SB 5779 — Concerning behavioral health integration in primary care.

S-1624.1SUBSTITUTES-1310.2SENATE SENATE BILL 5779State of Washington65th Legislature2017 Regular SessionBy Senate Human Services, Mental Health & Housing (originally sponsored by Senators Brown and O'Ban)READO'BanRead FIRSTfirst TIMEtime 02/17/17.AN02/09/17. ACT Relating to behavioral health integration in primary care;

Referred to Committee on Human Services, Mental Health & Housing.AN ACT Relating to behavioral health integration in primary care;

An important component to health care integration supported both by research and experience in Washington is primary care behavioral health, a model in which behavioral health providers, sometimes called behavioral health consultants, are fully integrated in primary care.care.Primary care settings are a gateway for many individuals with behavioral health and primary care needs.

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RobertA J.behavioral health consultant engages primary care patients and their caregivers during the same health care visit, often in the same exam room.

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This warm hand-off approach fosters coordinated whole-person care, increases access to behavioral health services, and reduces stigma and cultural barriers in a cost-effective manner.

Patients are provided evidence-based brief interventions and skills training, with more severe needs being effectively engaged, assessed, and referred to appropriate specialized care.While the benefits of primary care behavioral health are not restricted to children, the primary care behavioral health also provides a unique opportunity to engage children who have a strong relationship with primary care, identify problems early, and assure healthy development.

Investment in primary care behavioral health creates opportunities for prevention and early detection that pay dividends throughout the life cycle.Providers in Washington need guidance on how to effectively integrate behavioral health services into primary care practices in a manner that is also financially sustainable.

The review must involve stakeholder involvement and include consideration of the following principles to the extent allowed by federal law:(a) Payment rules must allow professionals to operate within the full scope of their practice;(b) Payment rules should allow medically necessary behavioral health services for covered patients to be provided in any setting;(c) Payment rules and provider communications related to payment should facilitate integration of physical and behavioral health services through multifaceted models, including primary care behavioral health, collaborative care, and other models;(d) Payment rules should be designed liberally to encourage innovation and ease future transitions to more integrated models of payment and more integrated models of care;(e) Payment rules should allow health and behavior codes to be reimbursed for all patients in primary care settings as provided by any licensed behavioral health professional operating within their scope of practice, including but not limited to psychiatrists, psychologists, psychiatric advanced registered nurse professionals, physician assistants working with a supervising psychiatrist, psychiatric nurses, mental health counselors, social workers, chemical dependency professionals, chemical dependency professional trainees, and marriage and family therapists,therapists;(f) and mental health counselor associates under the supervision of a licensed clinician;(f) Payment rules which limit same-day billing for providers using the same provider number, require prior authorization for low-level or routine behavioral health care, or prohibit payment when the patient is not present should be deployed only when consistent with national coding conventions and consonant with accepted best practices in the field.(2) Concurrent with the review described in subsection (1) of this section, the authority must create a matrix listing all behavioral health related codes available for provider payment through medical assistance programs and clearly explain applicable payment rules in order to increase awareness among providers, standardize billing practices, and reduce common and avoidable billing errors.

and(h) Ongoing performance reporting and quality improvement.(11) "Internal management" means the administration of medical assistance, medical care services, the children's health program, and the limited casualty program.(12) "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.(13) "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.(14) "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.(15) "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.(16) "Nursing home" means nursing home as defined in RCW 18.51.010.(17) "Poverty" means the federal poverty level determined annually by the United States department of health and human services, or successor agency.(18) "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.(19) "Primary care provider" means a general practice physician, family practitioner, internist, pediatrician, ((osteopath))osteopath, osteopathic physician, naturopath, physician assistant, osteopathic physician assistant, and advanced registered nurse practitioner licensed under Title 18 RCW.(((19))) (20) "Secretary" means the secretary of social and health services.NEW SECTION.  Sec. 4.  A new section is added to chapter 74.09 RCW to read as follows:Subject to the availability of amounts appropriated for this specific purpose, in order to increase the availability of behavioral health services to children and youth and incentivize adoption of the primary care behavioral health model, the authority must establish a methodology and rate which provides increased reimbursement to providers for behavioral health services provided to patients up to eighteen years of age in primary care settings.Sec. 5.  RCW 70.320.020 and 2014 c 225 s 107 are each amended to read as follows:(1) The authority and the department shall base contract performance measures developed under RCW 70.320.030 on the following outcomes when contracting with service contracting entities:

The authority and the department may adapt the outcomes to account for the unique needs and characteristics of discrete subcategories of populations receiving services, including ethnically diverse communities.(4) The authority and the department shall coordinate the establishment of the expected outcomes and the performance measures between each agency as well as each program to identify expected outcomes and performance measures that are common to the clients enrolled in multiple programs and to eliminate conflicting standards among the agencies and programs.(5)(a) The authority and the department shall establish timelines and mechanisms for service contracting entities to report data related to performance measures and outcomes, including phased implementation of public reporting of outcome and performance measures in a form that allows for comparison of performance measures and levels of improvement between geographic regions of Washington.(b) The authority and the department may not release any public reports of client outcomes unless the data ((have [has])) has been deidentified and aggregated in such a way that the identity of individual clients cannot be determined through directly identifiable data or the combination of multiple data elements.(6) The authority and department must establish a performance measure to be integrated into the statewide common measure set which tracks effectivethe integrationdegree practicesof integration of behavioral health services in primary care settings.NEW SECTION.  Sec. 6.  RCW 18.205.040 (Use of title) and 2014 c 225 s 108, 2008 c 135 s 17, & 1998 c 243 s 4 are each repealed.NEW SECTION.  Sec. 7.  This act may be known and cited as the youth behavioral health protection act.--- END ---