“The mission of the Mental Health Division is to promote recovery and safety.”

WA State Medicaid Mental Health Benefits

The Benefit Booklet for Medicaid Consumers is available for download in the following languages:

Cambodian	Laotian
Chinese	Russian
English	Spanish
Korean	Vietnamese

On this page, you will learn about mental health services available to people who receive Medicaid. You will find:

an explanation of what public mental health services are available;
how those services are provided;
where to get services;
your rights as a person who receives those services
how to protect your rights.

You will also find information about mental health services available in your service area. Service areas where mental health services are coordinated are known as Regional Support Networks (RSNs). You will learn about:

areas served by each RSN;
how to contact the RSNs or their authorized providers;
how to access crisis services; and
the languages in which services are available.

Definitions:

Community Mental Health Agency (CMHA) - A licensed facility providing mental health services. Throughout this page, community mental health agencies will be called agencies.

Emergent Care - Service provided for a person that, if not provided, would likely result in the need for crisis intervention or for hospital evaluation due to concerns of potential danger to self, others, or grave disability.

Enrollee - An individual who is a Medicaid recipient who has been enrolled in a mental health prepaid inpatient health plan.

Medical Necessity or Medically Necessary - A requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions in the recipient that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause or physical deformity or malfunction, and there is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the person requesting service. Course of treatment may include mere observation or, where appropriate, no treatment at all.

Additionally, the individual must be determined to have a mental illness covered by Washington State for public mental health services. The individual's impairment(s) and corresponding need(s) must be the result of a mental illness. The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning resulting from the presence of a mental illness. The individual is expected to benefit from the intervention. Any other formal or informal system or support can not address the individual's unmet need.

Mental Health Care Provider (MHCP) - The individual with primary responsibility for implementing an individualized plan for mental health rehabilitation services.

Mental Health Division (MHD) - The Division within the state Department of Social and Health Services (DSHS) with responsibility for public mental health services.

Mental Health Professional - An individual who meets the standards defined in Washington State law. The standards are based on how much education the person has and how much experience the person has in mental health. Most mental health professionals have a Master's Degree and at least two years experience in mental health. There are some exceptions which are defined in the law. Psychiatrists, psychologists, psychiatric nurses and social workers are all mental health professionals.

Ombudman Service - A person who can help you when you need to file a grievance or fair hearing.

Outpatient Service - Mental health services provided in the community.

Regional Support Network (RSN) - County or group of counties responsible for local public mental health services.

Urgent Care - To be provided to persons approaching a mental health crisis. If services are not received within 24 hours of the request, the person's situation is likely to deteriorate to the point that emergent care is necessary.

Who is eligible for public mental health services?

Medicaid recipients are automatically enrolled in a local mental health managed care plan which is called the Regional Support Network (RSN). RSNs coordinate mental health services offered within their service area through contracts with community mental health agencies.

People who receive Medicaid coupons are eligible for medically necessary mental health services at no cost. Any person needing mental health crisis services is eligible to receive them. If you think that you may need mental health services, you can call or drop by one of the authorized agencies located in the RSN where you live to schedule an appointment to learn what you may need. A list of agencies can be found on the RSN pages. All services must be authorized by the RSN in your area. This process will happen between your agency and RSN.

What services are available?

Hospital and outpatient mental health services are available to you and your family if they are needed. Some of services include:

Crisis services;
Individual therapy;
Group therapy; and
Medication evaluation, prescription and management.

You may also receive employment support services, case management and other services through your RSN.

For more detailed information, please call the RSN for your community listed on the RSN pages or call the Mental Health Division (MHD) at 1-888-713-6010.

Interpreter services are available upon request. Most written materials are translated into languages other than English based upon the service area population.

Some community mental health agencies have staff who speak other languages besides English. There is more information on the page for your RSN. If you or someone you know wants services in another language, your RSN must provide language assistance at no cost to you. Assistance can be provided both orally and in writing.

