WSR 16-17-046

[Filed August 11, 2016, 12:57 p.m.]

Title or Subject: Medicaid State Plan Amendment (SPA) 16-0018 Third Party Liability.

Description: The health care authority (HCA) intends to submit medicaid SPA 16-0018 in order to clarify that clients will no longer be exempt from enrollment into managed care based solely on the presence of creditable third party liability (TPL) health insurance. HCA continues to move toward value-based purchasing and a managed care business model. Beginning January 1, 2017, HCA will delegate TPL recovery and cost avoidance activities for these clients to the managed care organizations (MCO). MCOs will be responsible for TPL identification, coordinating benefits, and performing recovery activities from a liable primary health insurance carrier to ensure the MCO plan (delegated by the state medicaid agency) is the payer of last resort.

SPA 16-0018 is expected to have no effect on the annual aggregate expenditures for providers. Overall costs to MCOs are anticipated to neither increase nor decrease; any expenditure caused by an increase in the number of clients for whom MCOs coordinate benefits should be offset by an increase in recovery amounts.

A copy of SPA 16-0018 is available for review. HCA would appreciate any input or concerns regarding this SPA. To request a copy of the SPA or submit comments, please contact Mark Benya, Coordination of Benefits, 626 8th Avenue S.E., phone (360) 725-1891, TDD/TTY 1-800-848-5429, fax (360) 586-3005, e-mail mark.benya@hca.wa.gov (please note that all comments are subject to public review and disclosure, as are the names of those who comment).