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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 182. Health Care Authority |
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Chapter 182-538A. Washington apple health fully integrated managed care (FIMC). |
Section 182-538A-050. Definitions.
Latest version.
- The following definitions and abbreviations and those found in chapters 182-500 and 182-538 WAC apply to this chapter."Administrative hearing" means an adjudicative proceeding before an administrative law judge or a presiding officer that is governed by chapters 34.05 RCW and 182-526 WAC."Appeal" means a request for review of an action under WAC 182-538-110 and 42 C.F.R. Sec. 438.400(b)."Apple health adult coverage (AHAC)" means the range of services available to people eligible to receive health care coverage under the Washington apple health modified adjusted gross income (MAGI)-based adult coverage."Behavioral health" includes mental health, substance use disorders and conditions, and benefits related to treatment."Behavioral health administrative services organization (BH-ASO)" means an entity selected by the agency to administer behavioral health services and programs, including crisis services for all individuals in a defined regional service area, regardless of an individual's insurance status or ability to pay."Behavioral health services only (BHSO)" - The program in which enrollees only receive behavioral health benefits through a managed care delivery system."Brief intervention treatment" – Solution-focused and outcome-oriented cognitive and behavioral interventions intended to improve symptoms, resolve situational disturbances that are not amenable to resolution in a crisis service model of care, and which do not require long-term treatment to return the individual to previous higher levels of general functioning. This service is provided by or under the supervision of a mental health professional."Crisis services" – See WAC 182-538C-150."Division of behavioral health and recovery (DBHR)" means the department of social and health services designated state behavioral health authority to administer state-only, federal block grant, and medicaid-funded behavioral health programs."End enrollment" means ending the enrollment of an enrollee for one of the reasons outlined in WAC 182-538A-130."Fully integrated managed care (FIMC)" means the program covered by this chapter, under which behavioral health services are added to an agency managed care contract."Mental health professional" means:(a) A psychiatrist, psychologist, psychiatric nurse, or social worker as defined in chapters 71.05 and 71.34 RCW;(b) A person who is licensed by the department of health as a mental health counselor, mental health counselor associate, marriage and family therapist, or marriage and family therapist associate;(c) A person with a master's degree or further advanced degree in counseling or one of the social behavioral sciences from an accredited college or university who has at least two years of experience in direct treatment of persons with mental illness or emotional disturbance that was gained under the supervision of a mental health professional and is recognized by the department of social and health services;(d) A person who meets the waiver criteria of RCW 71.24.260, which was granted before 1986;(e) A person who had an approved waiver to perform the duties of a mental health professional that was granted by the mental health division before July 1, 2001; or(f) A person who has been granted a time-limited exception of the minimum requirements of a mental health professional by the department of social and health services consistent with WAC 388-865-0265."Patient days of care" means all voluntary patients and involuntarily committed patients under chapter 71.05 RCW, regardless of where in the state hospital the patients reside. Patients who are committed to the state hospital under chapter 10.77 RCW are not included in the patient days of care. Patients who are committed under RCW 10.77.088 by municipal or district courts after failed competency restoration and dismissal of misdemeanor charges are not counted in the patient days of care until a petition for ninety days of civil commitment under chapter 71.05 RCW has been filed in court. Patients who are committed under RCW 10.77.086 by a superior court after failed competency restoration and dismissal of felony charges are not counted in the patient days of care until the patient is civilly committed under chapter 71.05 RCW."Regional service area (RSA)" means a single county or multi-county grouping formed for the purpose of health care purchasing and designated by the agency and the department of social and health services."Wraparound with intensive services (WISe)" is a program that provides comprehensive behavioral health services and support to:(a) Medicaid-eligible people age twenty or younger with complex behavioral health needs; and(b) Their families.
Rules
182-500,182-538,182-526,182-538-110,182-538C-150,182-538A-130,388-865-0265,