New law takes major step in transforming behavioral health care

Inslee signs legislation to improve access to opioid-dependence treatment, mental health and other behavioral health services

Gov. Jay Inslee congratulates Rep. Eileen Cody during a bill signing ceremony Thursday, March 22, 2018, for HB 1388. (Legislative Support Services photo)

As part of his effort to transform mental health and substance abuse treatment services in Washington state, Gov. Jay Inslee signed a bill today that overhauls the oversight of behavioral health programs in Washington and integrates those programs with other health care services.

The move is part of a larger plan to transform the way Washington treats patients with behavioral health disorders. Instead of administering physical, mental and chemical-dependency health services as separate systems, Inslee has called for integrating behavioral and physical health care by 2020 to get more people treatment, including preventive services to help them avoid civil commitments at state psychiatric hospitals. The Legislature approved this effort in 2014.

Oftentimes, behavioral health patients end up in county jails, which are not ideal places to administer mental health or addiction treatment.

Instead, state health officials envision a robust health care system that treats the whole person — body and mind — and that streamlines state agencies to provide those services as efficiently and conveniently as possible.

Part of that vision includes increasing the number of behavioral health resources available throughout the state, so that patients can receive treatment in their own communities rather than in one of the state’s two psychiatric hospitals if that level of treatment is necessary.

The supplemental budget passed by the 2018 Legislature includes funding toward this goal, including more than $10 million to support opioid-abuse treatment, $69.3 million for behavioral health enhancements statewide, and more than $1 million of funding to expand Assisted Outpatient Treatment programs, which allow more patients to receive treatment in their own communities.

“Historically, mental health, substance-use disorder and physical health care services were delivered in different systems of care, making it difficult for patients to access all of the medical services and preventive care they needed,” Inslee said just before signing the legislation, HB 1388. “Our state is moving quickly to integrate behavioral health care and physical health care across the state, and we’re ready to make these agency structural changes right away.”

(Washington State Health Care Authority)

Reforming health care by ‘treating mind and body together’

The legislation requested by Inslee moves oversight of behavioral health programs out of the Department of Social and Health Services to the Health Care Authority and Department of Health, the two agencies that oversee the state’s mental and physical health care programs.

The measure’s primary sponsor, Rep. Eileen Cody, agreed that the bill is an important step in reforming health care in the state.

“Washington has been working to integrate our physical and behavioral health systems,” Cody said. “Treating body and mind together is imperative to addressing health care for all Washingtonians. We’ve already addressed purchasing and treatment and this is the last step in that process and brings oversight to the system. I am proud we’ve been able to make this dream a reality.”

The bill designates HCA as the state’s authority for behavioral health services and tasks the agency with developing a behavioral health program, including partnering with behavioral health organizations and requesting any necessary Medicaid waivers from the federal government.

Under the measure, HCA will also be responsible for:

  • Leading the state effort for physical and behavioral health integration in the Medicaid program.
  • Developing programs to prevent drug addiction, coordinating addiction services with other agencies and creating educational programs for people with addiction disorders.
  • Coordinating with state regions, counties, health care providers, tribes and other entities to provide services at the local level.

“As we work to integrate physical and behavioral health care services for Apple Health (Medicaid) clients around the state, we are excited to integrate the work at the state agency level, too,” HCA Director Sue Birch said. “This legislation will allow us to better treat the whole person by bringing together the state-level systems that do this work.”

Meanwhile, the bill aligns professional services within the Department of Health. DOH will be responsible for:

  • Certifying and licensing behavioral health providers and related service programs.
  • Establishing minimum standards for service providers and community services.
  • Disciplining service providers and community services that fail to meet those standards.
  • Tightly coordinating with HCA on prevention.
Gov. Jay Inslee and Navos’ Inpatient Programs Director Ravenna Candy, center, tour a Navos residential facility in 2016 in Seattle with Sandra, a resident. (Office of the Governor photo)

David Johnson, CEO of Navos and a licensed mental health counselor who has led community mental health organizations in King County for 30 years, praised the legislation.

“Abundant research and evidence support that the most effective and economical way to achieve whole person wellness is to fully integrate behavioral health into the full range of medical services,” he said. “Behavioral health has matured as a medical specialty, now using evidence-based practices and achieving measurable outcomes in improved psychological and physical functioning.”

Navos is one of the largest licensed community behavioral health care organizations in Washington, offering inpatient, outpatient and residential treatment for people of all ages, from infants to senior citizens.

“In order to best achieve integration,” Johnson added, “it makes sense to combine all these healthcare specialties into the Health Care Authority where the integration can be developed into smart system initiatives and practice protocols that reduce costs, increase the quality of care, and, ultimately, save lives. The HCA and DOH have long established ways of collaborating to promote this.”

DSHS will keep its authority over operating and maintaining state hospitals and the Child Study and Treatment Center. State leaders are analyzing whether and how to best move those services to HCA at a future date.