Effective October 1, the Washington state Health Care Authority (HCA) will increase the Medicaid professional fee schedule amounts for designated behavioral health, primary care, and pediatric critical care services. The new payment amounts reflect 15 percent increases for a range of behavioral health and adult primary care services and 21 percent increases for pediatric primary care and pediatric critical care services. HCA will follow the same criteria it used for the temporary primary care increases under the Affordable Care Act, which includes office evaluation and management services by specialty care providers.
The increases were included in the 2021-2023 biennium budget passed by the legislature and apply to services for Medicaid enrollees paid directly by HCA and through the Medicaid managed care organizations. While the new Medicaid payment amounts for these services still lag behind payment by Medicare and commercial insurers, WSHA strongly supports the increases and appreciates the legislature’s efforts to support access to behavioral health and other services to Medicaid enrollees through more sustainable payment.
HCA will post the updated fee schedule with the new payment amounts a few days prior to their October 1 effective date. Click here to view the specific codes that will be subject to the increase. (Andrew Busz, AndrewB@wsha.org)