RCW 71.24.045 gives BH-ASOs the statutory authority to contract with commercial carriers for Behavioral Health Crisis Services within their designated Region.

RCW 71.24 would not give  authority to a BH-ASO to contract outside of their designated region. However, one BH-ASO could contract with another BH-ASO to provide services for them in their region.

The BH-ASO can act as a provider network in their designated Region assuming that the BH-ASO has contracts with a sufficient number of behavioral health emergency services providers.  The BH-ASO would not be considered a Health Care Benefits Manager (HCBM) and as such are not subject to specific HCBM regulatory requirements.

When a BH-ASO negotiates with carriers, the negotiated rates should include their administrative costs.

As part of the contracting arrangement with commercial carrier, the carriers are likely to ask BH-ASO to provide them with the information about Mobile Crisis Response providers (initial set of information and updates) so that the carriers can communicate this to the OIC on Form A.

“Documentation of good faith efforts to contract may include, but is not limited to:”

This change permits a  carrier to submit certain  information to the Office of the Insurance Commissioner to show good faith efforts to contract. In recognition of the work that the carriers and the BHES Workgroup are currently engaged in, OIC confirmed to the carriers that for PY2023 they could submit  the following types of information to show “good faith efforts” in addition to outreach to providers/facilities to demonstrate to the OIC that they are working towards obtaining a contract for PY2024:

a.  Participation dates/level with working group  (for example – X person attends the meetings for Carrier)
b. Project plan for PY2022 that includes work to date and any items that are resolved
c.  Project plan for PY2023 to get to contract (could involve contracts with providers directly or via BH-ASO)
d. List of individuals, both internal and external, that they are working with (identify BHASOs, Providers, etc).

The AADR must follow standard requirements to waive coinsurance and must ensure the member incurs no greater cost then if a contract were executed.  This could mean paying billed charges.

OIC Commentary:

The carriers did request clarification as to whether these principles applied to both mobile crisis response  providers and  facilities.  The carriers may already have contracts or are in a better position to obtain contracts with the facilities at this point.  The   rule applies to both situations.  The carrier can make   a business decision as to whether they want  to file one AADR to address BH Emergency Services as a whole  or  submit separate AADRs to address the unique challenges specific to each service  in the BH Emergency delivery system (meaning Mobile Crisis Response Team and Facility).

Agencies will be credentialed at the agency level, per their DOH licensure.

270-271 transaction exchange / web portal queries, either directly with the carrier or via an eligibility clearinghouse service, will be the methodology used for determining eligibility, unless the BH-ASO and the commercial carrier mutually agree on a different approach in a Region, e.g., BH-ASO repository.

b) A fee-for-service billing methodology will be followed unless the BH-ASO and the commercial carrier mutually agree upon a fixed-cost or alternative methodology. Rates (Fee-for-Service or otherwise ) will be negotiated between the BH-ASO and the commercial carrier.

Claims (837) will be submitted to the commercial carrier by the BH-ASO on behalf of the agencies and any reimbursement (835) will be made to the BH-ASO.

c) The BH-ASO will pay providers the current fixed cost amount regardless of the payment amount received from the commercial carrier.

HCA’s allocation of General Fund Dollars to the BH-ASOs will remain the same

d) Revenue Cycle Systems for BH-ASOs and secure infrastructure to send 837Ps to Commercial Carrier and receive 835s and payments will be required.

Per HCA review of proviso language (05-31-2023 Meeting Synopsis), the BH-ASOs can use existing General Fund dollars to improve their system capabilities.  This would be improving the crisis system to allow for other insurance to cover crisis services based on legislation.  Up to 5% can be used on utilization and quality management, up to 10 % of administration.  Improving system capabilities could be either bucket.

When a claim is submitted to the commercial carrier, the carrier will adjudicate the claim based upon the patient’s/enrollee’s benefits and will reimburse the carrier’s contracted amount.  The carrier’s payment amount will not include the amount due from the patient/enrollee to the BH-ASO/Agency for deductible, co-pay, coinsurance or any other applicable cost sharing.  As an example, if the patient/enrollee has a HDHP and has not met their deductible, e.g., $6,500, then the deductible amount must be met  before the Carrier’s is responsible for any payment to the BH-ASO/agency.  For non-HDHP,  the average deductible amount in Washington State for single coverage is $1,740.

Per HCA (07-31-2023 Meeting Synopsis), BH-ASOs can use non-Medicaid funding to cover member cost share that is not paid by the commercial carriers, regardless of income.

Agencies within the Behavioral Health Crisis System will determine if subsequent appointments with the person presenting in crisis are needed. If a Behavioral Health Crisis System provider makes a determination that a person should be seen by a provider outside of the Behavioral Health Crisis System, then they will use the NDA process and contact list to make that appointment.