Washington State
House of Representatives
Office of Program Research
BILL
ANALYSIS
Health Care & Wellness Committee
SB 5228
Brief Description: Providing occupational therapy services for persons with behavioral health disorders.
Sponsors: Senators Dhingra, Hunt, Keiser, Lovelett, Lovick, Nguyen, Valdez and Wilson, C..
Brief Summary of Bill
  • Allows managed care organizations and behavioral health administrative services organizations to provide occupational therapy services to clients who have behavioral health disorders within available funding.
  • Directs the Health Care Authority to add coverage for occupational therapy to the Medicaid State Plan by June 30, 2024.
Hearing Date: 3/21/23
Staff: Ingrid Lewis (786-7293).
Background:

Medicaid State Plan.

Medicaid is a program funded jointly by states and the federal government that provides health coverage to eligible low-income state residents and their families.  The nature and scope of a state's Medicaid program is specified in the Medicaid State Plan ("plan") which is an agreement between the state and the federal government describing how the state will administer the program.  The Health Care Authority (HCA) is the state agency that administers the Washington Medicaid program called Apple Health.  The plan contains a mixture of mandatory benefits required under federal law and optional benefits, which may be authorized on a case-by-case basis if the state is able to comply with program requirements, including making services available statewide, and a willingness to contribute the state portion of the funding.  The plan must be approved by the Centers for Medicare and Medicaid Services in order to access federal Medicaid funds and may be amended as needed to reflect changes in state policy and federal law and regulation. 

Managed Care Organizations and Behavioral Health Administrative Services Organizations.

Medicaid services are primarily delivered through contracted managed care systems.  The HCA contracts with managed care organizations (MCOs) under a comprehensive risk contract to provide prepaid health care services to persons enrolled in a managed care Apple Health plan.

 

While most Medicaid clients receive behavioral health services through an MCO, behavioral health administrative service organizations (BHASOs) administer certain behavioral health services that are not covered by the MCO within a specific regional service area.  The services provided by a BHASO include maintaining continuously available crisis response services, administering services related to the involuntary commitment of adults and minors, coordinating planning for persons transitioning from long-term commitments, maintaining an adequate network of evaluation and treatment services, and providing services to non-Medicaid clients in accordance with contract criteria.
Summary of Bill:

Occupational therapy is added to the list of services that MCOs and BHASOs may provide to persons with behavioral health disorders who are enrolled in the Medicaid program, or who qualify for BHASO services, within funds appropriated by the Legislature.  The HCA must add coverage for occupational therapy to the Medicaid State Plan by June 30, 2024.
Appropriation: None.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.