The Health Care Authority (HCA) is the largest health care purchaser in Washington State. HCA serves individuals through the state Medicaid program (Apple Health), the Public Employees Benefits Board, and School Employees Board programs. HCA also provides behavioral health services to all residents in Washington State, regardless of insurance. HCA reports that approximately 2.2 million people are enrolled in Apple Health.
Medicaid Managed Care. Managed care is a prepaid, comprehensive system of medical and health care delivery, including preventive, primary, specialty, and ancillary health services. Apple Health offers eligible families, children under age 19, pregnant women, certain blind or disabled persons, and low-income adults a complete medical benefits package.
Since January 1, 2020, all physical health, mental health, and substance use disorder services have been fully integrated in a ten regional service area managed care health system for most Medicaid clients through Apple Health. The managed care organizations (MCOs) must have a sufficient network of providers to provide adequate access to behavioral health services for the residents of their regional areas.
State Office of Behavioral Health Consumer Advocacy. In July 2022, the Department of Commerce established the State Office of Behavioral Health Consumer Advocacy (SOBHCA) to provide policy direction, and to contract with a private nonprofit organization (contracting advocacy organization) to provide behavioral health consumer advocacy services, as directed by SOBHCA. The behavioral health ombuds office was discontinued and replaced with SOBHCA.
The stated intent of the Legislature is that regional behavioral health ombuds programs be integrated into the statewide program, that regional ombuds be assessed and certified by the contracting advocacy organization as behavioral health consumer advocates, and that the SOBHCA provide regional ombuds programs with any additional training that certified behavioral health consumer advocates may need to carry out their responsibilities.
There must be a behavioral health consumer advocate office within the boundaries of the region served by each behavioral health administrative services organization. Medicaid managed care organizations must contract with the contracting advocacy organization for the provision of behavioral health consumer advocacy services and must reimburse the SOBHCA for behavioral health consumer advocacy services provided to their enrollees.
Health Care Cost Transparency Board. The Health Care Cost Transparency Board (Transparency Board) was established in 2020 to analyze total health care expenditures in Washington, identify trends in health care cost growth, and establish a health care cost growth benchmark. Total health care expenditures include all health care expenditures in the state by public and private sources. Health care cost growth is a measure of the annual percentage change in total health care expenditures in the state. The health care cost growth benchmark is the target percentage for health care cost growth in the state. The Transparency Board must identify health care providers and payers that exceed the health care cost growth benchmark.
The Transparency Board is supported by HCA and consists of 13 voting members representing state agencies, local governments, consumers, Taft-Hartley health benefit plans, employers, persons who are actuaries or experts in health care economics, and an expert in health care financing. The Transparency Board has an advisory committee on data issues and an advisory committee of health care providers and carriers. The Transparency Board may establish other advisory committees.
State Office of Behavioral Health Consumer Advocacy. HCA must contract with the Department of Commerce for behavioral health consumer advocacy services delivered to individuals enrolled in a managed care organization by the advocacy organization selected by SOBHCA. The contract must require HCA to reimburse the Department of Commerce for the behavioral health advocacy services delivered to the individuals enrolled in a managed care organization.
Managed Care Organizations. A single definition is created for managed care organizations and other references in statute to managed care are amended and updated to match this term. "Managed care organization" means any health care organization, including health care providers, insurers, health care service contractors, health maintenance organizations, health insuring organizations, or any other entity or combination thereof, that provides directly or by contract health care services covered under this chapter and rendered by licensed providers, on a prepaid capitated basis and that meets the requirements of Title XIX of the federal social security act or federal demonstration waivers granted under section 1115(a) of Title XI of the federal social security act.
Additional Statutory Language Updates. The current statute language is amended to specify that the Washington State health information technology office is located within HCA and HCA is the state opioid treatment authority.HCA has rulemaking authority to implement the requirements for the Health Care Cost Transparency Board.
Technical corrections are made to various provisions of the Revised Code of Washington related to the HCA that: