1. (1) This chapter governs nonmedicaid funded behavioral health services provided under the medicaid agency's behavioral health services wraparound contract. See also chapter 182-538D WAC for rules applicable to nonmedicaid behavioral health services.
2. (2) Washington apple health integrated managed care (IMC) behavioral health wraparound services are available only through a managed care organization (MCO) contracted to provide IMC services.

3. (3) The MCO provides contracted nonmedicaid funded behavioral health wraparound services to medicaid enrollees in an IMC regional service area:

   1. (a) Within available resources;
   2. (b) Based on medical necessity; and
   3. (c) In order of priority to populations as identified by state and federal authorities.
4. (4) When nonmedicaid funding is exhausted, behavioral health wraparound services are no longer paid for and cannot be authorized regardless of medical necessity.
5. (5) For clients age 20 and younger, see the early periodic screening, diagnosis, and treatment (EPSDT) program described in chapter 182-534 WAC.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 26-07-031, s 182-538B-040, filed 3/11/26, effective 4/11/26. Statutory Authority: RCW 41.05.021 and 41.05.160, 2019 c 325, 2014 c 225, and 2018 c 201. WSR 19-24-063, § 182-538B-040, filed 11/27/19, effective 1/1/20. Statutory Authority: RCW 41.05.021, 41.05.160. WSR 16-05-051, § 182-538B-040, filed 2/11/16, effective 4/1/16.]