Post on 31-Mar-2015
Healthy Options and Health Homes
February 5, 2012
The Affordable Care Act and Health Homes
President Obama signed the Affordable Care Act (ACA) on March 23, 2010. 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.
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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 services3
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
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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
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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, 2013.
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Request for Application process
• RFA issued• Question and Answer period• Applications Submitted• Applications Evaluated• Successful Applicants announced• Contracts signed• Readiness Review• Implementation!
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Estimated Schedule of Release ActivitiesSubject to change at the discretion of HCA
Schedule*
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A B C
Coverage Area Coverage Area 4 Coverage Area 5 & 7 Coverage Areas 1, 2, 3, & 6
Activity Date/Time** Anticipated Date/Time**
Anticipated Date/Time**
RFA Release Date 11/26/2012 2/25/2013 5/10/2013Questions Due from Applicants
12/04/2012 3/6/2013 5/17/2013
HCA Response to Applicant Questions
12/18/2102 3/22/2013 6/27/2013
RFA Proposal Due Date 1/4/2013 4/9/2013 7/12/2013Projected Announcement of Apparently Successful Applicants
2/1/2013 5/2/2013 8/9/2013
Projected request debriefing conferences
2/4 – 2/11/2013 5/2 - 5/6/2013 8/12 – 8/16/2013
Projected protest period 2/12 – 2/14/2013 5/7 – 5/10/2013 8/9 – 8/21/2013Readiness Reviews 4/29 – 5/3/2013 5/20 – 5/24/2013 8/26 – 8/30/2013Contracts Signed 6/2013 6/2013 9/2013Projected Start Date of contracts
7/2013 7/1/2013 10/2013
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
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Effective 8-1-2012 Service Areas for Healthy Options, Children’s Health Insurance Program, Healthy Options Blind/Disabled, and
Healthy Options Foster Care Programs
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Garfield
Pend Oreille
Spokane
Walla Walla Asotin
Columbia
Stevens
Whitman
Ferry
Lincoln
Franklin
Adams
Douglas
Grant
Benton
Yakima
Klickitat
Chelan
San Juan
Whatcom Okanogan
Skagit
King
Kittitas
Snohomish
LewisPierce
Skamania
ClallamIsland
Clark
Cowlitz
KitsapMason
Wahkiakum
Pacific
Jefferson
Grays Harbor
AMG CCC CHP MHC UHC
CCCCHP MHCUHC
CCCCHP MHCUHC
CHPCCC MHCUHC
CCC CHP MHCUHC
CCCMHCUHC
CHPMHCUHC
CCC CHP MHC UHCAMG
CCCCHPMHCUHC
CCCCHP MHCUHC
AMG CCC CHP MHC UHC
CHPMHC
AMG CCC MHCUHC
CCC UHC
CHPCCC MHCUHCAMG
AMG CCC CHP MHC UHC
AMG CCC CHP MHC UHC
MHC
AMG CCC CHP MHC
AMG CHP MHCAMG CCC CHP UHC
AMG CCC CHP MHC UHC
CCCUHC
CHP MHCUHC CCC
CCCCHP MHCUHC
CHPMHC
CCCUHC
AMG CCC CHP MHCUHC
CCC CHP MHC UHCAMG
CHP MHCUHCAMG
Thurston
CCC UHC
AMG CHP MHCCCC
AMG CCC CHP MHC UHC
AMG CCC MHC UHC
AMGMHCUHC
CCCCHP MHCUHC
AMG CCC CHP MHC UHC
CCC, CHP, MHC, UHC
AMG CCC MHC
Managed Care Requirements
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• 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
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
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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
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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
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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
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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
How to Enroll
• Medicaid clients can make plan choices now by using the ProviderOne system
• https://www.waproviderone.org/client
• Call the IVR at 1-800-562-3022
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Questions
• Basic Health and Healthy Options Managed Care• http://www.hca.wa.gov/managed_care
• Healthy Options• http://hrsa.dshs.wa.gov/HealthyOptions/
• Basic Health• http://www.basichealth.hca.wa.gov
• Contact us:• Medicaid: http://hrsa.dshs.wa.gov/contact/default.aspx• Basic Health: Chat online with a representative at
www.basichealth.hca.wa.gov
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