Current through Register Vol. 24-18, September 15, 2024
(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. See also chapter 182-538D WAC for rules
applicable to nonmedicaid behavioral health services.
(2) The BH-ASO contracts with the agency to
provide behavioral health services within an integrated managed care (IMC)
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;
(ii) Operation of a behavioral health ombuds
(ombudsman); and
(iii)
Implementation of the Involuntary Treatment Act for both mental health and
substance use disorders.
(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, 71.24, or 71.34
RCW, 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, 71.24, and 71.34
RCW.
(3) The BH-ASO may
provide contracted noncrisis behavioral health services to people in an IMC
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 IMC regional service area, the BH-ASO is a subcontractor with all IMC
managed care organizations (MCOs) to provide crisis services for medicaid
enrollees and the administration of involuntary treatment acts under chapter
71.05, 71.24, or 71.34 RCW.
(5) For
medicaid-funded services subcontracted for by IMC managed care organizations
(MCOs) to the BH-ASO:
(a) Grievances and
appeals must be filed with the IMC 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.