If you need mental health services, an individual service plan will be developed with you. Your plan will consider your age and your culture. You may receive one or more of the services listed above. The plan will be fit to you, according to your strengths and needs. Your mental health care provider will decide with you which services you will be provided and for how long.

Your mental health care provider may also ask permission to work with people who provide you other services such as housing, healthcare, and employment.

Other Medicaid Benefits

You may qulify for other medicaid benefits depending on other factors

Physical health: Contact information on back of your card

CALL 911 for crisis

Medical Assistance Administration (MAA)

• Family Planning/TAKE CHARGE Hotline	1-800-770-4334
• Emergency Contraception Line	1-888-668-2528
• First Steps (Healthy Mothers, Healthy Babies)	1-800-322-2588
• MAA Customer Service	1-800-562-3022
• Medical Transportation Broker	1-800-624-4793
• Provider Inquiry	1-800-562-3022

Division of Alcohol and Substance Abuse (DASA)

• Alcohol/Drug 24-Hour Help Line	1-800-562-1240
• Washington State Alcohol/Drug Clearinghouse (green book requests)	1-800-662-9111
• DASA Main Line	1-877-301-4557
• Substance Abuse	1-877-301-4557

Division of Children and Family Services (DCFS)

• Child or Adult Abuse & Neglect Report	1-866-363-4276
• Children’s Services (DCFS)	1-800-562-5624
• Child Care Resource & Referral	1-800-446-1114
• Children’s Response Line	1-800-333-8185

Other Agencies or Resources

• Department of Health (DOH) Hotline	1-800-525-0127
• Domestic Violence Hotline	1-800-562-6025
• FAS Family Resource Institute	1-800-999-3429
• National Drug Information, Treatment & Referral Line 24 Hr. 7 days a week – counsel for physicians, providers, clients, general calls with linkage to local contacts	1-800-662-HELP

For Spanish-speaking callers

• For Spanish-speaking callers

1-800-66-AYUDA

Aging and Disability Administration

• Aging & Disability Services Administration

1-800-422-3263

Who provides services?

The Washington State public mental health system has fourteen (14) Regional Support Networks (RSNs). They are made up of one or more counties that serve your county and community. Locate your RSN on the RSN pages. Each RSN contracts with licensed agencies to provide mental health services. You can find information about each RSN and the authorized service providers that contract with the RSNs.

You may only go to these authorized agencies for covered services. You may be responsible for costs if you receive mental health services through other providers.

What choices do I have?

You may choose a mental health care provider at the agency from which you receive services. If you don't choose a mental health care provider, one will be assigned. You have the right to change mental health care providers during the first 30 days. You can also ask for a change once a year for any reason. If you think you have a good reason, you can ask for more changes. The change may or may not be granted.

What if I need crisis services?

If there is a life-threatening emergency, please dial 911. If you have a mental health crisis you can call your RSN's crisis line. All RSNs respond to crises 24 hours every day. You can find your RSN's crisis line looking up your county on the Crisis Line list.

How can I get outpatient services?

If you think you need services, call the toll-free or local telephone numbers. Those are listed with other RSN pages.

Public mental health services are designed to keep you well in your own community. All efforts will be made to keep you from needing hospital care.

What if I needed to be in the hospital for my mental illness?

Psychiatric hospital services are available to Medicaid enrollees. These services are at no cost, but must be approved in advance. If you think you need to be hospitalized, contact your mental health care provider. Your provider will help you with hospital services if they are necessary.

What if I get a bill?

If you received services from an agency that is not contracted with your RSN, you may be responsible for costs. If your coupon was not active, you may have to pay. If you had a coupon and receive a bill for an agencies services in error, contact the agency billing office. If you need further help, contact your RSN.

As a person receiving public mental health services, what are my rights?

