Washington 2021-2022 Regular Session Status: Passed Senate 6 D cosponsors

SB 5894 — Integrating behavioral health in primary care through the use of health navigators and a primary care collaborative.

Last action — Executive session scheduled, but no action was taken in the Senate Committee on Ways & Means at 10:00 AM.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2021-2022 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there are no live odds of enactment. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

229 added · 56 removed

Plain-language change summary

The updated version of Senate Bill 5894 now focuses on integrating behavioral health services within primary care through the use of health navigators and a collaborative approach. This change emphasizes a whole-person care model, recognizing the importance of mental health, care coordination, and social support, especially given that a significant number of students report feeling depressed and many new mothers suffer from mood disorders without adequate treatment. By highlighting the need for these services at the point of care, the bill seeks to improve health outcomes for families and ensure better coordination between primary care providers and behavioral health professionals.

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S-4054.1 SUBSTITUTE SENATE BILL 5894 State of Washington 67th Legislature 2022 Regular Session By Senate Behavioral Health Subcommittee to Health & Long Term Care (originally sponsored by Senators Frockt, Conway, Hasegawa, Nguyen, Nobles, Robinson, and C.
S-3675.2 SENATE BILL 5894 State of Washington 67th Legislature 2022 Regular Session By Senators Frockt, Conway, Hasegawa, Nguyen, Nobles, Robinson, and C.
Wilson) READ FIRST TIME 01/31/22.
Wilson Read first time 01/18/22.
AN ACT Relating to integrating means for payment of community health workers into primary care;
Referred to Committee on Health & Long Term Care.
adding new sections to chapter 41.05 RCW;
AN ACT Relating to integrating behavioral health in primary care through the use of health navigators and a primary care collaborative;
and creating new sections.
amending RCW 74.09.010;
adding a new section to chapter 74.09 RCW;
adding a new section to chapter 41.05 RCW;
creating new sections;
and providing an effective date.
The legislature finds that in 2021, over 44 percent of middle school students and 57 percent of high school students reported feeling depressed most days.
(1) The legislature finds that whole- person care that includes access to behavioral health, care coordination, and social supports at the point of entry is essential for families.
In 2021, over 44 percent of middle school students and 57 percent of high school students reported feeling depressed most days.
The unique relationship between pediatric primary care providers and their patients makes primary care well-positioned for investment in services and supports by community health workers.
Multiform strategies are needed to meet kids and families where they are to deliver needed behavioral health interventions and social supports.
These workers drive connectivity to other parts of the delivery system, address social determinants of health, and lower the total cost of care while freeing up licensed health care professionals to practice at the top of their scope of license, improving patient outcomes.
While current initiatives, like certified community behavioral health clinics, promise to expand access to integrated care and care coordination for families that present to behavioral health clinics, it is necessary to plan for whole-person care p.
NEW SECTION.
1 SB 5894 throughout the delivery system, including for families whose primary point of entry is through primary care.
(2) The legislature further finds that the unique relationship between primary care providers and patients makes primary care well positioned to deploy integrated whole-person care strategies that include behavioral health and social supports.
Primary care is a main driver of prevention and early detection, so investment in improved primary care services, connectivity to other parts of the delivery system, and patient engagement will improve patient outcomes and lower the total cost of care.
To achieve these outcomes, the legislature intends to invest in primary care transformation accomplished through a multipayer primary care transformation model developed by the health care authority in consultation with stakeholders across the health delivery system.
A new section is added to chapter 41.05 RCW to read as follows:
RCW 74.09.010 and 2020 c 80 s 55 are each amended to read as follows:
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Authority" means the Washington state health care authority.
(2) "Bidirectional integration" means integrating behavioral health services into primary care settings and integrating primary care services into behavioral health settings.
(3) "Children's health program" means the health care services program provided to children under eighteen years of age and in households with incomes at or below the federal poverty level as annually defined by the federal department of health and human services as adjusted for family size, and who are not otherwise eligible for medical assistance or the limited casualty program for the medically needy.
(4) "Chronic care management" means the health care management within a health home of persons identified with, or at high risk for, one or more chronic conditions.
Effective chronic care management:
(a) Actively assists patients to acquire self-care skills to improve functioning and health outcomes, and slow the progression of disease or disability;
(b) Employs evidence-based clinical practices;
(c) Coordinates care across health care settings and providers, including tracking referrals;
1 SSB 5894 Subject to the availability of amounts appropriated for this specific purpose, by January 1, 2023, the authority shall establish a pediatric community health worker program for reimbursement of services to patients up to age 18 provided by community health workers in primary care clinics whose patients are significantly comprised of pediatric patients enrolled in medical assistance under chapter 74.09 RCW.
2 SB 5894 (d) Provides ready access to behavioral health services that are, to the extent possible, integrated with primary care;
Community health workers funded under this section may provide outreach, informal counseling, and social supports for health-related social needs.
and (e) Uses appropriate community resources to support individual patients and families in managing chronic conditions.
(5) "Chronic condition" means a prolonged condition and includes, but is not limited to:
(a) A mental health condition;
(b) A substance use disorder;
(c) Asthma;
(d) Diabetes;
(e) Heart disease;
and (f) Being overweight, as evidenced by a body mass index over twenty-five.
(6) "County" means the board of county commissioners, county council, county executive, or tribal jurisdiction, or its designee.
(7) "Department" means the department of social and health services.
(8) "Department of health" means the Washington state department of health created pursuant to RCW 43.70.020.
(9) "Director" means the director of the Washington state health care authority.
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(10) "Full benefit dual eligible beneficiary" means an individual who, for any month:
Has coverage for the month under a medicare prescription drug plan or medicare advantage plan with part D coverage;
and is determined eligible by the state for full medicaid benefits for the month under any eligibility category in the state's medicaid plan or a section 1115 demonstration waiver that provides pharmacy benefits.
(11) "Health home" or "primary care health home" means coordinated health care provided by a licensed primary care provider coordinating all medical care services, and a multidisciplinary health care team comprised of clinical and nonclinical staff.
