If you are caring for a resident currently receiving behavioral health personal care (BHPC) MCO wraparound funding through a Managed Care Organization (MCO) – you need to take action. This funding will soon transition to Community Behavioral Health Supports (CBHS)-Supportive Supervision on July 1, 2024.
To continue to get paid for your eligible resident(s) after July 1, 2024, you will need to have a contract with the Health Care Authority (HCA) and the resident’s assigned MCO.
About This Change
The state is transitioning BHPC to a new program called Community Behavioral Health Supports (CBHS). CBHS services will be authorized and paid for by the Health Care Authority (HCA) for the Fee for Service (FFS) population or Managed Care Organizations (MCO) for Medicaid Managed Care members.
Most clients currently approved for BHPC MCO funding will qualify for the new service called “Supportive Supervision”.
Beginning July 1, 2024, Home and Community Services (HCS) will no longer have authority to authorize or pay for BHPC in a residential facility for:
- Any new residents, and
- Current residents during the implementation year (July 2024-June 2025) once the residents’ annual CARE assessment is completed. This means if a current resident is receiving BHPC, and their CARE assessment is due in November 2024, the provider will continue to have BHPC authorized and paid through HCS until November 2024. If eligible for CBHS service authorization and payment will transition to HCA/MCO on December 1, 2024.
There are two Managed Care Organization (MCO) services:
- Community Behavioral Health Supports (CBHS)–or-
- Intensive Behavioral Supportive Supervision (IBSS)
Eligibility for each service is based on diagnoses and behaviors. Both services are paid out to you at a tiered rate, based on the average number of supportive supervision hours needed.
The tier is determined by the MCO with input from the provider (good documentation will help ensure the resident is placed in the appropriate tier). To be paid for providing these services, providers need to complete the Core Provider Agreement through ProviderOne and then contract with the MCO that the resident is enrolled in.
Providers can choose to contract with all 5 MCOs so they are able to admit residents enrolled in a specific MCO who need these services.
Here are the training resources to learn more about the eligibility requirements for each program, how to complete the Core Provider Agreement, how to contract with the MCOs and how to bill/get paid from the MCOs.
Please see the highlighted recording and presentation slides from the trainings done by the Health Care Authority and MCOs. This section walks you through the required paperwork. Reach out to the MCO you are working with that is covering your resident for their specific paperwork.
Webinar Recordings and Presentation Slides
Recordings and presentation slides from recent trainings that will walk you through the Core Provider Agreement and Contracting processes are available below:
- Introduction to Supportive Supervision (CBHS/IBSS)
- Completing the Core Provider Agreement
- Information about Contracting with MCOs
Contact the Health Care Authority for help with completing the Core Provider Agreement and contracting with MCOs at: hca1915iservices@hca.wa.gov
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