HB 2247 — Addressing behavioral health provider shortages.

11 SHB 2247 (b) Licensed mental health counselor:

(II)p. Social and cultural diversity;

11 HB 2247 (II) Social and cultural diversity;

and p.(iv) Successful completion of continuing education requirements ((of 36 hours, with six)) established in rule by the secretary, including a minimum number of hours in professional ethics.

12 SHB 2247 (iv) Successful completion of continuing education requirements ((of 36 hours, with six)) established in rule by the secretary, including a minimum number of hours in professional ethics.

(i) Graduation from a master's degree or doctoral degree educational program in marriage and family therapy or graduation from an educational program in an allied field equivalent to a master's degreep. or doctoral degree in marriage and family therapy approved by the secretary based upon nationally recognized standards;

12 HB 2247 degree or doctoral degree in marriage and family therapy approved by the secretary based upon nationally recognized standards;

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13 SHB 2247 Sec.

(1) The secretary shall issue an associate license to any applicant who demonstrates to the satisfaction of the secretary that the applicant meets the following requirements for the applicant's practicep. area and submits a declaration that the applicant is working toward full licensure in that category:

(a)13 LicensedHB social2247 workerpractice associatearea —advancedand orsubmits licenseda socialdeclaration workerthat associate—the independentapplicant clinical:is working toward full licensure in that category:

(a) Licensed social worker associate—advanced or licensed social worker associate—independent clinical:

BeginningAn October 1, 2025, an applicant for an associate license under this section may practicepractice, withoutfor aup licenseto under the direct supervision of an approved supervisor for 120 days after the department receives the applicant's completed applicationapplication, orunder the direct supervision of an approved supervisor until the applicant's license is issued or denied,denied. whichever is sooner.

(6)(a) ((Except as provided in (b) of this subsection, an)) An associate license may be renewed ((no more than six times)), provided that the applicant for renewal has successfully completed ((eighteen hours of)), in the preceding year, continuing education ((in the preceding year)) requirements established in rule by the secretary.

14 SHBHB 2247 (6)(a)Beginning ((Exceptwith asthe providedsecond renewal, ((at least six of)) the continuing education requirements established in (b)rule ofby thisthe subsection,secretary an))must Anrequire associatethe licenseapplicant mayto becomplete reneweda ((nominimum morenumber thanof sixcontinuing times,education providedhours that)).in the preceding two years ((must be)) in professional ethics.

Until October 1, 2025, the applicant for renewal ((has)) must have successfully completed eighteen hours of continuing education in the preceding year.

After October 1, 2025, the applicant for renewal must have successfully completed, in the preceding year, continuing education requirements established in rule by the secretary.

Beginning with the second renewal, ((at least six of)) the continuing education requirements established in rule by the secretary must require the applicant to complete a minimum number of continuing education hours in the preceding two years ((must be)) in professional ethics.

The department shall periodically audit the list to remove persons who, p.or facilities that, no longer meet the minimum qualifications or fail to meet the minimum standards.

15 SHB 2247 or facilities that, no longer meet the minimum qualifications or fail to meet the minimum standards.

(a)p. ((Out-of-pocket expenses eligible for defrayment under this section include costs incurred in order to obtain supervised experience, such as fees or charges imposed by the individual or entity providing supervision, and any other expenses deemed appropriate by the department.)) To be eligible for the stipend program under this subsection (2), a supervisor must:

15 HB 2247 (a) ((Out-of-pocket expenses eligible for defrayment under this section include costs incurred in order to obtain supervised experience, such as fees or charges imposed by the individual or entity providing supervision, and any other expenses deemed appropriate by the department.)) To be eligible for the stipend program under this subsection (2), a supervisor must:

and (ii) BeCharge activelyno providingmore supervisionthan to$150 atper leasthour oneto the associate completingreceiving supervisedsupervision, experienceup requirementsto undera RCWtotal 18.225.090.of $2,000 per year;

(b)and ((Associates))(iii) SupervisorsBe participatingactively inproviding thesupervision stipendto programat establishedleast inone thisassociate sectioncompleting shall document their ((out-of- pocket)) expenses attributable to each supervised associateexperience andrequirements time spent supervising each associate under theirRCW supervision18.225.090. in a manner specified by the department.

