Public Behavioral Health Services. The state funds behavioral health services in Washington through the Medicaid program, by including behavioral health services as a mandatory benefit, and through behavioral health administrative services organizations (BHASOs), which within appropriated funding, provide behavioral health services which either are not covered by the Medicaid program, or provide covered services who do not qualify for Medicaid coverage. Medicaid services for nontribal enrollees are administered by managed care organizations (MCOs), which are risk-bearing entities that contract with the state to provide services to covered individuals within regional service areas.

The State Medicaid Plan. The State Medicaid Plan (state plan) is a document negotiated between the state and federal government to define the services available to Medicaid enrollees. Under the state plan medically necessary occupational therapy services are covered subject to limitations as part of:

• home health services;
• medical and remedial care services;
• habilitative therapy services;
• early and periodic screening, diagnosis, and treatment;
• school-based health care services to a child with a disability;
• hospice care; and
• speech, hearing, and language disorder services.

Coverage for occupational therapy services is not listed under rehabilitative services, the section of the state plan that defines the benefit package available to clients of licensed or certified behavioral health agencies (BHAs).

Occupational Therapy. Occupational therapy is a form of therapy for those recuperating from physical or mental illness that encourages rehabilitation through performance of activities required in daily life. Occupational therapists (OTs) are rehabilitative practitioners with master’s degree level training in psychology, functional anatomy, neurology, and kinesiology whose goal is to facilitate participation in preferred or necessary daily activities. OTs work in a consultative, short-term capacity with clients.

Managed care organizations and BHASOs may provide occupational therapy services to persons with behavioral health disorders who are enrolled in the Medicaid program, or who qualify for BHASO services.

The Health Care Authority must expand coverage in the state Medicaid program to ensure that licensed or certified behavioral health agencies are reimbursed by managed care organizations for the medically necessary occupational therapy needs of their clients.

PRO: This bill came about when I was touring crisis centers around the state looking for creative interventions. A BHA I visited uses OTs but pays them using temporary funding outside the Medicaid program. OTs use a holistic approach to teach skills to manage acute symptoms. OTs support the effort to decrease psychiatric hospitalizations. We need OTs in behavioral health, not just medical. Permanent supportive housing is a challenge after years of living unsheltered so help with daily activities is needed. This bill has the capacity to improve the life of thousands. I left my OT career and transitioned to a different profession because I couldn't use my degree to work with people with behavioral health disorders. Working as a social worker I still use my OT skills every day. Almost no OTs are in outpatient settings, leaving clients without the care they need.

PRO: OT typically stops when a patient is discharged. Many mental health patients experience disabilities that occupational therapists and their assistants are specifically trained to address. Behavioral health agencies typically are not employing occupation therapists. This bill would reduce hospital readmissions, which is not reflected in the fiscal note and would completely offset the costs of this bill. Downtown Emergency Services Center provides permanent supportive housing, which is life changing for clients. Transitioning into this housing is difficult, which is why we have hired an OT with private funds and it is successful. This bill will result in cost savings by serving people in the community rather than in inpatient settings. This bill will help grow the behavioral health workforce by getting occupational therapy professionals into behavioral health jobs, especially students looking for their first job.

OTHER: I support this bill, although I signed in as other. I think the bill can be improved by including therapeutic dieticians and lifestyle coaches as research has shown mental disorders are metabolic disorders of the brain.