YOU CAN EXERCISE THE FOLLOWING RIGHTS:

To be treated with respect and dignity
To have your privacy protected
To help develop a plan of care and services that meet your needs
To participate in decisions regarding your mental health care
To receive services in a barrier-free location (accessible)
To request information about names, location, phones, and languages for local agencies
The right to receive the amount and duration of services you need
To request information about the structure and operation of the RSN
The right to services within 2 hours for emergent care and 24 hours for urgent care
To be free from use of seclusion or restraints
To receive age and culturally appropriate services
To be provided a certified interpreter and translated material at no cost to you
To understand available treatment options and alternatives
To refuse any proposed treatment
To receive care that does not discriminate against you (e.g. age, race, type of illness)
To be free of any sexual exploitation or harassment
To receive an explanation of all medications prescribed and possible side effects
To make an advance directive, which states your choices and preferences for mental health care
To receive quality services that are medically necessary
To have a second opinion from a mental health professional
To file a grievance with your agency or RSN
To file a PIHP appeal based on a PIHP written Notice of Action
To choose a mental health care provider or choose one for your child who is under thirteen years of age
To change mental health care providers during the first 30 days, and sometimes more often
To file a request for an administrative (fair) hearing
To request and receive copy of your medical records and ask for changes
Be free from retaliation

You may want to ask your mental health care provider for more information about your rights. Your rights will be provided to you in writing when you request services. An independent Ombudman may be available in your RSN to help you if you have complaints. When you receive mental health care in a hospital, you have additional rights.

You have the right to request policies and procedures of the RSN and CMHAs as they pertain to your rights.

What is a mental health advance directive?

A mental health advance directive is a written document that describes what you want to happen if you become so incapacitated by mental illness that your judgment is impaired and/or you are unable to communicate effectively. It can inform others about what treatment you want or don't want, and it can identify a person to whom you have given the authority to make decisions on your behalf.

How do I complete a mental health advance directive?

A model "fill-in-the-blanks" form was included in the state law and it is probably the best and easiest way to create a mental health advance directive. You can print or save the mental health advance directive form. Your mental health provider may also have copies of the form.

Does my provider have to follow what I say?

The law requires mental health providers to respect your mental health advance directive, but they are not required to follow it in all cases. If instructions or preferences in your mental health advance directive are against hospital policy or are unavailable, or would violate state or federal law or immediately endanger you or others, providers are not obligated to comply with those provisions. Also, if you are involuntarily hospitalized under the Involuntary Treatment Act, or are incarcerated in jail, your mental health advance directive may not be fully honored.

Member Satisfaction

Once a year, the Mental Health Division does a survey to see what you or your child feel about the services you received. Questions are about access, quality and appropriateness. Your participation is voluntary, however, we strongly believe that your voice is the best way to improve the system. Therefore, we hope that if you are contacted, you will take the time to respond.

What can I do if I am unhappy or unsatisfied with my services?

There are two types of formal complaints and an informal complaint that you may make. The formal types include: 1) a grievance, which is a formal complaint about dissatisfaction with services from the Community Mental Health Agency (CMHA) or a Prepaid Inpatient Health Plan (PIHP), also known as a Regional Support Network (RSN). See below for a description of the grievance process; and 2) an appeal, which is a formal complaint about an action. An action is a denial, suspension, reduction, or termination of certain services. See below for a description of the appeal process. See below for the description of an informal complaint.

What is a complaint?

A complaint is an informal way the state allows you to express your dissatisfaction with either a Community Mental Health Agency (CMHA) or a Prepaid Inpatient Health Plan (PIHP), also known as a Regional Support Network (RSN). It's a good idea to try to resolve your complaint with the person directly involved or ask the Ombudman to assist you, before you try other things. Explain your concern. Let the person know what would work better for you. Be clear about what your complaint is. Also, be clear about what an acceptable solution will be. Try to find some ways to reach agreement that will satisfy both you and the other person.

What does an Ombudman do?

Ombudman receive complaints and help enrollees resolve them. Each PIHP has an Ombudman Service that can assist you with the complaint and grievance process. See listing of Ombudman Service phone numbers listed for each PIHP on the RSN pages. If you are receiving services, your CMHA can also provide you with the number.

