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Community Protection Waiver Changes
This is a program change notification for mental health treatment services provided to clients participating in the Community Protection waiver through the Department of Social and Health Services.
What is changing?
All medically necessary treatment services provided to CP participants by mental health providers will no longer be payable through CP waiver. Services should be billed according to the Apple Health requirements to the client’s mental health treatment services payer, including Health Care Authority, the client’s Apple Health Managed Care Organization, and/or the client’s primary insurance.
What does this affect?
This affects the payment and delivery of mental health treatment services provided to individuals in CP waiver. DSHS, HCA, and the Apple Health MCOs are coordinating to transition care as seamless as possible, including planned outreach to the individuals on the CP waiver affected by this as well as their providers.
- Eligible providers will need to follow Apple Health (Medicaid) State Plan requirements for payment and delivery of mental health treatment services. This includes enrolling and working with the client’s Apple Health payer (MCO or HCA) and any primary insurance (e.g., Medicare), and billing the client’s payer accordingly.
- If the client’s current mental health provider does not meet Apple Health provider eligibility or chooses not to work with the client’s mental health treatment payer, this may affect the choice of provider available to the client for mental health services.
When will the change occur?
These changes will occur no later than the client’s annual assessment effective date occurring between January 1, 2026 and December 31, 2026. Changes may occur earlier if the provider or client chooses. Outreach by DSHS and the MCOs to affected providers and clients will occur before the client’s effective date.
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