Contractor and provider resources

This page contains billing and contract resources for behavioral health contractors, providers, and partners.

Provider relief funds

HCA was provided $100 million in workforce stabilization and relief funds from the 2022 Washington State supplemental community behavioral health budget.

The funds will provide lump sum payments to eligible community behavioral health treatment providers contracted and receiving payment through a managed care organization or behavioral health - administrative service organization.

This includes Indian health care providers who have received payments by MCOs or BH-ASOs with or without a contract per 25 U.S. Code § 1621e a Right of Recovery.

What is the status of the Workforce Stabilization Provider Relief Fund payments?

On Tuesday, September 20, HCA distributed contracts to most eligible enrolled behavioral health organizations. Eligible organizations needed to submit claims and encounters through an Managed Care Organization (MCO) or Behavioral Health agency (BHA) between July through December of 2019 and/or 2021.

As BHA’s sign and return contracts HCA will disperse lump sum gross adjustment payments to the eligible enrolled and contracted providers with NPI’s who are also enrolled to receive payment in ProviderOne. Payments will be received on the next payment cycle within 10 days.

There are a small number of contracts following a different process. Including those under review of dispute requests, and Tribal Behavioral health Agencies.

What can the relief funds be used for?

These funds are non-grant-based payments that can be used for:

  • Immediate workforce retention and recruitment.
  • Costs incurred due to the COVID-19 public health emergency.
  • Childcare stipends.
  • Student loan repayment, tuition assistance, relocation expenses, or other recruitment efforts.

How will you know if you are eligible?

HCA has determined the listed providers to be eligible for the workforce stabilization and relief funds.

If you believe your Behavioral Health Agency was eligible and is not listed and you wish to initiate a dispute you may do so by filling out the dispute form

To learn more

For MCOs and BH-ASOs

Behavioral Health Data System (BHDS) and data guide

The BHDS incorporates integrated behavioral health and substance abuse data, storage, and supporting reporting functions. It also includes data from two legacy systems:

  • The Treatment and Assessment Reports Generation Tool (TARGET), covering SUD clients and services.
  • The Mental Health Consumer Information System (MH-CIS), covering community mental health clients and services.

BHDS data guide

The data guide contains reporting requirements for managed care organizations (MCOs) and behavioral health-administrative services organizations (BH-ASOs) to meet state and federal reporting requirements related to funding.

Transition resources

Eligibility/preauthorization/screening
Involuntary treatment
Global Assessment of Individual Needs-Short Screener (GAIN-SS)

The Global Assessment of Individual Needs-Short Screener (GAIN-SS) is a evidence-based, five-minute screening tool for general populations to identify clients who have one or more behavioral health disorders.

Behavioral Health Assessment Solution (BHAS)

For fee-for-service (FFS) treatment

Billing and payment information
Contract documents

Behavioral health comparison rates project

HCA is partnering with contracted actuaries on a project to develop comparison rates for behavioral health. These rates will provide transparent benchmark estimates of provider payment rates for Medicaid-funded behavioral health services.

Background

Currently, HCA has funding only for developing comparison rates for behavioral health. HCA is not considering developing the rates under this project as a state fee-for-service schedule or a state-directed payment under managed care.

The project consists of multiple phases:

  • Phase 1: Initial development of comparison rates for a limited set of services. Read the Phase 1 report and view a stakeholder Phase 1 presentation.
  • Phase 2: Refinement of comparison rates developed in Phase 1 and an evaluation of historical Medicaid managed care organization (MCO) payment rates to the comparison rates. This phase is currently underway. HCA will deliver a preliminary report to the Office of Financial Management and relevant committees of the Legislature by June 30, 2023.

What is the purpose of this project?

  • To develop and publish behavioral health provider payment comparison rates that are consistent with efficiency, economy, quality of care, and access to care.
  • To provide an examination and understanding of the provider resources involved in delivering individual covered behavioral health services.
  • To provide transparent payment rate benchmarks for use for all, including during negotiations between payers and providers.
  • To support HCA's ability to:
    • Make informed decisions when proposing changes to covered benefits.
    • Improve transparency in analysis and communication between HCA and other stakeholders, such as the state Legislature, providers, insurers, and advisory work groups.
    • Evaluate variation in provider payments by comparing actual payment rates to comparison benchmark rates.
Provider cost and wage survey

HCA, in partnership with Milliman, released a provider cost and wage survey to gather specific information and feedback from a wide range of providers. The information collected through the survey, along with other data sources, will be used to refine the comparison rates developed in phase 1 of this project.

How do I participate in the survey?

Download the spreadsheet and complete it for your organization. Email the completed survey to Applehealth.Info@Milliman.com. If you use a screen reader and need additional assistance completing the survey, please email Milliman. Staff are available to provide you individual support.

What is the timeline?

The survey is open now and closes on November 10, 2022.

Who should complete the survey?

Providers delivering services under Section 13d Rehabilitative Services of Washington’s Medicaid State Plan. This includes mental health and substance use disorder outpatient providers, substance use disorder and mental health residential providers, and WISe and PACT service providers.

For the purpose of this survey, the term “provider” refers to an individual or entity engaged in the delivery, ordering, or referring of the above-mentioned services.

Why is my participation important?

The data that you and other providers submit will provide important insights into behavioral health providers' costs and wages. This data will inform the payment rate assumptions used to refine the behavioral health comparison rates developed in Phase 1.

Need help?

HCA and Milliman will host a live Q&A session on Thursday, October 20 from 9-10 a.m. Submit questions to AppleHealth.Info@Milliman.com by October 14. Register to attend.

Resources

Email any other questions about the survey to AppleHealth.Info@Milliman.com.

For substance use prevention

Yearly surveys

The Health Care Authority (HCA) partners with the Social and Economic Sciences Research Center (SESRC) at Washington State University to conduct yearly surveys for behavioral health providers and enrollees.

For behavioral health providers

This survey is an opportunity for BH treatment agencies to let us know about their agency, the improvement efforts they are currently undertaking, and the diversity of their behavioral health clinical staff.

For behavioral health enrollees

Who is invited to participate in the survey?

  • SESRC invites a random sample of enrollees who received outpatient behavioral health services.
  • Enrollees will be asked to complete the survey online or by telephone (US mail surveys are available if requested.)
  • The survey is voluntary, and the information collected will be kept confidential. All data will be reported in group form so that no identifying data will be available.