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January 28, 2019

Mental and behavioral health access

During the 2019 state legislative session, the WSMA is supporting funding and policies that provide better care, both physical and mental, to Washingtonians.


Topping the list of WSMA's advocacy imperatives for the 2019 state legislative session is support for mental and behavioral health services. The governor has made investments in behavioral health the centerpiece of his $54.4 billion spending plan released in December, supporting efforts already underway across the state to transform Washington’s behavioral health system. The importance of WSMA’s advocacy efforts during the 2019 session can’t be overstated, to ensure allocation of funds and development of policy in the mental/behavioral health arena are informed by clinician expertise.

Issues we expect to be addressed by lawmakers this session include: supporting Medicaid sustainability and access to care by boosting rates for mental health, substance abuse, and primary care; strengthening the mental/behavioral health workforce through psychiatric fellowships and residencies; improving state mental and behavioral health facilities; providing additional beds for patients with mental, behavioral health, and substance use disorders; and much more.

Why it matters

The WSMA seeks increased access to behavioral health treatment for all patients. We support whole-person care and the state’s effort to integrate mental and behavioral health into primary care settings. Treatment in the primary care setting helps keep problems from becoming acute. To effectively achieve these aims, physician interests such as administrative burden, burnout, and access to care should be integrated into policy development to allow physicians to do what they do best—care for patients.

Call to action

Support increased Medicaid reimbursement for treatment of mental/behavioral health and substance use disorder in primary care:

  • Increase Medicaid reimbursements to Medicare rates for mental/behavioral health and substance use disorder treatments provided in the outpatient primary care setting.
  • Support mental/behavioral health and primary care integration through: increasing accepted patient panel size; increasing number of available clinicians; making participation predictable.

Support mental/behavioral health workforce:

  • Increase funding for student loan repayment program for mental/behavioral health physicians and providers; fully fund unmet need for certain mental/behavioral health professions. Loan repayment can act as a magnet to keep physicians practicing in communities.
  • Increase funding for in-state psychiatric residency and fellowship positions. Evidence shows that the best predictor of where a physician stays to practice is where they complete their training; increasing the number of training opportunities available for mental/behavioral health physicians is a crucial component of addressing Washington’s shortage of psychiatric clinicians.

Support integration of mental/behavioral health treatment in primary care:

  • Expand the list of professions eligible to bill for behavioral health services. As directed by Senate Bill 5779 from 2017, the Health Care Authority has proposed adjustments to payment codes related to integrated primary and behavioral health care to incentivize bi-directional integration. If implemented, we expect expansion of who is eligible to bill under specific codes.

Support tele-psych consult and training programs:

  • Continue to support statewide consultation and training programs to improve access for provider- to-provider consults on patient cases across the state, such as the Child Psychiatry Partnership Access Line (PAL), the new Perinatal Mental Health Support Program (PAL for Moms), and the Psychiatry and Addictions Case Conference (PACC) based on the ECHO model; fund programs that would offer telehealth clinical consultation, training, and support for physicians and providers caring for adults and older adults with mental health and substance use disorders in underserved areas. Consider coupling with an evaluation component to monitor the effect these strategies have on access to behavioral health professionals in underserved areas.

More information

Kathryn Kolan, JD

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