Section 388-865-0242 - Behavioral health organizations-Payment for behavioral health services Within available resources as defined in RCW 71.24.025(2), a behavioral health organization (BHO) must ensure an individual's eligibility for and payment for behavioral health services meet the following:
(1) An individual who is eligible for medicaid is entitled to receive covered medically necessary behavioral health services without charge to the individual, consistent with the state's medicaid state plan or federal waiver authorities. A medicaid recipient is also entitled to receive behavioral health services from a behavioral health organization (BHO) managed care plan without charge.(2) An individual who is not eligible for medicaid is entitled to receive behavioral health services consistent with priorities established by the department. The individual, the parent(s) of an individual who has not reached their eighteenth birthday, the individual's legal guardian, or the estate of the individual: (a) Is responsible for payment for services provided; and(b) May apply to the following entities for payment assistance:(i) The health care authority (HCA) for medical assistance;(ii) The behavioral health service provider for payment responsibility based on a sliding fee scale; or(iii) The BHO for authorization of payment for involuntary evaluation and treatment services.Wash. Admin. Code § 388-865-0242
Adopted by WSR 16-13-087, Filed 6/15/2016, effective 7/16/2016