Bill
SB 5228
SB 5228 adds occupational therapy to Medicaid behavioral health services; HCA must expand coverage so BH agencies are reimbursed for medically necessary OT.
Status and key dates
- Chaptered into law (Chapter 113, 2023 Laws).
- Governor signed: April 20, 2023.
- Effective date: July 23, 2023.
- Implementation deadline for Medicaid coverage expansion: HCA must act by June 30, 2024.
- Fiscal note: available; the bill contains no direct appropriation and provides services “within funds appropriated by the Legislature.”
Purpose and intent
SB 5228 adds occupational therapy (OT) explicitly to the menu of services that managed care organizations (MCOs) and behavioral health administrative services organizations (BHASOs) may provide to people with behavioral health disorders enrolled in Apple Health (Medicaid). It directs the Health Care Authority (HCA) to expand Medicaid coverage so licensed or certified behavioral health agencies are reimbursed by MCOs for medically necessary OT for their clients.
Main provisions
- Amends RCW 71.24.385 to list occupational therapy among the program elements MCOs and BHASOs may use to serve people with mental disorders and substance use disorders (subject to available legislative funding).
- Adds a new section directing the Washington State Health Care Authority to expand coverage in the Medicaid program by June 30, 2024 so that licensed/certified behavioral health agencies are reimbursed by MCOs for medically necessary occupational therapy for behavioral health clients.
- Leaves design and delivery flexibility to MCOs/BHASOs “within funds appropriated” and within contractual terms; encourages evidence‑based practices and alternatives to institutional care.
- Does not appropriate new funds in the bill itself; implementation depends on legislative appropriations and Medicaid plan amendment/approval processes.
Who is affected
- Medicaid (Apple Health) enrollees with behavioral health disorders — access to OT services specifically tied to behavioral health needs.
- Managed care organizations and behavioral health administrative services organizations — may incorporate OT into behavioral health service arrays and reimbursement models.
- Licensed or certified behavioral health agencies and occupational therapists — potential new source of reimbursement for delivering OT services in behavioral health settings.
- Health Care Authority — required to amend the Medicaid State Plan/coverage policies and manage implementation, including federal approval where required.
Potential impact and implementation notes
- Aims to support community stability, activities of daily living, medication/self‑care routines, housing transitions, and reduce hospital readmissions and institutionalization.
- Implementation requires HCA rulemaking/Medicaid State Plan amendment and likely CMS approval; practical rollout (provider qualifications, billing codes, rates, prior authorization) depends on HCA policy work and available appropriations.
- The bill treats the service expansion as subject to legislative funding (“within funds appropriated”), so the scope and timing of service availability will depend on subsequent budget actions.
Stakeholder input
- Testimony uniformly in support from occupational therapists and behavioral health advocates, citing parity with physical health OT coverage and benefits for community-based recovery and cost avoidance. No recorded opposition.
Compiled from official sources — confirm details with the bill’s official record.
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