(c)(b) ((When((Associates)) adoptingSupervisors theparticipating stipendin program, the departmentstipend shallprogram considerestablished defrayingin out-of-pocketthis expensessection associatedshall withdocument unpaidtheir internships((out-of- thatpocket)) areexpenses, parttime ofspent ansupervising applicant'seach educationalassociate program.)) (i) Supervisors receiving a stipend under thistheir sectionsupervision, areand eligibleany forfees upthat to $2,000 per year per associate if the supervisorsupervisors maintainscharge the supervisoryassociate relationshipin fora themanner entirespecified yearby and subject to the availabilitydepartment. of funds.

(c) ((When adopting the stipend program, the department shall consider defraying out-of-pocket expenses associated with unpaid internships that are part of an applicant's educational program.)) Supervisors receiving a stipend under this section are eligible for up to $2,000 per year per associate if the supervisor maintains the supervisory relationship for the entire year and subject to the availability of funds.

(ii)(d) IfThe adepartment participatingshall supervisor'sestablish documented expenses attributable to a supervised associate exceed the stipend theprogram supervisorno receiveslater underthan (c)(i)July of1, this((2024)) subsection2025. for supervising that associate, the participating supervisor may charge the associate a fee to recoup the excess expenses attributable to that associate.

In no case may a fee charged to an individual associate under this subsection (2)(c)(ii) exceed $1,600.

The supervisor shall report any fees charged to the associate to the department.

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16 SHB 2247 (d) The department shall establish the stipend program no later than July 1, ((2024)) 2025.

NEW SECTION.

ARCW new48.43.045 sectionand is2015 addedc to237 chapters 71.052 RCWare each amended to read as follows:

For(1) theEvery purposeshealth ofplan thisdelivered, chapter,issued infor additiondelivery, toor therenewed definitionby ofa the term as defined in RCW 71.05.020, "mental health professional"carrier includeson aand licensedafter psychologicalJanuary associate1, as1996, describedshall: in chapter 18.83 RCW.

NEW(a) SECTION.Permit every category of health care provider to provide health services or care included in the basic essential health benefits benchmark plan established by the commissioner consistent with RCW 48.43.715, to the extent that:

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16 HB 2247 (i) The provision of such health services or care is within the health care providers' permitted scope of practice;

(ii) The providers agree to abide by standards related to:

(A) Provision, utilization review, and cost containment of health services;

(B) Management and administrative procedures;

and (C) Provision of cost-effective and clinically efficacious health services;

and (iii) The plan covers such services or care in the essential health benefits benchmark plan.

The reference to the essential health benefits does not create a mandate to cover a service that is otherwise not a covered benefit.

(b) Annually report the names and addresses of all officers, directors, or trustees of the health carrier during the preceding year, and the amount of wages, expense reimbursements, or other payments to such individuals, unless substantially similar information is filed with the commissioner or the national association of insurance commissioners.

This requirement does not apply to a foreign or alien insurer regulated under chapter 48.20 or 48.21 RCW that files a supplemental compensation exhibit in its annual statement as required by law.

(2) If a health plan's provider network includes participating providers licensed under chapter 18.83 or 18.225 RCW, the plan may not categorically exclude associate licensees under those chapters.

(3) The requirements of subsection (1)(a) of this section do not apply to a licensed health care profession regulated under Title 18 RCW when the licensing statute for the profession states that such requirements do not apply.

TheRCW health74.09.522 careand authority2023 shallc ensure51 thats all43 services provided by associate licenses under chapters 18.225 and 18.83 RCW are includedeach inamended theto stateread medicaidas program,follows: including filing any necessary state plan amendments by January 1, 2025.

(1) For the purposes of this section, "nonparticipating provider" means a person, health care provider, practitioner, facility, or entity, acting within their scope of practice, that does not have a written contract to participate in a managed care organization's provider network, but provides health care services to enrollees of programs authorized under this chapter or other applicable law whose health care services are provided by the managed care organization.

