Behavioral health

Apple Health clients have access to behavioral health (mental health and drug and alcohol treatment) services, including crisis services, short-term mental health treatment, and inpatient psychiatric services.

Learn more about this program and how to become a behavioral health provider.

Behavioral health covered services

In most of Washington

Services are covered as follows:

  • Lower level mental health services are covered by:
    • Apple Health managed care plans, or
    • Apple Health fee-for-service (FFS) program.
  • All other mental health and drug and alcohol treatment services are covered by:
    • Behavioral Health Organizations (BHOs), or
    • Apple Health fee-for-service (FFS) program.

In Clark and Skamania counties

All behavioral health services are covered by:

  • Apple Health Fully Integrated Managed Care plans, or
  • Apple Health managed care plans under the Behavioral Health Service Only benefit package, or
  • Apple Health fee-for-service (FFS) program.

Become a behavioral health provider

Apple Health behavioral health fee-for-service (FFS) program

To provide lower level outpatient mental health and drug and alcohol treatment services

Contact Health Care Authority (HCA) at 1-800-562-3022 (ext. 16137).

To provide all other mental health services

You must be affiliated with a Community Mental Health Agency (CMHA). For more information, contact the Division of Behavioral Health and Recovery (DBHR).

  • To help make this program a success, DSHS and HCA are asking mental health and substance use disorder treatment providers to participate in the Apple Health FFS program. Only DSHS Division of Behavioral Health and Recovery (DBHR) licensed and certified providers are eligible to apply to be an Apple Health behavioral health FFS provider. You do not need to be a Behavioral Health Organization (BHO) provider to be a FFS provider.
  • Once you have indicated your interest in participating, we will provide you with more information and technical assistance to help you become an Apple Health behavioral health FFS provider. This will include:
    • Enrolling with HCA as a billing provider, including signing the Core Provider Agreement; and
    • Ensuring the DSHS Agency Licensing and Certification System (ALCS) database lists the most current Administrator; and
    • Registering with DBHR through the Provider Entry Portal. Providers will submit client data for these clients to the Behavioral Health Data Store through this portal.
  • In order to continue to provide services and receive reimbursement for your current Apple Health (Medicaid) AI/AN clients, or if you are interested in participating as a FFS provider, contact DSHS at bhaffsproviders@hca.wa.gov.

Apple Health managed care program

Behavioral Health Organizations 

American Indian/Alaska Native Apple Health clients

Beginning on July 1, 2017, American Indians/Alaska Natives on Washington Apple Health (Medicaid) will have the choice to receive their Apple Health coverage for treatment of mental health and substance use disorder (together, known as “behavioral health”) either through the managed care program or through the Apple Health fee-for-service (FFS) program.

Providers treating clients in the Apple Health FFS program will bill the state directly through the ProviderOne claims system and be paid according to the published rate schedule.  

Currently, there is not a choice – these clients are automatically enrolled in their local behavioral health organization for mental health services and in the Apple Health fee-for-service program for substance use disorder treatment services. With this change, they will be able to choose their Apple Health coverage for behavioral health services, just like for physical health services.

To find out what coverage an AI/AN client has selected, providers need to check the ProviderOne Benefit Inquiry screen, which will show:

  • The name of the Behavioral Health Organization (if the enrollee has BHO coverage); and/or
  • The name of the Fully Integrated Managed Care Plan (if the enrollee has FIMC coverage); and/or
  • The name of the managed care plan (if the enrollee has Behavioral Health Services Only (BHSO) benefit package.

If the enrollee has active Medicaid coverage but no BHO, FIMC, or BHSO plan is listed, that means that the enrollee has behavioral health fee-for-service coverage.

  • Providers will not be able to see if a client is AI/AN.

To participate

Email: bhaffsproviders@dshs.wa.gov

Questions

Email: ffsquestions@dshs.wa.gov

Note: If AI/AN Apple Health clients are eligible to receive care at an Indian Health Service (IHS) facility, Tribal health program, or urban Indian health program, this change will not affect their ability to receive care at those programs. In addition, those programs may be able to help AI/AN clients make their choice for Apple Health coverage for behavioral health services.