What is a grievance?

Grievance means an expression of dissatisfaction about any matter other than an action, as ''action'' is defined in this section. The term is also used to refer to the overall system that includes grievances and appeals handled at the PIHP level and access to the State fair hearing process.

Here are the steps in the grievance process:

To start a grievance, contact the Community Mental Health Agency where you receive services or the PIHP in which you reside. See the RSN pages for a list of PIHPs and CMHAs.
You may request assistance with your grievance from your PIHP's Ombudman service. See the end of this document for the telephone number for the Ombudman service in your PIHP. Interpreter and TTY/TTD services are available to help you, if needed. You may also receive help from other individuals of your choice.
You may start a grievance with a phone call or a letter. If you choose to start with a phone call, you must also send a letter within 7 days. Please include in your letter your name, how to best contact you, the nature of your grievance, and what you are requesting as a resolution for your grievance.
When your CMHA or PIHP receives your grievance, you will get a letter or phone call within one working day telling you that it has been received.
Your grievance will first be considered by people at your CMHA who have not been previously involved with the issue of concern in your grievance. If your grievance is about treatment issues, these people will also be mental health professionals.
While your grievance is under consideration, you may request to continue your services. However, in some circumstances if your grievance is not resolved in your favor, you may be asked to pay for these services.
Your CMHA will make a decision about your grievance within 30 calendar days from the day you started your grievance.
You will receive a written statement of your agency's decision.
If you are unhappy with this decision, you may ask for additional consideration of your grievance from the PIHP but you must do so within 5 calendar days from your receipt of your agency's decision.
Your PIHP will make a decision about your grievance within 60 calendar days from the day you started your grievance, if you started with your agency or within 30 days if you started with your PIHP. You may request an additional 14 calendar days if you believe it is in your best interest to request this extension. Or, in some instances, the PIHP may request up to 14 additional days to make its decision if there is a need for additional information and the delay is in your best interest.
You will receive a written statement of your PIHP's decision.
If you are unhappy with this decision, under certain circumstances you may ask for additional consideration of your formal grievance from the state Mental Health Division but you must do so within 5 calendar days. To contact the state Mental Health Division, call 1-888-713-6010 The whole grievance procedure should not exceed 90 days from the time you started your grievance at the CMHA.
After your grievance is resolved, your CMHA, your PIHP, and the MHD must keep any records about your grievance separate from your treatment records in a confidential file. Also, your PIHP will follow-up with you to be sure that no one has treated you badly because you filed a grievance.

What is an action?

An action is a denial, suspension, reduction, or termination of your services as defined below:

Denial: The decision by a PIHP not to authorize covered Medicaid mental health services that meet the Mental Health Division Access to Care Standards or the Medical Assistance Administration memorandum #01-03 MAA, Psychiatric Hospitalization. The decision by a PIHP not to authorize covered Medicaid mental health services due to lack of medical necessity. The decision by a Community Mental Health Agency not to provide a covered service is not a denial and can not be appealed. However, an enrollee who objects to a CMHA deciding not to provide a covered service may request a grievance or second opinion.
Suspension: The decision by a PIHP to temporarily stop an enrollee's previously authorized covered Medicaid mental health services. The decision by a CMHA to temporarily stop a covered service is not a suspension.
Reduction: The decision by a PIHP to decrease an enrollee's previously authorized covered Medicaid mental health services. The decision by a CMHA to decrease a covered service is not a reduction.
Termination: The decision by a PIHP to stop an enrollee's previously authorized covered Medicaid mental health services. The decision by a CMHA to stop a covered service is not a termination.

If one of the above events occurs, you will get a written Notice of Action. You may file an appeal whenever you get a Notice of Action.

What is an appeal?

