Access Lines. The Health Care Authority (HCA), in collaboration with the University of Washington Department of Psychiatry and Behavioral Sciences (UW) and Seattle Children's Hospital, implements three phone consultation services to improve behavioral health care access at no cost for individuals, families, and providers across the state. These programs assist providers with managing their patients' psychiatric needs and help connect people to care.

Washington Partnership Access Line. The Washington Partnership Access Line (PAL) service, operated by Seattle Children's Hospital since 2008, is a phone consultation service for primary care providers to consult with a pediatric psychiatrist about children's mental health care such as diagnostic clarification, medication adjustment, or treatment planning.

Perinatal Psychiatry Consultation Line. The PAL for Moms, also known as the Perinatal Psychiatry Consultation Line for providers (PPCL), has been operated by UW since 2019 and helps support providers caring for patients with behavioral health disorders who are pregnant, postpartum, or planning pregnancy.

Mental Health Referral Service for Children and Teens. The Mental Health Referral Service for Children and Teens (MHRS), created in 2019, is operated by Seattle Children's Hospital and helps connect patients and families with available children's mental health services in their community.

Psychiatric Consultation Line. HCA, in collaboration with UW, implements the Psychiatry Consultation Line (PCL) to provide emergency department providers, primary care providers, and county and municipal correctional facility providers with on-demand access to psychiatric and substance use disorder clinical consultation for adult patients. The clinical consultation may occur via telemedicine.

Data and Reporting. UW and participating hospitals must collect the following information for PAL, PPCL, and PCL:

• the number of individuals served;
• demographic information on the individuals served, including age, gender, and city and county of residence;
• demographic information on the providers placing the calls, including type of practice, and city and county of practice;
• insurance information, including health plan and carrier;
• a description of the resources provided; and
• provider satisfaction.

Funding Model. The Legislature directed HCA in 2020 to begin collecting a fee or assessment from Washington health insurers based on the number of covered lives to keep PAL and PCL services operational. The funding model is as follows:

• HCA consults with UW and Seattle Children's Hospital to determine the annual costs of operating each program, including HCA's administrative costs;
• HCA calculates the proportion of clients in each program covered by Medicaid or state medical assistance programs, and the state pays for the cost for these clients; and
• HCA collects a proportional share of program, excluding HCA's administrative costs, from each of the following entities that are not for covered lives under contract with HCA as Medicaid managed care organizations:
  
  1. health carriers;
  2. self-funded multiple employer welfare arrangements; and
  3. employers or other entities that provide health care in Washington, including self-funding entities or employee welfare benefit plans.

HCA contracts with a third-party administrator to calculate and administer the assessments, which are deposited into the Telebehavioral Health Access Account to support telebehavioral health programs.

First Approach Skills Training. First Approach Skills Training (FAST) programs provide brief, evidence-based behavioral therapy for youth and families with common mental health concerns in settings such as primary care clinics or schools where longer-term treatment is not typically provided. For each FAST program, there is a two-page educational handout that can be given out by primary care or school-based providers as the first step in care, prior to referral for the clinician-guided intervention.

The FAST program is added to the list of access lines that HCA, in collaboration with UW and Seattle Children's Hospital, must implement. The FAST program is also added to the existing funding model in statute for PAL and PCL.

UW and participating hospitals must collect the following information for the FAST program:

• number of providers trained;
• number of clinics supported;
• number of ongoing consultation training sessions delivered;
• utilization rates of the FAST website video and materials; and
• updates on all new materials created for the program such as new translations.

PRO: The FAST program allows schools to get behavioral health services to children and youth quickly and stem the level of crisis. The FAST consultation service provides clinical support, and this bill aligns the FAST program with the other behavioral health referral lines that provide clinical support to providers in the field.