First Friday Forum Alison Robbins Section Manager Managed

First Friday Forum Alison Robbins Section Manager, Managed Care Programs Medicaid Purchasing Operations and Integrity August 5, 2016

Updates • Apple Health Managed Care Contract will be updated for January 1, 2017. Changes include: – New CMS managed care regulations (HCA still working out extent of the changes; – “Clean up” items – including arrangement of benefits language; – Rates and network changes for January 1, 2017 2

Updates • Apple Health Core Connections – in month five of the contract; still working out the “bugs” but a relatively smooth implementation. • Health Homes Coming to King and Snohomish Counties effective January 1, 2017. Request for Applications due out on August 12, 2016. – Health Homes is a program provided through both MCOs and FFS. The FFS program includes dual eligible enrollees and has greatly improved outcomes for this population. 3

Earlier Enrollment • Provides for enrollment of newly eligible Medicaid beneficiaries into managed care the first of the month in which the beneficiary becomes eligible. – Enrollment backdated to the first of the current month – Purpose is to maintain continuity of care – eliminates 2 – 6 weeks of fee for service before enrollment – MCOs cover services provided from the first of the current month – HCA covers services provided prior to the current month 4

Earlier Enrollment What doesn’t change? • Current enrollees who change plans do so for the following month • Enrollment in Primary Care Case Management is prospective for the following month • Clients with other insurance or Medicare not enrolled in managed care • Enrollment in Voluntary County (Clallam) is still voluntary 5

Earlier Enrollment • NOTE: enrollment information can take 48 hours to get to MCOs, but shows in Provider. One the day after eligibility is determined. – It goes from the Health Benefit Exchange to ACES (DSHS) to Provider. One (HCA) – If there are emergent needs, the enrollee or navigator can call HCA customer service for assistance 6

Questions? More Information hcamcprograms@hca. wa. gov • Medical Assistance Customer Service Center (MACSC) 1 -800 -562 -3022 Alison Robbins, Manager Managed Care Programs Alison. Robbins@hca. wa. gov Tel: 360 -725 -1634 7