An appeal is a formal complaint to a PIHP about an action. Here are the steps in the appeal process:

To start an appeal, contact the PIHP that sent you the Notice of Action you wish to appeal. You must start the appeal within 10 days if your appeal is about previously authorized services and you wish them to continue. Otherwise, you must start the appeal within 20 days of receiving the Notice of Action.
You may request assistance with your appeal from your PIHP's Ombudman service. See the RSN pages for the telephone number of the Ombudman service in your PIHP. Interpreter and TTY/TTD services are available to help you, if needed. You may also receive help from your community mental health agency or anyone else you choose.
You may start an appeal with a phone call or a letter. Please include your name, how we can best contact you, the reason for your appeal, and any evidence you wish to submit.
You may request a fast appeal if you or your mental health care provider believes that a longer time for resolution would jeopardize your ability to maintain or regain maximum functioning. If your request for a fast appeal is granted, your PIHP will make a decision about your appeal within 3 working days. If the PIHP takes additional time without your request, you will be notified of the reason for the delay. If your request for a fast appeal is not granted, your PIHP will promptly notify you that your appeal will be decided within the usual 45-day timeframe.
When your PIHP receives your appeal, you will get a letter or phone call acknowledging its receipt within one working day. If you choose, your PIHP will allow you 72 hours to informally discuss your appeal with the PIHP before you decide to continue the appeal process.
During the appeal process, you and anyone helping you can look at your treatment and other records to help you prepare your appeal.
Your appeal will be considered by persons who have not been previously involved with your Action and who have the proper training.
While your appeal is under consideration, you may request to continue your services, if:

Your appeal is filed timely;
Your appeal involves the reduction, suspension or termination of previously authorized covered Medicaid mental health services;
Your covered Medicaid mental health services were ordered by the CMHA;
The current period covered by the authorization has not expired; and
You have requested a continuation of services.
If the decision is not your favor, you may be asked to pay for the services you received during the appeal.

Unless you request a fast appeal, your PIHP will make a decision about your appeal within 45 days from the day you started your appeal. In some instances, additional time may be taken if you request it or if it is in your best interest. If the PIHP takes additional time without your request, you will be notified of the reason for the delay.
You will receive a written statement of your PIHP's decision.
After your appeal is resolved, the PIHP and CMHA must keep any records about your appeal separate from your treatment records in a confidential file.

What is an Administrative or Fair Hearing?

If you are unhappy with the decision regarding your PIHP appeal, you may ask for additional consideration of your appeal from the state Office of Administrative Hearings. An administrative hearing, also known as a fair hearing, is a complaint to the State Office of Administrative Hearings (OAH). The OAH is an independent part of state government. They are not part of the Department of Social and Health Services (DSHS), the Mental Health Division (MHD) or any PIHP. The OAH decision about your appeal must be carried out by the MHD, the PIHP, and your CMHA. You may have an Ombudman represent or assist you with the hearing at no cost. A lawyer or anybody you choose at your own expense may also represent you. You must ask for an administrative hearing within certain time limits. You should consult the Ombudman or somebody who knows about the time limits.

Note: In some situations, an enrollee may request a state fair hearing before filing an appeal with a PIHP. This is allowed when there has been a violation of state rules. Examples are the failure of a PIHP to authorize services in a timely manner or to process an appeal according to the required timelines. You may call the OAH or your Ombudman if you feel your complaint may qualify for a state fair hearing prior to your PIHP reviewing it.

If you want to ask the Office of Administrative Hearings to review your complaint, you can send a request to:

Office of Administrative Hearings
P.O. Box 42489
Olympia, WA 98504
The toll-free telephone number is: 1-800-583-8271.

There are several local offices of OAH. Your case will be assigned to one near your home. If an in-person hearing is needed, it will be held in a location close to you.

Adobe Acrobat Reader is required to view PDF files and you can download it for free. If you do not have an application that can display Microsoft Word documents (.doc), you can download a free Word Viewer.

For more ways to get in touch with the Department of Mental Health Services, go to the DSHS Contact Information Web page. Mental Health Related Questions Contact: