Specifications include, but are not limited to: The consultant(s) shall provide the Department of Community and Human Services (DCHS) Finance, Administration, and Compliance Services (FACS) team, the Behavioral Health & Recovery Division (BHRD), and the King County Integrated Care Network (KCICN) with expert advice and guidance regarding Medicaid and Non-Medicaid financial policies, processes, and strategies, which may include but is not limited to: A. Advice, technical assistance, and financial modeling related to: 1. Assisting in the understanding of how King County’s financial models interact with the Washington state Medicaid behavioral rate setting process; 2. Evaluating and making recommendations to adjust the KCICN Medicaid behavioral health provider payment models to effectively incentivize and positively influence community access to, and utilization of, quality behavioral health services; 3. Identifying how King County investment decisions promote fiscal efficiency and effectiveness in the behavioral health system; 4. Building complex financial forecast models that include projecting revenue that mirror MCO payment models with KCICN, and project expense from account actual run rates and utilization factors; and 5. Any other financial aspect of managing King County Integrated Care Network (KCICN) or the King County Behavioral Health Administrative Services Organization (BHASO) requirements. B. Assist in implementing a private insurance billing model where King County can bill for behavioral crisis services that were previously not covered by private insurance, including developing appropriate service rates, assisting in contract negotiations, and informing internal King County insurance claims processes. C. Assist in understanding of how King County’s Medicaid fiscal policy decisions impact and influence state Medicaid rate setting and actuarial process. D. Assist in negotiations with Managed Care Organization (MCO) to determine appropriate and beneficial payment rates and contract terms by evaluating both King County and MCO proposals. E. Provide expert advice and guidance as it pertains to understanding and complying with federal Medicaid and Non-Medicaid Behavioral Health fiscal and policy rules and regulations. F. Consult on clinical operations environments as they intersect with financial operations, ensuring both clinical and fiscal processes can be effectively administered and the risk of unintended consequences is mitigated
