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Healthy Options and Health Homes

Healthy Options and Health Homes. May 6, 2012. What is a Health Home?. A “Health Home” is a network of community based providers who will work together to provide a continuum of needed services for eligible beneficiaries

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Healthy Options and Health Homes

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  1. Healthy Options and Health Homes May 6, 2012

  2. What is a Health Home? • A “Health Home” is a 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 • MCOs are considered community based providers

  3. Who Can Act as a Qualified Health Home? • An organization such as a Regional Support Network, Area Agency on Aging, Managed Care Organization or other entity with the ability to contract with or form Memorandums of Understanding (MOU) with other community based entities and perform administrative functions.

  4. Who is Eligible for Health Homes? • Medicaid-only Fee for Service clients • Dual Eligible Fee for Service • Healthy Options Enrollees • Primary Care Case Management Enrollees

  5. 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 they are enrolled in • Dual Eligible and Fee for Service clients enrolled by Health Care Authority

  6. AMG CCC CHP UHC AMG CCC CHP MHC UHC Effective 8-1-2012 Service Areas for Healthy Options, Children’s Health Insurance Program, Healthy Options Blind/Disabled, and Healthy Options Foster Care Programs AMG CHP MHC CCC Whatcom Okanogan Ferry Stevens Pend Oreille AMG CHP MHC CHP MHC UHC AMG CHP MHC UHC CCC CCC CHP MHC UHC AMG Skagit San Juan CHPMHC AMG CCC CHP MHC Chelan Clallam Snohomish Island MHC AMG CCC CHP MHC UHC Spokane CCC CHP MHC UHC Jefferson AMG CCC CHP MHC UHC Lincoln CCC CHP MHC UHC CCC UHC CCC MHC UHC Kitsap AMG CCC CHP MHC UHC Mason Grays Harbor AMG CCC MHC UHC Douglas Grant CHP CCC MHC UHC AMG Kittitas CHP MHC UHC CHP CCC MHC UHC Adams Whitman King AMG CCC CHP MHC UHC CCC CHP MHC UHC AMG CCC MHC UHC AMG CCC CHP MHC UHC Yakima Pierce Thurston Pacific Lewis CCC CHP MHC UHC Franklin AMG CCC CHP MHC UHC Garfield CCC CHP MHC UHC AMG AMG CCC MHC CCC CHP MHC UHC Benton Columbia CCC CHP MHC UHC CCC CHP MHC UHC AMG CCC CHP MHC UHC AMG MHC UHC Wahkiakum Cowlitz Skamania CHP MHC CCC UHC CCC UHC Walla Walla Asotin Klickitat CCC UHC Clark CCC, CHP, MHC, UHC

  7. Eastern Washington Health Home Coverage Areas • Coverage Area 6: Adams, Chelan, Douglas, Ferry, Grant, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens and Whitman • RFA will be released May 10, response due July 12, Contracts start October 1, 2013

  8. Eastern Washington Health Home Coverage Areas • Coverage Area 7: Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, and Yakima • RFA Awards announced May 2 for July 1 start date • Successful respondents: • Optum Health • United Healthcare Community Plan • Community Health Plan of Washington • Coordinated Care Corporation • SE Washington Aging and Long Term Care

  9. 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

  10. What are Health Home Services? Individuals receiving Health Home services will be assigned a Health Home coordinator who will partner with beneficiaries, their families, doctors, and other agencies providing services to ensure coordination across these systems of care. In addition, the health home coordinator will make in-person visits and be available by telephone to help the individual, their families, and service providers.

  11. Health Home Services • Health Home Care Coordinators also ensure appropriate referrals are made, provide education to the enrollee and his/her family about his/her condition, and that transitional services from hospital to home are provided to reduce re-hospitalizations • Other services available from the Health Homes include assistance with arranging transportation, locating housing and accessing interpreter services

  12. Questions/Information • More information about Health Homes can be found at: • http://www.hca.wa.gov/Pages/health_homes.aspx • For questions about managed care contact us at: • hcamcprograms@hca.wa.gov

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