State in Process of Drawing Boundaries for Behavioral Health Purchasing

October 22, 2014


The Washington State Health Care Authority (HCA) and the Department of Social and Health Services (DSHS) are in the process of determining the regional boundaries they will use for purchasing mental health and substance use disorder services in the future.  The state has released its proposed regional service area boundary plans dividing the state into 10 regions, and has been accepting comments on the proposal.  The state has heard from the Washington State Hospital Association (WSHA) and the Association of Washington Public Hospital Districts (AWPHD), as well as others, that two of the regions pose problems for medical referral patterns: Cowlitz County and the Central Region, where some question if Spokane is the right boundary area for central counties.  Stakeholders held a meeting on Monday, October 6, 2014 in Wenatchee to discuss options for revising the regional service areas boundaries for central region counties.

The boundary lines will be immediately important for mental health and substance use disorder services delivered by the Regional Support Networks (soon to be renamed Behavioral Health Organizations).  In the short term, Medicaid managed care plans in the areas will continue to cover acute care, mental health, and substance use disorder service for non-Regional Support Network clients.  Long term, state law requires the financial integration of all Medicaid acute care and behavioral health services.  In the future, these boundary lines will serve as the contracting areas and funding streams for all medical services for all Medicaid clients.  WSHA and AWPHD will continue to work with HCA to understand the impact of the boundary lines on medical care referral patterns. (Zosia Stanley,

Medicare Advantage Open Enrollment Begins

The open enrollment period for seniors to choose their Medicare Advantage (MA) plan for 2015 began on October 15.  Seniors wishing to enroll in a MA plan for 2015 must do so by December 7. Hospitals may wish to compare the new plan offerings to their current enrollment to prepare for any potential changes or shifts in their MA enrollment. Hospitals will also want to inform patients which MA plans they are contracted with. As of October, more than 340,000 Washington residents were enrolled in MA plans.

Hospitals and providers can access a report of current MA enrollment in their county.   The plan offerings available for 2015 can be determined on the Centers for Medicare and Medicaid Services (CMS) Medicare Plan Finder website. (Andrew Busz,

CMS Announces New ACO Models  

On October 15, the CMS announced the availability of new Accountable Care Organization (ACO) models, with applications available summer 2015.  CMS is expanding its model options to encourage the establishment of new ACOs in rural and underserved areas and to encourage existing ACOs to accept additional financial risk.  Establishment of ACOs in rural areas has so far been limited due to the high numbers of enrollment required, though some efforts are underway.  It is unclear how the new model options will interact with these efforts. For more on the new model, see the CMS Fact Sheet. (Andrew Busz,


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