New Health Care Authority (HCA) Opportunity to Support Individuals in Your Setting with Complex Behavioral Health Needs – Coming in 2023

New Health Care Authority (HCA) Opportunity to Support Individuals in Your Setting with Complex Behavioral Health Needs – Coming in 2023

The Health Care Authority has announced some new supports are coming for individuals in assisted living with complex behavioral health needs.

Assisted Living Facilities serving individuals with complex behavioral health needs will be able to contract with the Health Care Authority (HCA) and Managed Care Organizations (MCOs) for new community behavioral health supports. Currently, many individuals are provided additional support through enhanced rates paid by the MCOs but authorized through the Aging and Long-Term Support Administration (ALTSA). Changes are coming that will shift the payment for these additional support services to be paid directly by the HCA and MCOs. 

Last year legislation directed the HCA, in partnership with ALTSA, to create an Apple Health (Medicaid) benefit to better support providers in meeting the needs of individuals with complex behavioral health needs in long-term care settings. To move forward with this new Apple Health benefit, we have submitted a 1915(i) State Plan Home and Community-Based Services application to Centers for Medicare and Medicaid Services (CMS). 

The goal of this benefit is to support eligible individuals towards stabilized living and community integration. This proposed new benefit has an overarching title of Community Behavioral Health Support Services (CBHS) and includes two services: 1) protective supervision and oversight, and 2) skill development and restoration.

What is changing?

Beginning January 2023, this new Apple Health benefit will offer two services:

  1. Protective supervision and oversight
  2. Tailored staffing supports, provided by the Assisted Living Facility, to help the resident retain and/or improve community living.  Including direct monitoring, redirection, diversion, and cueing of the resident to prevent at risk behavior. These interventions are not related to the provision of personal care.
  • Includes some of the behavioral health supports Assisted Living Facilities are currently providing.
  • The main difference is the funding source. Instead of contracting with DSHS, ALFs will contract directly with the Managed Care Organizations for Medicaid enrollees under managed care and HCA for Medicaid enrollees under fee for service to provide this service.
  • ALFs will continue to contract with DSHS directly for personal care (CARE rate). For residents who qualify for protective supervision, these services will be provided concurrently with personal care.
  • This service will be paid based on a per diem rate and tiered according to acuity of the resident.Skill development and restoration
  • Tailored supports to acquire, retain, and/or improve community living skills.
  • New service under Apple Health provided by licensed Behavioral Health Agencies on an hourly basis.  Assisted Living Facilities dually licensed as a licensed Behavioral Health Agency will be an allowable provider type under this new benefit.
  • Interested providers will contract directly with the Managed Care Organizations for Apple Health clients enrolled in managed care and HCA for Apple Health clients without a managed care plan (also known as fee-for-service).
  • Contracted providers will work with the individual’s identified support system (family, care giver, AFH staff, etc.).
  • Interventions may include behavior analysis, as well as emotional and behavioral management.

 Next steps

  • HCA and ALTSA will communicate to providers when we have received full approval from CMS.
  • HCA and ALTSA will set up a webinar meet and greet, as well as provide additional information and guidance.
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Contact Wes Miller at wes.miller@hca.wa.gov with questions.

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