Behavioral health Medicaid rate increases must be grounded with the rate-setting process for the provider type or practice setting. The Health Care Authority (HCA) must work with the actuaries responsible for establishing Medicaid rates for Behavioral Health Services to assure appropriate adjustments are made.
The authority shall establish a process for verifying that funds appropriated for targeted behavioral health provider rate increases are used for that objective. The process must establish transparency and accountability mechanisms to demonstrate that appropriated funds for targeted behavioral health provider rate increases are passed through, in the manner intended, to the behavioral health providers who are the subject of the funds. Additionally, the process must include a method for determining if the funds have increased access to the behavioral health services offered by the behavioral health providers who are the subject of the rate increases. The process must include the participation of representatives from the Managed Care Organizations (MCOs), behavioral health administrative services organizations, and providers that are the subject of the rate increases. By November 1st of each year, the authority shall report the established process for each appropriation.
Striker amendment 1246:
- Adds MCOs to the entities the HCA must work with in ensuring that behavioral health rate increases include appropriate adjustments for services that are paid with case rate
- Requires actuarial information be included in the process for verifying provider rate increases are used for the objectives stated in the appropriation and that the process establish which behavioral health provider types the funds are intended for
- Allows for the process to:
- Include a quantitative method for determining if the funds have increased access to behavioral health services
- Ensure the viability of pass-through payments in a capitated rate methodology
- Ensure that Medicaid rate increases account for the impact of value-based contracting on provider reimbursements and implementations of pass-through payments.
- Clarifies the requirements of the bill apply to rate increases provided through MCOs
The process is no longer required but instead allowed to include representatives from specified organizations and the method to determine whether the funds provided for rate increases have increased access to services may be quantitative