Who is eligible for public mental health services?

Medicaid recipients are automatically enrolled in a local mental health managed care plan with the Regional Support Network (RSN). In order to receive services through the Thurston Mason RSN you must meet eligibility criteria. Eligibility requires that you:

• Live in Thurston or Mason County; and
• Have a medical identification card showing enrollment in a Medicaid program; and
• Meet criteria for “medical necessity” for mental healthcare
• Meet “access to care standards”

What is Medical Necessity?

Medical necessity is a term for describing a requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions in the recipient that endanger life, or cause suffering or pain, or result in illness or infirmity or threaten to cause or aggravate a handicap or cause physical deformity or malfunction, and there is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the person requesting service. For the purpose of this section, “course of treatment” may include observation or, where appropriate, no treatment at all.

What is Access to Care?

Access to Care means the minimum eligibility requirements for Medicaid eligible adults and children to access mental health services through the publicly funded system.

Who pays for the services?

People who have a medical identification card, also known as Medicaid coupons are eligible for medically necessary mental health services at no cost to the person. Any person needing mental health crisis services is eligible to receive them. All services must be authorized by the Thurston Mason RSN. The Thurston Mason RSN and contracted providers will handle this part of the process.

What if I get a bill?

If you received services from a provider that is not a Thurston Mason RSN Network Provider, you may be responsible for any and all costs for services received. If your coupon was not active at the time of services, you may have to pay. If you had a coupon and receive a bill from a provider for services in error, contact the agency billing office. If you need further help, contact the Thurston Mason RSN at (360) 867-2602.

What services are available?

Inpatient and outpatient mental health services are available to you and your family if they are needed. Some of those services include:

• Case Management;
• Individual therapy;
• Group therapy;
• Medication evaluation, prescription, and management; and
• Crisis Services

For more information, see Outpatient Programs.

You may also receive employment support services, residential support, and other services through the Thurston Mason RSN Network Providers. Interpreter services are available upon request. Written materials such as brochures, client rights, Enrollee Handbook, intake forms, Notice Letters, etc. are translated into Spanish. Materials available through the Department of Social and Health Services may be available in additional languages.

If you need mental health services, an individual service plan will be developed with you. Your plan will consider your age and your culture. You may receive one or more of the services listed above. The plan will fit your treatment goals, according to your strengths and needs. Your mental health care provider will decide with you which services are most appropriate for you and for how long.

Your mental health care provider may also ask your permission to work with people who provide you other services such as housing, healthcare, and employment.

Who provides services?

The Thurston Mason RSN contracts with local licensed Community Mental Health Agencies (CMHA) which form the Thurston Mason RSN Provider Network. For a list of Thurston and Mason County CMHA’s go to the TMRSN Network Provider List.

You may only go to these authorized agencies for covered services. You may be responsible for costs if you receive mental health services through other providers.

What choices do I have?

You may choose a mental health care provider at the agency from which you receive services. If you don't choose a mental health care provider, one will be assigned. You have the right to change mental health care providers during the first 30 days. You can also ask for a change once a year for any reason. If you think you have a good reason, you can ask for more changes. The change may or may not be granted.

What if I need crisis services?

If there is a life-threatening emergency, please dial 911. When the situation is not life threatening, you should first use your personalized crisis plan and then, if necessary contact your Mental Health Care Providers on-call service or call the crisis line at 1-800-627-2211. You can also go to the Evaluation and Treatment Facility (E&T) for crisis services or call (360) 754-1338 or (360) 528-2590.

Mental Health Crisis when NOT enrolled with a TMRSN Network Provider: Individuals residing in either Thurston or Mason County without a Thurston Mason RSN Network Provider who are involved in a situation which is NOT life threatening should contact the Evaluation and Treatment Facility at (360) 754-1338.

How can I get outpatient services?

If you think you need services, call the toll-free or local telephone numbers on the Network Provider list. Public mental health services are designed to keep you well in your own community. All efforts will be made to keep you from requiring inpatient care.

What if I needed to be in an inpatient facility for my mental illness?

Psychiatric inpatient services are available to Medicaid enrollees. These services are at no cost, but must be approved in advance. If you think you need to be hospitalized, contact your mental health care provider. Your provider will help you with inpatient services if they are medically necessary.

What can I do if I am unhappy or unsatisfied with my services?

There are two types of formal concerns and one informal concern that you may make. You can make an informal complaint by expressing your dissatisfaction to your provider or with the Thurston Mason RSN. It's a good idea to try to resolve your complaint with the person directly involved or ask the Ombuds to assist you, before you try other things. You can also contact the Thurston Mason RSN directly at (360) 876-2602.
 

For more information, see Additional Questions and Answers [PDF].