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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