Under the microscope: WA mental health contracts
Any agency involved with mental health services has likely engaged a Regional Support Network (RSN) to access state and Medicaid funds. Every hospital, clinic, therapist, even homeless service provider must go through their respective RSNs in order to receive any support. These RSNs have wide-ranging authority over who receives funding, and how much they receive.
Washington state consists of 11 RSNs, operated by both public and private entities. RSNs are empowered to provide or manage everything from psychiatric care to crisis residential services, dictated by a number of different contracts with the state Division of Behavioral Health and Rehabilitation.
These contracts are public record but are not easily obtained. After several months of public record requests, State of Reform was able to obtain almost 4500 pages worth of contracts with all eleven Washington RSNs. You can access an RSN Map here.
Despite the ubiquity of RSNs in health administration, too few truly understand the nature of the relationship between the RSNs and the state while even fewer understand what outcomes and metrics to which the RSNs are held.
That is why we are providing you with not only an analysis of the different contracts, but the actual copies of the contracts themselves. Click through the menu below to find links to each RSN contract and the most recent amendment (where applicable). Brief descriptions of each type of contract can be found below the menu.
King County RSN
Optimum Health/Pierce County RSN
North Sound Mental Health Administration RSN
Spokane County RSN
Southwest Washington Behavioral Health RSN
Thurston Masin RSN
Greater Columbia Behavioral Health RSN
Grays Harbor County RSN
Chelan/Douglas County RSN
Primary contracts cover several areas, from direct therapeutic services, inpatient treatment, even housing in some cases. Each base contract is amended on an annual basis in order to change or introduce newly-required services or processes that the RSN must follow. The contract categories include:
Mental Health Block Grant Contracts (MHBG): The purpose of the MHBG contract is to provide services to promote recovery for seriously mentally ill (SMI) adults and resiliency for seriously emotionally disturbed (SED) children, as dictated by federal laws and regulations. Contractors are required to submit an MHBG plan, which dictates the types of services for which the RSN will be responsible. Regular progress reports are required in order to track the outcomes identified in the MHBG plan. It should be noted that while certain expectations are outlined, the special terms and conditions do not include specific methods or metrics that the RSN would use to show progress, outside of those established by the RSNs in the plan.
State Mental Health Contract (SMHC): SMHC concerns mental health services supported by state funds only. These contracts are similar to PIHP contracts in structure. Amendments to these contracts include some region-specific changes focused around local fund dispersal, among other things. The most recent amendment adds the same transfer protocol established in the PIHP contracts.
Prepaid Inpatient Health Plan Contracts (PIHP): PIHP consists of prepaid capitated payments for inpatient hospital or institutional services. PIHP contracts are more extensive than most other RSN contracts in that they go into much more detail regarding definitions, processes, and requirements. The base contract includes 17 sections and is 67 pages long not including anywhere from one to five exhibits. Amendments to PIHP contracts authorize continued funding, establish new rates, and highlight new services, such as Wraparound Intensive Services (WISe). The most recent amendment also established the RSN Transfer Protocol, which requires RSNs to establish protocols for transferring individuals to other RSNs when necessary. The referring RSN is responsible for specialized, non-Medicaid services for a period of time between six and twelve months, determined by the number of risk-factors present at the time of transfer.
Projects for Assistance in Transition from Homelessness (PATH): Services provided under PATH include case management, housing assistance and mental health services for homeless adults with a diagnosable and persistent mental or emotional impairment, including co-occurring substance use disorders. A federally-funded program with a non-federal funding match, the PATH contract authorizes an RSN to provide these services as dictated by federal regulation.
Permanent Supportive Housing (PSH): PSH is an evidence-based practice of the Permanent Options for Recovery-Centered Housing (PORCH) grant. The structure of these contracts is similar to others with the exception of its performance standards, which are much more extensive and detailed. In fact, much of the funding provided under this contract is contingent upon timely filing of reports showing progress towards outcomes identified in the contract.
All of these contracts are intended to ensure that RSNs are providing adequate mental health and supportive services for a wide spectrum of individuals, including single adults, families, children and those experiencing, or at risk of experiencing, homelessness.
While many changes are on the horizon for RSNs, maintaining a clear understanding of their roles is good practice in holding them accountable moving forward.