care organization and its behavioral health services providers, including provider networks described in (h) of this subsection, and between a managed care organization and a behavioral administrative service organization, in any of their agreements or contractsp. under this section, which may include but are not limited to:

(i)5 Value-basedHB purchasing1515 efforts(ii) consistentPayment withmethods that secure a sufficient amount of ready and available capacity for levels of care that require staffing 24 hours per day, 365 days per year, to serve anyone in the authority'sregional value-basedservice purchasingarea strategy,with sucha asdemonstrated capitatedneed paymentfor arrangements,the comprehensiveservice population-basedat paymentall arrangements,times, orregardless caseof ratefluctuating arrangements;utilization.

or (ii) Payment methods that secure a sufficient amount of ready and available capacity for levels of care that require staffing 24 hours per day, 365 days per year, to serve anyone in the regional service area with a demonstrated need for the service at all times, regardless of fluctuating utilization.

(6) The authority shall recognizerequire andeach supportmanaged care organization participating in a delegationprocurement arrangementprocess betweenunder anythis managedsection careto organizationdemonstrate andprior anational provideror networkin-state underexperience subsectionwith (4)(h)contracting ofand thisnetwork sectiondevelopment for thea performancefull continuum of anybehavioral orhealth allservices essentialthat are substantially similar to the behavioral health administrativeservices functionscovered agreedunder tothe byWashington themedicaid twostate parties.plan.

(7)At Thea authorityminimum, this shall expandinclude theexperience typescontracting offor behavioralcrisis, healthoutpatient, crisisresidential, serviceswithdrawal thatmanagement, canand beinpatient fundedbehavioral withhealth medicaidservices, toand theshall maximuminclude extentpast allowableand undercurrent federaldata law,on includingperformance, seekingquality, approval from the centers for medicare and medicaidoutcomes. services for amendments to the medicaid state plan or medicaid state directed payments that support the 24 hours per day, 365 days per year capacity of the crisis delivery system when necessary to achieve this expansion.

(8)(7) The authority shall developrecognize contractingand methodssupport thata increasedelegation arrangement between any managed care organizations'organization accountabilityand whena theirprovider enrolleesnetwork requireunder long-termsubsection involuntary(4)(h) inpatientof behavioralthis healthsection treatmentfor andthe shallperformance exploreof opportunitiesany toor maximizeall medicaidessential fundingbehavioral ashealth appropriate.administrative functions agreed to by the two parties.