Resources for behavioral health providers

Behavioral health covered services

All behavioral health services are covered by:

• Apple Health managed care plans.
• Apple Health Behavioral Health Services Only.
• Apple Health coverage without a managed care plan (also known as fee-for-service).

Billing resources

For MCOs and BH-ASOs

• Billing toolkit for behavioral health agencies
• How do providers identify the correct payer?

For FFS providers

• Provider billing guides and fee schedules
• ProviderOne Billing and Resource Guide
• Provider enrollment and contract information

Evaluation tools

Involuntary treatment

• Designated crisis responders (DCR)
• NPI list for ITA hearings

Eligibility/preauthorization/screening

• Preadmission Screening and Resident Review (PASRR)

Global Appraisal of Individual Needs-Short Screener (GAIN-SS)

The Global Appraisal of Individual Needs Short Screener (GAIN-SS) is a brief 10-minute instrument designed to quickly and accurately screen general populations of both adults and adolescents for psychiatric disorders, substance use disorders, or crime and violence problems. A result of moderate to high problem severity in any single area or overall suggests the need for further assessment.

• GAIN-SS version 3.0 (fillable version)
• GAIN-SS version 3.0 (not fillable version)
• Previous GAIN-SS form
• Scoring the GAIN-SS
• GAIN-SS manual

Behavioral Health Assessment Solution (BHAS)

• BHAS new features and updates webinar (January 2022)

Reporting tools

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.

• Behavioral Health Data System (BHDS) data guide (version 5.9)

Transition resources

• List of inpatient providers enrolled in ProviderOne
• TARGET user instructions

For substance use prevention

Online reporting system (Minerva)

Additional resources

Behavioral health service delivery guide

The Health Care Authority (HCA) was tasked with the development of a statewide behavioral health service directory that would include a comprehensive list of behavioral health services throughout Washington state.

HCA contracted with a consultant, Berry Dunn, who developed a guide that reflects current information on the service modalities, facilities, and providers that make up Washington's community behavioral health delivery system.

• View the behavioral health service delivery guide. (July 1, 2023)

Behavioral health provider listening session

Every month, HCA hosts a listening session for behavioral health providers to provide program updates.

• Subscribe to receive monthly invitations.
• View November's listening session slides.

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.

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.

View behavioral health enrollee reports.

Behavioral health comparison rates project

HCA, in partnership with our contract actuaries at Milliman, is working on a project to develop comparison rates for behavioral health services. These rates are intended to estimate the actual provider cost of delivering specific behavioral health services and serve as a transparent benchmark to compare current payment levels to. This work is limited to Medicaid services covered under Section 13(d) of the Washington Medicaid State Plan.

Background

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. Read the Phase 2 report.
• Phase 3: Multi year phase. Development of comparison rates for services not addressed in Phase 1 or Phase 2. Continued refinement of Phase 1 and Phase 2 rates. Prepare to implement a minimum fee schedule (MFS) based on the comparison rates. Estimate the cost of implementing a MFS based on the comparison rates. View the stakeholder kick off presentation.

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 wage and cost survey

HCA and Milliman are releasing a provider cost and wage survey to gather specific information and feedback from a wide range of providers. The information you and other providers submit through the survey, along with other data sources, will be used to refine the comparison rates developed in phase 1 and 2 of this project, as well as inform rates for services not previously covered. Your input will provide important insights into behavioral health provider costs and wage.

How do I participate in the survey?

• Download the Excel-based survey and complete it for your organization.
• Email your completed copy to Milliman.
• If you use a screen reader and need additional assistance completing the survey, email Milliman for individual support.

What is the timeline for participating in the survey?

The survey is open from November 4 through January 10.

Who should complete the survey?

Providers delivering services under Section 13d Rehabilitative Services of Washington’s Medicaid State Plan. These include mental health and substance use disorder outpatient providers, substance use disorder and mental health residential providers, and WISe and PACT service providers. For purposes of this survey, the term “provider” refers to an individual or entity engaged in the delivery, ordering, or referring of the above-mentioned services.

Need more help?

Watch an instructional video for a detailed walk through on how to complete the survey or read frequently asked questions.