182-538C-040  <<  182-538C-050 >>   182-538C-070

WAC 182-538C-050

Definitions.

The definitions and abbreviations in this section and those found in chapter 182-500 WAC apply to this chapter. If conflict exists, this chapter takes precedence.
"Action" means the denial or limited authorization of a service covered under the behavioral health administrative services organization (BH-ASO) contract based on medical necessity.
"Available resources" means funds appropriated for the purpose of providing community behavioral health programs.
(a) This includes:
(i) Federal funds, except those provided according to Title XIX of the Social Security Act; and
(ii) State funds appropriated by the legislature for the purpose of providing services under the BH-ASO contract.
(b) This does not include funds appropriated for the purpose of operating and administering the state psychiatric hospitals.
"Behavioral health" means mental health and substance use disorder conditions and related benefits.
"Behavioral health administrative services organization (BH-ASO)" means an entity selected by the medicaid agency to administer behavioral health programs, including crisis services for individuals in a fully integrated managed care regional service area. The BH-ASO administers crisis services for all individuals in its defined regional service area, regardless of an individual's ability to pay.
"Complaint" - See "grievance."
"Crisis" means an actual or perceived urgent or emergent situation that occurs when:
(a) An individual's stability or functioning is disrupted; and
(b) There is an immediate need to resolve the situation to prevent:
(i) A serious deterioration in the individual's mental or physical health; or
(ii) The need for referral to a significantly higher level of care.
"Fully integrated managed care (FIMC)" means the program under which a managed care organization provides:
(a) Physical health services funded by medicaid; and
(b) Behavioral health services funded by other available resources as defined in this chapter.
"Grievance" means an expression of dissatisfaction made by or on behalf of an individual and referred to a behavioral health administrative services organization (BH-ASO) about any matter other than an action.
"Less restrictive alternative (LRA)" means court-ordered outpatient treatment in a setting less restrictive than total confinement.
"Noncrisis services" means services funded by nonmedicaid funding sources that are provided to individuals who are not enrolled in Washington apple health or otherwise eligible for medicaid. These services may be provided at the discretion of the behavioral health administrative services organization (BH-ASO) within available resources, such as:
(a) Crisis stabilization;
(b) Outpatient mental health or substance use disorder services; and
(c) Withdrawal management.
"Patient days of care" means all voluntary patients and involuntarily committed patients under chapter 71.05 RCW, regardless of where in the state hospital the patients reside. Patients who are committed to the state hospital under chapter 10.77 RCW are not included in the patient days of care. Patients who are committed under RCW 10.77.088 by municipal or district courts after failed competency restoration and dismissal of misdemeanor charges are not counted in the patient days of care until a petition for ninety days of civil commitment under chapter 71.05 RCW has been filed in court. Patients who are committed under RCW 10.77.086 by a superior court after failed competency restoration and dismissal of felony charges are not counted in the patient days of care until the patient is civilly committed under chapter 71.05 RCW.
"Regional service area" means a single county or multi-county grouping formed for the purpose of health care purchasing and designated by the agency and the department of social and health services.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 16-05-051, § 182-538C-050, filed 2/11/16, effective 4/1/16.]
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