The term "coordinating all medical care services" shall not be construed to require prior authorization by a primary care provider in order for a patient to receive treatment for covered services by an optometrist licensed under chapter 18.53 RCW.
Primary care health home services shall include those services defined as health home services in 42 U.S.C.
Sec.
1396w-4 and, in addition, may include, but are not limited to:
p.
3 SB 5894 (a) Comprehensive care management including, but not limited to, chronic care treatment and management;
(b) Extended hours of service;
(c) Multiple ways for patients to communicate with the team, including electronically and by phone;
(d) Education of patients on self-care, prevention, and health promotion, including the use of patient decision aids;
(e) Coordinating and assuring smooth transitions and follow-up from inpatient to other settings;
(f) Individual and family support including authorized representatives;
(g) The use of information technology to link services, track tests, generate patient registries, and provide clinical data;
and (h) Ongoing performance reporting and quality improvement.
(12) "Internal management" means the administration of medical assistance, medical care services, the children's health program, and the limited casualty program.
(13) "Limited casualty program" means the medical care program provided to medically needy persons as defined under Title XIX of the federal social security act, and to medically indigent persons who are without income or resources sufficient to secure necessary medical services.
(14) "Medical assistance" means the federal aid medical care program provided to categorically needy persons as defined under Title XIX of the federal social security act.
(15) "Medical care services" means the limited scope of care financed by state funds and provided to persons who are not eligible for medicaid under RCW 74.09.510 and who are eligible for the aged, blind, or disabled assistance program authorized in RCW 74.62.030 or the essential needs and housing support program pursuant to RCW 74.04.805.
(16) "Multidisciplinary health care team" means an interdisciplinary team of health professionals which may include, but is not limited to, medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral and mental health providers including substance use disorder prevention and treatment providers, doctors of chiropractic, physical therapists, licensed complementary and alternative medicine practitioners, home care and other long-term care providers, and physicians' assistants.
p.
4 SB 5894 (17) "Nursing home" means nursing home as defined in RCW 18.51.010.
(18) "Poverty" means the federal poverty level determined annually by the United States department of health and human services, or successor agency.
(19) "Primary care behavioral health" means a health care integration model in which behavioral health care is colocated, collaborative, and integrated within a primary care setting.
(20) "Primary care provider" means a general practice physician, family practitioner, internist, pediatrician, osteopathic physician, naturopath, physician assistant, and advanced registered nurse practitioner licensed under Title 18 RCW.
(21) "Secretary" means the secretary of social and health services.
(22) "Whole-person care in behavioral health" means a health care integration model in which primary care services are integrated into a behavioral health setting either through colocation or community- based care management.
(23) "Health navigator" means a member of a health care team who helps individuals overcome barriers and facilitate access to services by increasing health knowledge and self-sufficiency through a range of evidence-based activities such as outreach, community education, informal counseling, social support, and advocacy which impact social determinants of health.
Health navigators are nonlicensed and are typically trusted members of the community with an unusually close understanding of the community served.
A new section is added to chapter 41.05 RCW to read as follows:
A new section is added to chapter 74.09 RCW to read as follows:
(1) The authority shall work with stakeholders to develop a multipayer primary care transformation model to improve access to and quality of services covered by medicaid, public employees' benefits board, and school employees' benefits board programs and begin phasing in value-based payment and accountability for primary care clinics starting January 1, 2023.
By January 1, 2023, managed care organizations shall make reimbursement for care coordination services performed by nonlicensed staff acting in the role of a health navigator available to primary care clinics that have not fully transitioned to the multipayer primary care transformation model developed pursuant to section 4 of this act, using funding provided for medicaid administrative services.
(2) The multipayer primary care transformation model shall, among other components, explore sustainable reimbursement options for integration of community health workers in primary care to address the health-related social needs of families.
The department of health shall contract with an organization that represents pediatric primary care needs in Washington state to convene community-based organizations dedicated to children's mental health in order to establish and implement an equity-focused curriculum by January 1, 2023, with the goal to prepare community health workers to meet the unique needs of children, adolescents, and their families.
A new section is added to chapter 41.05 RCW to read as follows:
p.
5 SB 5894 (1) The authority shall work with stakeholders to complete development of its multipayer primary care transformation model to improve access to and quality of services covered by medicaid, public employees' benefits board, and school employees' benefits board programs and begin phasing in value-based payment and accountability for top tier readiness certification clinics by January 1, 2023.
(2) The multipayer primary care transformation model shall, if practicable, be designed to achieve cost neutrality when fully phased in for each participating clinic.
(3) The multipayer primary care transformation model shall include, but not be limited to, the following components:
(a) Coordination of payer functions and resources, such as centralizing evaluation of performance and standing;
(b) Reduction of burden on practices by reducing the need to comply with multiple contracting and compliance standards for different payers;
(c) Receipt of a consolidated service payment that removes the incentive to bill for a higher volume of services;
(d) Standardization of accountabilities for standards of care and practice capability expectations, which shall include, but not be limited to:
(i) Use of appropriate behavioral health screening tools annually with documented follow-up protocols;
and (ii) Access to team-based care strategies including patient support through health navigator services;
(e) A transformation fee to support practices while they are building capacity to satisfy provider accountabilities;
and (f) Increased payment for quality based on performance across several quality measures, including behavioral health.
(4) The authority shall report to the governor and appropriate committees of the legislature by December 1, 2023, describing the final multipayer primary care transformation model, progress with implementation, and a strategy and timeline to complete implementation in primary care clinics across the state.
NEW SECTION.
Sec.
5.
The department of health shall contract with an organization that represents pediatric primary care needs in Washington state to convene community-based organizations dedicated to children's mental health in order to establish and implement an equity-focused curriculum by January 1, 2023, with the goal to p.
6 SB 5894 prepare health navigators in the unique needs of children, adolescents, and their families.
NEW SECTION.
Sec.
6.
This act takes effect July 1, 2022.
2 SSB 5894
7 SB 5894
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Action History