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17 HB 2247 (2) The authority shall enter into agreements with managed care organizations to provide health care services to recipients of medicaid under the following conditions:

(a) Agreements shall be made for at least thirty thousand recipients statewide;

(b) Agreements in at least one county shall include enrollment of all recipients of programs as allowed for in the approved state plan amendment or federal waiver for Washington state's medicaid program;

(c) To the extent that this provision is consistent with section 1903(m) of Title XIX of the federal social security act or federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act, recipients shall have a choice of systems in which to enroll and shall have the right to terminate their enrollment in a system:

PROVIDED, That the authority may limit recipient termination of enrollment without cause to the first month of a period of enrollment, which period shall not exceed twelve months:

AND PROVIDED FURTHER, That the authority shall not restrict a recipient's right to terminate enrollment in a system for good cause as established by the authority by rule;

(d) To the extent that this provision is consistent with section 1903(m) of Title XIX of the federal social security act, participating managed care organizations shall not enroll a disproportionate number of medical assistance recipients within the total numbers of persons served by the managed care organizations, except as authorized by the authority under federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act;

(e)(i) In negotiating with managed care organizations the authority shall adopt a uniform procedure to enter into contractual arrangements, including:

(A) Standards regarding the quality of services to be provided;

(B) The financial integrity of the responding system;

(C) Provider reimbursement methods that incentivize chronic care management within health homes, including comprehensive medication management services for patients with multiple chronic conditions consistent with the findings and goals established in RCW 74.09.5223;

(D) Provider reimbursement methods that reward health homes that, by using chronic care management, reduce emergency department and inpatient use;

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18 HB 2247 (E) Promoting provider participation in the program of training and technical assistance regarding care of people with chronic conditions described in RCW 43.70.533, including allocation of funds to support provider participation in the training, unless the managed care organization is an integrated health delivery system that has programs in place for chronic care management;

(F) Provider reimbursement methods within the medical billing processes that incentivize pharmacists or other qualified providers licensed in Washington state to provide comprehensive medication management services consistent with the findings and goals established in RCW 74.09.5223;

(G) Evaluation and reporting on the impact of comprehensive medication management services on patient clinical outcomes and total health care costs, including reductions in emergency department utilization, hospitalization, and drug costs;

and (H) Established consistent processes to incentivize integration of behavioral health services in the primary care setting, promoting care that is integrated, collaborative, colocated, and preventive.

(ii)(A) Health home services contracted for under this subsection may be prioritized to enrollees with complex, high cost, or multiple chronic conditions.

(B) Contracts that include the items in (e)(i)(C) through (G) of this subsection must not exceed the rates that would be paid in the absence of these provisions;

(f) The authority shall seek waivers from federal requirements as necessary to implement this chapter;

(g) The authority shall, wherever possible, enter into prepaid capitation contracts that include inpatient care.

However, if this is not possible or feasible, the authority may enter into prepaid capitation contracts that do not include inpatient care;

(h) The authority shall define those circumstances under which a managed care organization is responsible for out-of-plan services and assure that recipients shall not be charged for such services;

(i) Nothing in this section prevents the authority from entering into similar agreements for other groups of people eligible to receive services under this chapter;

and (j) The authority must consult with the federal center for medicare and medicaid innovation and seek funding opportunities to support health homes.

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19 HB 2247 (3) The authority shall ensure that publicly supported community health centers and providers in rural areas, who show serious intent and apparent capability to participate as managed care organizations are seriously considered as contractors.

The authority shall coordinate its managed care activities with activities under chapter 70.47 RCW.

(4) The authority shall work jointly with the state of Oregon and other states in this geographical region in order to develop recommendations to be presented to the appropriate federal agencies and the United States congress for improving health care of the poor, while controlling related costs.

(5) The legislature finds that competition in the managed health care marketplace is enhanced, in the long term, by the existence of a large number of managed care organization options for medicaid clients.

In a managed care delivery system, whose goal is to focus on prevention, primary care, and improved enrollee health status, continuity in care relationships is of substantial importance, and disruption to clients and health care providers should be minimized.

To help ensure these goals are met, the following principles shall guide the authority in its healthy options managed health care purchasing efforts:

(a) All managed care organizations should have an opportunity to contract with the authority to the extent that minimum contracting requirements defined by the authority are met, at payment rates that enable the authority to operate as far below appropriated spending levels as possible, consistent with the principles established in this section.

