Contractor and provider resources

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

On this page

Public notice of changes to the Medicaid State Plan

The Health Care Authority intends to submit State Plan Amendment 21-0003 to update the language of Attachment 3.1-A and 3.1-B, Section 13d: Rehabilitation Services, of the Medicaid State Plan. 

The language changes to the State Plan will include:

  • Structural changes to regroup services.
  • Aligning allowable provider type(s) with Department of Health (DOH) scope of practice.
  • Added co-occurring disorder professionals as an allowable provider type.
  • Referencing a team-based model within crisis stabilization (including peers).
  • Removing outdated mental health peer language.
  • Increasing transition of care services to substance use disorder (SUD).

If approved by the legislature, a new provision will be added that would allow Medicaid funds to be used on problem gambling treatment services, which are currently paid for with state funds. This State Plan Amendment is the first phase in a longer-term plan.

How can I comment on the State Plan Amendment?

  1. Read the public notice.
  2. Read the draft of the State Plan Amendment. 

Email Jessica.Diaz@hca.wa.gov to make any comments on the State Plan Amendment.

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. The survey is now closed.

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.

Community behavioral health legislative funding increases

There have been several legislatively mandated rate increases that affect behavioral health providers in 2023. Read an FAQ about these funding and rate increases to learn more.

Behavioral health provider listening session

Every month, HCA hosts a listening session for behavioral health providers to provide Division of Behavioral Health and Recovery (DBHR) program updates.

Related links