WAC 182-531-0425 Collaborative Care

WAC 182-531-0425 Collaborative Care

Effective March 23, 2018

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:
   1. 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.
   2. Collaborative care model is a model of behavior health integration that enhances usual primary care by adding two key services:
      1. Care management support for patients receiving behavioral health treatment; and 
      2. Regular psychiatric consultation with the primary care team, particularly clients whose conditions are not improving.
   3. 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:
      1. Psychiatrists;
      2. Psychologists;
      3. Psychiatric advanced registered nursing professionals;
      4. Physician assistants working with a supervising psychiatrist;
      5. Psychiatric nurses;
      6. Mental health counselors;
      7. Social workers;
      8. Chemical dependency professionals;
      9. Chemical dependency professional trainees;
      10. Marriage and family therapists; and 
      11. Mental health counselor associates under the supervision of a licensed clinician.
3. The primary billing provider must meet all of the following:
   1. Be enrolled with the agency as one of the following:
      1. A physician licensed under Titles 18 RCW and 246 WAC;
      2. An advanced registered nurse practitioner licensed under Titles 18 RCW and 246 WAC;
      3. 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;
      4. An FQHC; or 
      5. an RHC.
   2. Complete, sign, and return the Attestation for Collaborative Care Model, HCA 13-0017, to the agency; and 
   3. Agree to follow the agency's guidelines for practicing a collaborative care model.
4. Providers of collaborative care must:
   1. Use a registry to track the patients clinical outcomes;
   2. Use a validated clinical rating scale;
   3. Ensure the registry is used in conjunction with the practice's electronic health records (EHR);
   4. Include a plan of care; and
   5. 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, 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, HCA 13-0017.