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PDFWAC 182-538C-040

Behavioral health services.

(1) This chapter governs crisis-related and other behavioral health services provided under the medicaid agency's behavioral health administrative services organization (BH-ASO) contract.
(2) The BH-ASO contracts with the agency to provide behavioral health services within a fully integrated managed care (FIMC) regional service area.
(a) The BH-ASO provides the following services to all people, regardless of insurance status, income level, ability to pay, and county of residence:
(i) Mental health crisis services; and
(ii) Operation of a behavioral health ombuds (ombudsman).
(b) The BH-ASO may provide substance use disorder crisis services within available resources to all people, regardless of the person's insurance status, income level, ability to pay, and county of residence.
(c) The BH-ASO provides the following services to people who are not eligible for medicaid coverage and are involuntarily or voluntarily detained under chapter 71.05 or 71.34 RCW, RCW 70.96A.140, or a less restrictive alternative (LRA) court order:
(i) Evaluation and treatment services;
(ii) Substance use disorder residential treatment services; and
(iii) Outpatient behavioral services, under an LRA court order.
(d) To be eligible to contract with the agency, the BH-ASO must:
(i) Accept the terms and conditions of the agency's contracts; and
(ii) Be able to meet the network and quality standards established by the agency.
(e) Services related to the administration of chapters 71.05 and 71.34 RCW and RCW 70.96A.140.
(3) The BH-ASO may provide contracted noncrisis behavioral health services to people in an FIMC regional service area:
(a) Within available resources;
(b) Based on medical necessity; and
(c) In order of priority to populations as identified by state and federal authorities.
(4) Within an FIMC regional service area, the BH-ASO is a subcontractor with all FIMC managed care organizations (MCOs) to provide crisis services for medicaid enrollees and the administration of involuntary treatment acts under RCW 70.96A.140 or chapter 71.05 or 71.34 RCW.
(5) For medicaid-funded services subcontracted for by FIMC managed care organizations (MCOs) to the BH-ASO:
(a) Grievances and appeals must be filed with the FIMC MCO; and
(b) The grievance and appeal system and the agency's administrative hearing rules in chapter 182-538 WAC apply instead of the grievance and appeal system and hearing rules in this chapter.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-23-200, § 182-538C-040, filed 11/22/17, effective 12/23/17; WSR 16-05-051, § 182-538C-040, filed 2/11/16, effective 4/1/16.]
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