Page 261

appropriation are provided solely for the authority to maintain pilot 1 programs for intensive outpatient services and partial 2 hospitalization services for certain children and adolescents and, 3 pursuant to chapter 94, Laws of 2022 (2SSB 5736), add coverage for 4 these services into the state medicaid program beginning January 1, 5 2024. 6 (a) The authority must establish minimum standards, eligibility 7 criteria, authorization and utilization review processes, and payment 8 methodologies for the programs in contract. 9 (b) Eligibility for the pilot sites is limited pursuant to the 10 following: 11 (i) Children and adolescents discharged from an inpatient 12 hospital treatment program who require the level of services offered 13 by the pilot programs in lieu of continued inpatient treatment; 14 (ii) Children and adolescents who require the level of services 15 offered by the pilot programs in order to avoid inpatient 16 hospitalization; and 17 (iii) Services may not be offered if there are less costly 18 alternative community-based services that can effectively meet the 19 needs of an individual referred to the program. 20 (c) Eligibility for services through the state medicaid program 21 shall be consistent with criteria approved by the centers for 22 medicare and medicaid services pursuant to implementation of chapter 23 94, Laws of 2022 (2SSB 5736). 24 (d) The authority must collect data on the program sites and work 25 with the actuaries responsible for establishing managed care rates 26 for medicaid enrollees to develop and submit an annual report to the 27 office of financial management and the appropriate committees of the 28 legislature each December of the fiscal biennium that includes the 29 following information: 30 (i) A narrative description of the services provided at each 31 program site and identification of any specific gaps the sites were 32 able to fill in the current continuum of care; 33 (ii) Clinical outcomes and estimated reductions in psychiatric 34 inpatient costs associated with each of the program sites; 35 (iii) Recommendations for whether the pilot models should be 36 expanded statewide, whether modifications should be made to the 37 models to better address gaps in the continuum identified through the 38 pilot sites, whether the models could be expanded to community 39 behavioral health providers, and whether statewide implementation 40 p. 260 ESSB 5187.SL