(b) Managed care organizations should compete for the award of contracts and assignment of medicaid beneficiaries who do not voluntarily select a contracting system, based upon:

(i) Demonstrated commitment to or experience in serving low- income populations;

(ii) Quality of services provided to enrollees;

(iii) Accessibility, including appropriate utilization, of services offered to enrollees;

(iv) Demonstrated capability to perform contracted services, including ability to supply an adequate provider network;

(v) Payment rates;

and (vi) The ability to meet other specifically defined contract requirements established by the authority, including consideration of p.

20 HB 2247 past and current performance and participation in other state or federal health programs as a contractor.

(c) Consideration should be given to using multiple year contracting periods.

(d) Quality, accessibility, and demonstrated commitment to serving low-income populations shall be given significant weight in the contracting, evaluation, and assignment process.

(e) All contractors that are regulated health carriers must meet state minimum net worth requirements as defined in applicable state laws.

The authority shall adopt rules establishing the minimum net worth requirements for contractors that are not regulated health carriers.

This subsection does not limit the authority of the Washington state health care authority to take action under a contract upon finding that a contractor's financial status seriously jeopardizes the contractor's ability to meet its contract obligations.

(f) Procedures for resolution of disputes between the authority and contract bidders or the authority and contracting carriers related to the award of, or failure to award, a managed care contract must be clearly set out in the procurement document.

(6) The authority may apply the principles set forth in subsection (5) of this section to its managed health care purchasing efforts on behalf of clients receiving supplemental security income benefits to the extent appropriate.

(7) Any contract with a managed care organization to provide services to medical assistance enrollees shall require that managed care organizations offer contracts to mental health providers and substance use disorder treatment providers to provide access to primary care services integrated into behavioral health clinical settings, for individuals with behavioral health and medical comorbidities.

(8) Managed care organization contracts effective on or after April 1, 2016, shall serve geographic areas that correspond to the regional service areas established in RCW 74.09.870.

(9) A managed care organization shall pay a nonparticipating provider that provides a service covered under this chapter or other applicable law to the organization's enrollee no more than the lowest amount paid for that service under the managed care organization's contracts with similar providers in the state if the managed care p.

21 HB 2247 organization has made good faith efforts to contract with the nonparticipating provider.

(10) For services covered under this chapter or other applicable law to medical assistance or medical care services enrollees, nonparticipating providers must accept as payment in full the amount paid by the managed care organization under subsection (9) of this section in addition to any deductible, coinsurance, or copayment that is due from the enrollee for the service provided.

An enrollee is not liable to any nonparticipating provider for covered services, except for amounts due for any deductible, coinsurance, or copayment under the terms and conditions set forth in the managed care organization contract to provide services under this section.

(11) Pursuant to federal managed care access standards, 42 C.F.R.

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438, managed care organizations must maintain a network of appropriate providers that is supported by written agreements sufficient to provide adequate access to all services covered under the contract with the authority, including hospital-based physician services.

The authority will monitor and periodically report on the proportion of services provided by contracted providers and nonparticipating providers, by county, for each managed care organization to ensure that managed health care systems are meeting network adequacy requirements.

No later than January 1st of each year, the authority will review and report its findings to the appropriate policy and fiscal committees of the legislature for the preceding state fiscal year.

(12) If a managed care organization's provider network includes participating providers licensed under chapter 18.83 or 18.225 RCW, the plan may not categorically exclude associate licensees under those chapters.

(13) Payments under RCW 74.60.130 are exempt from this section.

The examininghealth boardcare ofauthority psychologyshall mayensure adoptthat anyall rulesservices necessaryprovided toby implementassociate sectionslicenses 2under throughchapters 1218.225 ofand this18.83 act.RCW are included in the state medicaid program, including filing any necessary state plan amendments by January 1, 2025.

The secretary of health may adopt any rules necessary to implement sections 1 and 13 through 16 of this act.

(1)The Sectionboard 1of psychology and the secretary of thishealth actmay takesadopt effectany Januaryrules 1,necessary 2028.to implement this act.

(2)p. Sections 2 through 12, 14, 16, and 17 of this act take effect October 1, 2025.

22 HB 2247 NEW SECTION.

Sec.

21.

Sections 1 through 18 of this act take effect October 1, 2025.

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