The Senate budget puts forward significant changes to how care is delivered for patients living with a mental illness. WSHA is supportive of this new direction that attempts to address some of the underlying problems with the system, including moving care from the state hospitals to community hospitals and caring for patients post-hospitalization. We will be working to ensure these changes make effective investments in the system to ensure care can be delivered in the most appropriate settings.
The budget decreases state hospital beds, moves patients to community hospitals and invests in post-acute discharge facilities. It also assumes that 90- and 180-day mental health commitments at state hospitals will be paid for through Medicaid managed care plans by 2020. The possible effects and timing of this change may create some uncertainty, especially in light of the many other changes in behavioral health funding that will be happening on that same time schedule.
In summary, the budget provides the following community investments:
- Medicaid billing for integrated mental health in primary care. WSHA advocated for changing Medicaid billing codes in order to pay for coordinated mental health care provided by on-site care managers working with off-site psychiatrists. ($4 million).
- 90/180 day commitments in community hospitals. Beginning January 1, 2019, the state will begin to pay for and contract with willing community hospitals to serve patients on 90/180 day commitment orders who would otherwise go to the state hospital. The budget invests $10.5 total funds in 2017-2019 and $37 million in 2019-2021. WSHA is working with a handful of hospitals that are interested in providing treatment.
- Psychiatric rate increase. WSHA advocated for a payment correction using additional funds for newly opened psychiatric beds. The Senate budget provides $10.8 million in the biennium which should address this need and may allow for some general increase for inpatient psychiatric care.
- Other mental health investments. The state also invests in $10.8 million in crisis walk in centers and $3 million in community-like centers with resources for mental health clients.
- Post-acute setting rate increase. The budget assumes a rate increase for patients with behavioral health needs who hospitals have troubles discharging back to the community ($21.8 million). The budget also increases payment for adult family homes, nursing homes, community facilities and home care agency serving patients with developmental disabilities and patients with long term care needs ($164 million).
The budget also makes the following budget changes targeting Western and Eastern State Hospitals.
- In January 2019, the budget assumes the closure two civil wards for a savings of $3.4 million. In the 2019-2021 budget, the budget assumes the closing of several wards. WSHA is still analyzing the assumptions behind these closures and it is our position that we need to ensure we have enough capacity before taking beds offline.
- Targets decreasing the state hospital waitlists for $12.9 million for patients who need placement in adult family homes etc. As well as, an addition $3.3 million to develop new state operated facilities for people living with developmental disabilities.
- Invests $53 million for staff to comply with the Centers for Medicare and Medicaid Services Conditions of Participation.
More education slots and clinical training for psychiatric advanced registered nurse practitioners. WSHA advocated to provide funding in order to increase the number of mental health providers.