HCA plans to submit amendment to behavioral health waiver

The Health Care Authority (HCA) is planning on submitting an amendment to the current 1915(b) behavioral health waiver. The HCA posted the following notice outlining what the amendment would accomplish.


The Health Care Authority (HCA) intends to submit an amendment to the current 1915(b) behavioral health waiver. If approved, the proposed changes to the waiver would

  • Facilitate movement of the following regions into a fully integrated model:
    • Pierce County
    • King County
    • North Sound Regional Service Area (Skagit, San Juan, Island, Snohomish, and Whatcom Counties)
    • Greater Columbia Regional Service Area (Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, Whitman, and Yakima Counties)
    • Spokane Regional Service Area (Adams, Ferry, Lincoln, Pend Oreille, Spokane, and Stevens Counties)
  • Move Klickitat County into the Southwest Regional Service Area and move Okanogan County into the North Central Regional Service Area. The Southwest and North Central regions are already participating in the fully integrated approach.
  • Place behavioral health services for foster children in Medicaid managed care into a single statewide Managed Care Organization (MCO).
  • Transfer responsibilities previously delegated to the Division of Behavioral Health and Recovery (DBHR) within the Department of Social and Health Services (DSHS) back to HCA.

Movement of the five regions into the fully integrated model is part of an ongoing transition from a Behavioral Health Organization (BHO) model to a fully integrated approach. In fully integrated regions, there are no BHOs, and MCOs managed both medical and behavioral health services for those individuals in the managed care system. While all regions of the state must adopt the fully integrated model by 2020, the five regions above have chosen to implement full integration earlier, on January 1, 2019.

The transfer of services for foster children into a single MCO is meant to address issues around coordination of care. Under the new approach, if a foster child is moved from one placement to another, having a single entity manage their care across counties is expected to improve continuity of care.

If approved, the waiver amendment will move some oversight and waiver submission responsibilities back to HCA as part of an ongoing agency integration process. Many DBHR responsibilities and staff are being transferred to HCA as part of an ongoing movement toward integrating physical and behavioral health services.

Upon CMS approval, the waiver amendment will take effect on January 1, 2019. A copy of the draft renewal request document can be accessed from the HCA Public Notices webpage.

Note that Section D of the draft waiver will not be updated until the end of September. Please send all comments and questions regarding this amendment to Richard VanCleave, by phone at (360) 725-3703 or by email at richard.vancleave@hca.wa.gov. Comments are due by September 15, 2018. When making comments please reference the page number(s) in the waiver document to indicate the location of the subject matter. Please forward this information to any interested party.