Kennewick senator says stopping teen suicides could start at the doctor’s office

Heartbroken by a rash of suicides in the Tri-Cities, Sen. Sharon Brown set out to find out what was wrong with mental health care for children.

The result is legislation with broad bipartisan support that could land on Gov. Jay Inslee’s desk within weeks.

The Youth Behavioral Heath Protection Act removes a bureaucratic obstacle that prevents Medicaid-eligible patients from seeing both a primary care physician and a mental health professional in the same visit.

If approved, it will encourage physicians and pediatricians to bring in mental health experts when patients come in for routine visits.

Washington’s Health Care Authority rules prevent it from reimbursing primary care offices if the same patient sees two professionals in the same visit.

That means if a doctor thinks a patient would benefit from a talk with a mental health professional during a checkup, the clinic isn’t reimbursed for both services.

Instead, they may refer patients to psychologists or school counselors, reducing the odds the patient will follow through with a visit.

Brown said she was moved to act after 51 Tri-Citians died by suicide in 2015 — 12 of them were under 25 years old.

“That’s just unacceptable,” Brown said. “I would say one suicide is too many.”

If approved, the act will direct the health authority to change its rules so clinics can get paid. The aim is to bring mental health services into the primary care clinic, treating problems early.

“This is one of the pieces of legislation that I am most proud of,” said Brown, a Kennewick Republican who has served in the state senate since 2013.

Brown co-sponsored the bill with Sen. Steve O’Ban, a Pierce County Republican. The Senate passed it unanimously on March 1. Then, the House voted 94 to 3 on Monday to pass a revised version.

Rep. Larry Haler, R-Richland, cast one of the “no” votes. He could not be reached Tuesday about his vote.

The bill will head to the governor for his signature after the Senate signs off on the House revisions.

Mark Lee of the Youth Suicide Prevention Program of Benton/Franklin County applauded Brown for her work on the issue.

“As with all processes and fixes there is no magic fix,” he said. “I am glad she is working hard to increase access.”

There were 1.9 million Washington residents eligible for Medicaid in Washington in January, including nearly 860,000 children. Most, but not all, Medicaid-eligible Washington residents are served through Apple Care.

The behavioral health act is part of a larger suite of moves by both the state and local government to integrate mental health services with physical health ones.

The 2014 Legislature set a 2020 deadline for communities to integrate services in a managed care setting. The Benton and Franklin county commissions recently agreed to hire a Yakima-based consultant to develop a road map for mental health services under the changing rules.

A Yakima physician identified an obstacle to integrating physical and mental health services.

Thatcher Felt, a pediatrician with the Yakima Valley Farm Worker’s Clinic, embedded mental health professions to see patients after he spotted a need.

But when the clinic billed the state for services, its claims were rejected under the rules prohibiting two professional visits by the same person.

For Brown, that flew in the face of the state mandate to integrate the two.

“They were putting up all these barriers to achieving the integration of behavioral and physical health,” she said.

Brown’s original bill focused on pediatric offices. The House of Representatives expanded its scope to cover all Medicaid-eligible patients, including both children and adults. Despite the change, it retained the Youth Behavioral Health Protection Act name.

Brown said she was pleasantly shocked when the Health Care Authority, which administers Medicaid, sent officials to a hearing.

“They didn’t oppose it,” she said.

Specifically, Senate Bill 5779 directs the Health Care Authority to review payment codes related to behavioral health and adjust payment rules to integrate mental health into primary care. It also requires the agency to share information with health care providers.

This story was originally published April 11, 2017 at 6:46 PM with the headline "Kennewick senator says stopping teen suicides could start at the doctor’s office."