Welcome to the December 2023 issue of Prenatal - 5: Grow & Thrive - HCA’s monthly newsletter about our behavioral health work in the early years of life. 

We welcome you to keep reading to find out more of what’s happening in the P-5 behavioral health world, including a request for information about substance use disorder services for pregnant & parenting individuals, changes to Apple Health billing for developmental screening, a new training cohort for Child Parent Psychotherapy, and a special spotlight on the continuous Apple Health eligibility for young children. If you’ve missed earlier editions of this newsletter, you can find them on our IECMH webpage, under IECMH updates. 

Note: Prenatal – 5: Grow & Thrive is a spin-off newsletter of HCA’s Prenatal – 25: Thrive newsletter, which focuses on behavioral health for the entire age span of pregnancy to early adulthood. If you missed it, check out the most recent edition of the P-25 Thrive newsletter. 

Effective for claims with dates of service on and after January 1, 2024, the Health Care Authority (HCA) will implement legislatively mandated rate increases for developmental and behavioral health screening authorized in the 2023-25 state operating budget.  

Effective for claims with dates of service on and after January 1, 2024, HCA will also begin requiring the use of a modifier when submitting claims to indicate whether a need was identified during the developmental and behavioral health screening. HCA will revise the appropriate billing guides to reflect this new policy. 

These changes are the result of an agency decision package for the 2024 Legislative Session, recognizing the importance of early identification and referral to services. The use of modifiers provides an opportunity for state-specific data on the need for services and supports for Apple Health (Medicaid) enrolled children and youth.  

In 2024, the Barnard Center will launch a Child Parent Psychotherapy (CPP) Learning Collaborative, led by CPP trainers Haruko Watanabe, LMHC, IMH-E and Mindy Davis, LICSW. CPP is an intervention model for children aged 0-5 who have experienced traumatic events and/or are experiencing mental health, attachment, and/or behavioral problems. A central goal is to support and strengthen the caregiver-child relationship as a vehicle for restoring and protecting the child’s mental health. CPP is included within the Apple Health Evidence Based Reporting Guide as an approved training entity for infant mental health. 

Through the 18-month Learning Collaborative, participants will gain core CPP knowledge and competencies to enable them to adopt CPP. Participating agencies will increase their capacity to provide an evidence-based trauma treatment for children in the birth to six age range. More details about the training overview, components, and materials are available in the CPP Learning Collaborative Overview. 

The dates of the learning collaborative are yet to be determined, but providers may submit an Expression of Interest application for a limited number of seats until January 8th.  

If you have any questions, please email Joyce Yang, Program Manager.

Following Centers for Medicare & Medicaid Services (CMS) approval in April 2023, children under the age of six who are enrolled in a free Apple Health program receive continuous eligibility through the end of their sixth birthday month. Continuous eligibility means that eligible children between the ages of 0 and 6 keep their Apple Health coverage for a certain amount of time, regardless of changes in household income. Washington state is the second state in the nation to institute extended continuous Medicaid eligibility for young children, and work is also underway to apply extended continuous eligibility to children enrolled in Apple Health with premiums (CHIP) in the future. 

Continuous eligibility is a key strategy to prevent coverage gaps, also referred to as ‘churn.’ Coverage gaps or churn can increase unmet health care needs, including unmet behavioral health care needs (Sugar et al., 2021). Coverage gaps are particularly problematic for young children, given how significantly the early years impact lifelong growth and social-emotional development (Somers & Maul, 2019). Before instituting continuous eligibility, 11% of children under the age of six in Washington state experienced Medicaid coverage gaps each year, and these gaps fell disproportionately on children of color (HCA’s MTP Waiver Renewal Application).  

Stable coverage, on the other hand, enables providers to develop relationships with families and to track health and social-emotional development over time. This is particularly critical in early childhood, as the first years of life are an important developmental period when frequent screenings and check-ups are recommended (CMS, 2021). Continuity of coverage for young children will provide an essential base for Apple Health providers and health plans to focus their efforts on primary and preventive care, including the early diagnosis and treatment of behavioral health problems.