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Healthy Options and Health Homes February 5, 2012.

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Presentation on theme: "Healthy Options and Health Homes February 5, 2012."— Presentation transcript:

1 Healthy Options and Health Homes February 5, 2012

2 The Affordable Care Act and Health Homes President Obama signed the Affordable Care Act (ACA) on March 23, The ACA will make health care more affordable, guarantee choices when purchasing health insurance, expand health coverage to more Americans and improve quality of care received. 2

3 Section 2703 Health Homes Section 2703 of the ACA governs Health Homes and includes: – Intensive/comprehensive Care Management – Care Coordination and Health Promotion – Comprehensive transitional care – Individual and family support services – Referral to community and social support services. – Use of health information technology to link services 3

4 What is a Health Home? A Health Home Network of community based providers who will work together to provide a continuum of needed services for eligible beneficiaries Each Health Home has a lead entity responsible for administrative and oversight functions – Lead entity contracts with Care Coordination Organizations (CCOs) for service provision 4

5 Services Covered The HH Network includes providers for: – Primary and acute medical care – Mental health – Substance use disorder and – Long term services and supports Services are coordinated by CCO, who also ensures 2703 Health Home services are provided 5

6 Health Home Request for Applications HCA/DSHS is issuing Request for Applications (RFA) statewide on a phased in approach. Depending on the service area, Heatlh Home services will begin either July 1, 2013 or October 1,

7 Request for Application process RFA issued Question and Answer period Applications Submitted Applications Evaluated Successful Applicants announced Contracts signed Readiness Review Implementation! 7

8 Estimated Schedule of Release Activities Subject to change at the discretion of HCA Schedule* 8 ABC Coverage AreaCoverage Area 4Coverage Area 5 & 7Coverage Areas 1, 2, 3, & 6 ActivityDate/Time**Anticipated Date/Time** RFA Release Date11/26/20122/25/20135/10/2013 Questions Due from Applicants 12/04/20123/6/20135/17/2013 HCA Response to Applicant Questions 12/18/21023/22/20136/27/2013 RFA Proposal Due Date1/4/20134/9/20137/12/2013 Projected Announcement of Apparently Successful Applicants 2/1/20135/2/20138/9/2013 Projected request debriefing conferences 2/4 – 2/11/20135/2 - 5/6/20138/12 – 8/16/2013 Projected protest period2/12 – 2/14/20135/7 – 5/10/20138/9 – 8/21/2013 Readiness Reviews4/29 – 5/3/20135/20 – 5/24/20138/26 – 8/30/2013 Contracts Signed6/2013 9/2013 Projected Start Date of contracts 7/20137/1/201310/2013

9 Coverage areas by County COVERAGE AREA COUNTY 1 Kitsap, Clallam, Grays Harbor, Jefferson, Lewis, Mason, Pacific, and Thurston 2 Island, San Juan, Skagit, Snohomish, and Whatcom 3 King 4 Pierce 5 Clark, Cowlitz, Klickitat, Skamania, and Wahkiakum 6 Adams, Chelan, Douglas, Ferry, Grant, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens and Whitman 7 Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, and Yakima 9

10 Effective Service Areas for Healthy Options, Childrens Health Insurance Program, Healthy Options Blind/Disabled, and Healthy Options Foster Care Programs 10 Garfield Pend Oreille Spokane Walla Asotin Columbia Stevens Whitman Ferry Lincoln Franklin Adams Douglas Grant Benton Yakima Klickitat Chelan San Juan Whatcom Okanogan Skagit King Kittitas Snohomish Lewis Pierce Skamania Clallam Island Clark Cowlitz Kitsap Mason Wahkiakum Pacific Jefferson Grays Harbor AMG CCC CHP MHC UHC CCC CHP MHC UHC CCC CHP MHC UHC CHP CCC MHC UHC CCC CHP MHC UHC CCC MHC UHC CHP MHC UHC CCC CHP MHC UHC AMG CCC CHP MHC UHC CCC CHP MHC UHC AMG CCC CHP MHC UHC CHP MHC AMG CCC MHC UHC CCC UHC CHP CCC MHC UHC AMG AMG CCC CHP MHC UHC MHC AMG CCC CHP MHC AMG CHP MHC AMG CCC CHP UHC AMG CCC CHP MHC UHC CCC UHC CHP MHC UHC CCC CCC CHP MHC UHC CHP MHC CCC UHC AMG CCC CHP MHC UHC CCC CHP MHC UHC AMG CHP MHC UHC AMG Thurston CCC UHC AMG CHP MHC CCC AMG CCC CHP MHC UHC AMG CCC MHC UHC AMG MHC UHC CCC CHP MHC UHC AMG CCC CHP MHC UHC CCC, CHP, MHC, UHC AMG CCC MHC

11 Managed Care Requirements 11 Health Plans must ensure: – Guaranteed access to a Primary Care Provider – Choice of multiple Primary Care Providers and Specialists – 24/7 access to a Nurse Advice Line – Coordination of care among providers and systems of care: for example, between medical and mental health systems – Prescription coverage

12 Managed Care and Health Homes Managed Care Plans may act as Lead Entity in community based health homes or participate as a provider – Managed care enrollees enrolled in HH through plan – Dual Eligible and Fee for Service clients enrolled by Health Care Authority 12

13 Eligible Clients Clients eligible based on: –At least one chronic condition and at risk of a second AND –Risk score of 1.5 OR –Two or more hospitalizations in the prior 15 months Chronic conditions include physical and behavioral health conditions or long term care needs 13

14 Care Management Expectations of Plans Stronger contractual requirements To assist new enrollees: Rxs written prior to enrollment Get care from non-par providers or new PCP Transitional care requirements to mitigate risk of re-hospitalization/re-institutionalization Care coordination with focus on integrated care between physical and behavioral health Intensive Care Management for high needs enrollees 14

15 Medical Care Services Effective December 1, 2012, the Medical Care Services Managed Care Program became a Voluntary program This means that MCS-eligible clients can choose enrollment with CHPW OR receiving services via the fee for services system 15

16 Basic Health/Medical Care Services Basic Health and Medical Care Services (the program formerly known as GAU and/or DL) will both end as of December 31, 2013, Both programs will be part of Medicaid expansion: – Most MCS enrollees in Healthy Options – BH may be in HO or the Exchange, depending on income. 16

17 How to Enroll Medicaid clients can make plan choices now by using the ProviderOne system https://www.waproviderone.org/client Call the IVR at

18 Questions Basic Health and Healthy Options Managed Care Healthy Options Basic Health Contact us: Medicaid: Basic Health: Chat online with a representative at 18


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