  1. Executive session scheduled, but no action was taken in the Senate Committee on Ways & Means at 10:00 AM.

  2. Scheduled for public hearing in the Senate Committee on Ways & Means at 09:00 AM

  3. Public hearing in the Senate Committee on Ways & Means at 9:00 AM.

  4. Referred to Ways & Means.

  5. Scheduled for public hearing in the Senate Committee on Behavioral Health Subcommittee to Health & Long Term Care at 11:30 AM

  6. And refer to Ways & Means.

  7. BH - Majority; 1st substitute bill be substituted, do pass.

  8. Executive action taken in the Senate Committee on Behavioral Health Subcommittee to Health & Long Term Care at 11:30 AM.

  9. Scheduled for public hearing in the Senate Committee on Behavioral Health Subcommittee to Health & Long Term Care at 10:30 AM

  10. Public hearing in the Senate Committee on Behavioral Health Subcommittee to Health & Long Term Care at 10:30 AM.

  11. Scheduled for public hearing in the Senate Committee on Health & Long Term Care at 08:00 AM

  12. Referred to Behavioral Health Subcommittee to Health & Long Term Care.

  13. Executive action taken in the Senate Committee on Health & Long Term Care at 8:00 AM.

  14. First reading, referred to Health & Long Term Care.

Sponsors

Sponsorship breakdown

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1 sponsors · 6 co-sponsors · 144 not signed on

Sponsors (1)

  • Frockt

Co-sponsors (6)

Not signed on (144)

144 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

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Subjects

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Frequently asked questions

Who sponsors SB 5894?
SB 5894 is sponsored by June Robinson (Democrat), T'wina Nobles (Democrat), Bob Hasegawa (Democrat), Steve Conway (Democrat), Frockt, Joe Nguyen (Democrat), and Claire Wilson (Democrat).
What is the current status of SB 5894?
This bill died with 2021-2022 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 5894?
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