HEALTH CARE AUTHORITY
[Filed November 16, 2018, 1:34 p.m., effective November 16, 2018, 1:34 p.m.]
Effective Date of Rule: Immediately upon filing.
Purpose: The agency is creating rules for coverage of a new model of care called collaborative care, which is part of the integration of mental health and physical health.
Citation of Rules Affected by this Order: New WAC 182-531-0425.
Under RCW 34.05.350
the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: As directed by SSB 5779 and funding authorized in SSB 5883, the agency is creating rules for the coverage of collaborative care, which is part of the integration of mental health and physical health. Emergency rules are necessary to implement this requirement while the permanent rule-making process is completed. This emergency filing continues the previous filing under WSR 18-16-007 which expires on November 17, 2018. Since the last emergency filing, the agency has completed an external stakeholder review and is preparing to file a CR-102 Proposed rule making and schedule a public hearing. The text of this draft does not differ from the previous filing.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.
Date Adopted: November 16, 2018.
WAC 182-531-0425Collaborative care.
(1) Under the authority of RCW 74.09.497
, and subject to available funds, the medicaid agency covers collaborative care provided in clinical care settings.
(2) For the purposes of this section:
(a) Collaborative care means a specific type of integrated care where medical providers and behavioral health providers work together to address behavioral health conditions, including mental health conditions and substance use disorders.
(b) Collaborative care model is a model of behavior health integration that enhances usual primary care by adding two key services:
(i) Care management support for clients receiving behavioral health treatment; and
(ii) Regular psychiatric consultation with the primary care team, particularly for clients whose conditions are not improving.
(c) Collaborative care team means a team of licensed behavioral health professionals operating within their scope of practice who participate on the primary care team along with the primary billing provider to provide collaborative care to eligible clients. These professionals include, but are not limited to:
(i) Advanced registered nurses;
(ii) Chemical dependency professionals;
(iii) Chemical dependency professional trainees under the supervision of a certified chemical dependency professional;
(iv) Marriage and family therapists;
(v) Marriage and family therapist associates under the supervision of a licensed marriage and family therapist or equally qualified mental health practitioner;
(vi) Mental health counselors;
(vii) Mental health counselor associates under the supervision of a licensed mental health counselor, psychiatrist, or physician;
(ix) Physician assistants under the supervision of a licensed physician;
(xi) Psychiatric advanced registered nurses;
(xiii) Registered nurses;
(xiv) Social workers;
(xv) Social worker associate-independent clinical, under the supervision of a licensed independent clinical social worker or equally qualified mental health practitioner; and
(xvi) Social worker associate-advanced, under the supervision of a licensed independent clinical social worker, advanced social worker, or equally qualified mental health practitioner.
(3) The primary billing provider must meet all of the following:
(a) Be enrolled with the agency as one of the following:
(i) A physician licensed under Titles 18
RCW and 246 WAC;
(ii) An advanced registered nurse practitioner licensed under Titles 18
RCW and 246 WAC;
(iii) A clinic that is not a federally qualified health center (FQHC) or rural health clinic (RHC) that meets the requirements of Titles 70
RCW and 247 WAC;
(iv) An FQHC; or
(v) An RHC.
(b) Complete, sign, and return the Attestation for Collaborative Care Model, form HCA 13-0017, to the agency; and
(c) Agree to follow the agency's guidelines for practicing a collaborative care model.
(4) Providers of collaborative care must:
(a) Use a registry to track the client's clinical outcomes;
(b) Use a validated clinical rating scale;
(c) Ensure the registry is used in conjunction with the practice's electronic health records (EHR);
(d) Include a plan of care; and
(e) Identify outcome goals of the treatments.
(5) If a provider no longer meets the agreed upon requirements in the agency's Attestation for Collaborative Care Model, form HCA 13-0017, the provider must immediately notify the agency. The agency does not pay for collaborative care if a provider does not meet the agreed upon requirements.
(6) Providers are subject to post pay review by the agency. The agency may recoup payment if the provider is found to have not met the requirements for providing collaborative care as agreed to in the agency's Attestation for Collaborative Care Model, form HCA 13-0017.