WSR 15-05-086
HEALTH CARE AUTHORITY
[Filed February 18, 2015, 11:16 a.m.]
NOTICE
Title or Subject: Medicaid State Plan Amendment (SPA) 15-0011 Health Homes.
Effective Date: January 1, 2015, for the SPA in general. Effective date of the elimination of the incentive provisions to be determined on a date after this notice.
Description: Medicaid SPA for health homes.
The health care authority (the agency) is planning to submit medicaid SPA 15-0011 regarding health homes. The health home program is a joint venture between the agency and the department of social and health services (DSHS). Because the agency does not believe that imposing lower rates on its contracted health home lead organizations within a fee-for-service payment environment helps achieve the stated goals of the program, SPA 15-0011 will eliminate the financial penalty for low engagement rates assessed to those leads. SPA 15-0011 will also support changes to tribal contracting and eliminate the request for application process to qualify leads by providing a contracting option.
Health homes are defined as a set of medicaid services granted through the Affordable Care Act, enacted on March 30, 2010, entitled "State Option to Provide Health Homes for Enrollees with Chronic Conditions." Section 2703 adds section 1945 to allow states to elect this option under a medicaid SPA. Health home services will be available to both managed care and fee-for-service beneficiaries. Health homes provide an opportunity to build a person-centered system that achieves improved outcomes for beneficiaries and increases the quality and efficiency of the state's medicaid program. Health homes provide targeted and intensive interventions that improve health outcomes and the beneficiary's experience in accessing and navigating the care system, and reduce preventable hospitalizations, emergency room visits, and unnecessary institutionalizations.
Health homes are defined by a set of six specific care coordination services:
1. Comprehensive care management.
2. Care coordination and health promotion.
3. Comprehensive transitional care from inpatient to other settings, including appropriate follow-up.
4. Individual and family support, which includes authorized representatives.
5. Referral to community and social support services, if relevant.
6. The use of health information technology to link services, as feasible and appropriate.
The health home interim report is available at http://www.hca.wa.gov/medicaid/health_homes/Documents/HH_interimrpt_120514.pdf.
Legislative authority granted through SSB 5394 requires that funding for health homes remains budget neutral. The agency is unable to project the fiscal impact of removing the penalty clause based on participation rate because the methodology has not been approved. If the calculated improvement in year two relies on an entire year of experience, the impact will be impossible to ascertain, since removing the penalty section means a year two calculation will not be performed.
Health Home Rates Without Withold [Withhold]
Stage of Care Coordination
Administrative Portion of the Rate
Total Rate
Outreach, Engagement, and Health Action Plan
Per Participate [Participant]
$25.29
$252.93
Intensive Health Home Care Coordination
Per Participate [Participant] per Month
$17.26
$172.61
Low-Level Health Home Care Coordination
Per Month with Encounter
$6.75
$67.50
Health Home Rates With Original Withhold
Stage of Care Coordination
Total Rate
Rate Net of Withhold
Total Administrative
Withhold Portion of Administrative
Administrative Net Withhold
Outreach, Engagement, and Health Action Plan
Per Participate [Participant]
$252.93
$252.93
$25.29
 
N/A
$25.29
Intensive Health Home Care Coordination
Per Participate [Participant] per Month
$172.61
$169.16
$17.26
 
$3.45
$13.81
Low-Level Health Home Care Coordination
Per Month with Encounter
$67.50
$66.15
$6.75
 
$1.35
$5.40
The SPA is in the drafting process and is not yet available for review. Please contact the agency via Becky McAninch-Dake at Becky.McAninch-Dake@hca.wa.gov for information or with comments. Comments will be posted on the health home web site for review by the public.
For additional information, contact Becky McAninch-Dake, Health Homes, Division of HealthCare Services, 626 8th Avenue S.E., Olympia, WA 98501, phone (360) 725-1642, TDD/TTY 711 or 1-800-848-=5429 [1-800-848-5429], fax (360) 753-5429, e-mail Becky.McAninch-Dake@hca.wa.gov, web site http://www.hca.wa.gov/medicaid/health_homes/Pages/index.aspx.