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Managed Care Changes Basic Health and Healthy Options

Managed Care Changes Basic Health and Healthy Options. Alison Robbins Washington State Health Care Authority September 18, 2012. Procurement Process. Conducted in 2011 – 2012 New contracts signed March 2012 Program c hanges implemented July 1, 2012

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Managed Care Changes Basic Health and Healthy Options

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  1. Managed Care ChangesBasic Health and Healthy Options Alison Robbins Washington State Health Care Authority September 18, 2012

  2. Procurement Process • Conducted in 2011 – 2012 • New contracts signed March 2012 • Program changes implemented July 1, 2012 • Exiting Plans: Group Health Cooperative, Regence BlueShield, Asuris NW Health, Kaiser, Columbia United Providers.

  3. Healthy Options Plans for 2012 • Amerigroup/Real Solutions • Community Health Plan of Washington • Coordinated Care Corporation • Molina Healthcare of Washington • UnitedHealth Care Community Plan

  4. 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 Programsas of 6-5-12 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 Garfield AMG CCC CHP MHC UHC 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 County enrollment in managed care is voluntary.

  5. Division of Developmental Disabilities • Enrollment in Healthy Options will not impact: • The services you are currently receiving from DDD • Your case management with DDD • Your eligibility for DDD

  6. Medicaid Healthcare Services • Fee for Services • Healthy Options managed care

  7. Medicaid Managed Care • 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

  8. Ensuring plan readiness • Comprehensive readiness reviews of each health plan • Examination of contractual and quality requirements • Bi-weekly plan training sessions • Bi-weekly individual health plan meetings • Ad hoc meetings as requested • Bi-weekly network development assessment • Agency staff response to plan questions • Review of plan materials

  9. New Eligible Clients New population added to managed care: • Categorically Needy SSI Blind and Disabled: • Medicaid Only • Mandatory Enrollment – must enroll in managed care unless client meets exemption requirement • Voluntary enrollment for foster care children • Foster children may enroll but are not required to enroll

  10. Exempt from Managed Care Medicaid Only, Blind/Disabled clients will enroll except clients: • Living in institutional settings • Enrolled in Chronic Care Management Programs • Enrolled in the Program of All-Inclusive Care for the Elderly (PACE) • On hospice • American Indians/Alaska Natives • Enrolled in the Washington Medicaid Integration Partnership (WMIP) • Enrolled in the Medically Intensive Children’s Program (MICP) • Third Party Insurance

  11. Healthy Options enrollment process • Clients receive: • Notice of enrollment in a health plan and instructions on how to change plans; • Enrollment Handbook with information about Healthy Options • Enrollment form • Enrollments effective the first of the following month: Changes for November 1 can be made until October 30.

  12. How you can help • Know what to tell clients • Check eligibility for Healthy Options • Find out which plan(s) each doctor or specialist contracts with: • Help determine appropriate plan • Help enrolling in or changing plans • Help clients contact providers or plan for help coordinating care • Report issues to the plan and/or HCA

  13. 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

  14. Care Management Expectations • Intensive Care Management for enrollees with special health care needs (ESHCN) • Identification of ESHCN • Initial Health Screen-Initial Health Assessment • Treatment plans • Quality Assurance and special programs

  15. Managed Care Facts • Enrollees: • May change plans every month – most don’t • Are allowed to get second opinions through the plan • New Enrollees: May keep current prescriptions, care plans and providers for 90 days or until accessed by the new plan • There is no balance billing; no co-pays for Medicaid clients

  16. Exemption/Disenrollment • WAC 182-538-130 currently undergoing revision; • Requests reviewed on case by case basis by HCA medical consultant • Clients who contact MACSC will be directed to work with the plan to receive services

  17. Third Party Insurance • What is “Third Party Insurance” • Third party insurance provides insurance benefits comparable to Healthy Options – it may be Medicare, TriCare, or an insurance like Group Health or Premera • Clients with third party insurance are exempt from enrollment in Healthy Options • Call 1-800-562-3022 ext. 16134 • Monday 7:30 – 4:30 • Tuesday – Friday 7:30 – 1:00

  18. 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

  19. Health Plan Contact Information Customer Services: 1-800-600-4441 Website: www.amerigroup.com Provider line - 1-800-454-3730Website: http://washington.joinagp.com Customer Service: 1-800-440-1561 Website: www.chpw.org Provider line - 1-800-440-1561Website: http://www.chpw.org/for-providers/ Customer Service: 1-877-644-4613 Website: www.coordinatedcarehealth.com Provider line - 1-877-644-4613Website: http://www.coordinatedcarehealth.com/for-providers/become-a-provider/ Customer Service: 1-800-869-7165 Website: www.molinhealthcare.com Provider line - Phone: 1-800-869-7175Website: http://www.molinahealthcare.com/medicaid/providers/wa/Pages/home.aspx Customer Service: 1-877-542-8997 Website: www.uhccommunityplan.com Provider Line - 1-877-542-9231Website: http://www.uhccommunityplan.com/health-professionals

  20. 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: • Managed Care mailbox: hcamcprograms@hca.wa.gov

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