Description: The health care authority (HCA) intends to submit medicaid SPA 18-0032 to implement certain directives in SSB 5779, signed by the governor on May 5, 2017. SSB 5779 directs HCA to promote "bidirectional integration," which means integrating behavioral health services into primary care settings and primary care services into behavioral health settings. SPA 18-0032 will assist bidirectional integration by removing state-imposed limitations on the following:


•	Professional mental health services:

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Professional mental health services:


º	Allow psychologists to provide and bill for services delivered in an inpatient hospital setting
º	Remove the limitation of one psychiatric service per day
º	Remove limitations on the place of service for behavioral health services

Allow psychologists to provide and bill for services delivered in an inpatient hospital setting

Remove the limitation of one psychiatric service per day

Remove limitations on the place of service for behavioral health services


•	Tobacco cessation services:

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Tobacco cessation services:


º	Allow physicians to provide and bill for services provided in their office, in addition to the current ability to bill for Quitline referrals
º	Clarify in the state plan that these services are available to eligible, nonpregnant medicaid clients

Allow physicians to provide and bill for services provided in their office, in addition to the current ability to bill for Quitline referrals

Clarify in the state plan that these services are available to eligible, nonpregnant medicaid clients


•	Health and behavior services:

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Health and behavior services:


º	Allow behavioral health providers to provide and bill for health and behavior services to allow a person with a medical diagnosis to have access to counseling to help them make behavior changes that could have a positive impact on their medical condition. Currently only psychologists, physicians, and advanced registered nurse practitioners may bill for these services (except when billed with substance use disorder or maternity support services modifiers)

Allow behavioral health providers to provide and bill for health and behavior services to allow a person with a medical diagnosis to have access to counseling to help them make behavior changes that could have a positive impact on their medical condition. Currently only psychologists, physicians, and advanced registered nurse practitioners may bill for these services (except when billed with substance use disorder or maternity support services modifiers)

Please note that HCA may remove limitations on places of service, provider types, and amounts of service only when those limitations are not federally mandated.

At this time, HCA does not [have] sufficient information to estimate what effect SPA 18-0032 could have on providers' aggregate expenses/payments. The rates for the affected services are not being changed. It is currently unknown whether the addition of provider types to furnish the services described above and any accompanying increased client usage will result in increased provider payments.

SPA 18-0032 is in the development process; therefore, a copy is not yet available for review. HCA would appreciate any input or concerns regarding this SPA. To request a copy when it becomes available, you may contact the agency in your county listed in the table or the person named below. To submit comments, please contact the person named below (please note that all comments are subject to public review and disclosure, as are the names of those who comment).

Contact Rebecca Peters, Clinical Evaluation, P.O. Box 45506, phone 360-725-1194, fax 360-725-1966, email Rebecca.peters@hca.wa.gov.