WSR 13-14-117
(Medicaid Program)
[Filed July 3, 2013, 9:33 a.m., effective July 3, 2013, 9:33 a.m.]
Effective Date of Rule: Immediately upon filing.
Purpose: Strike subsection (5) of WAC 182-557-0050 Health home—General.
Citation of Existing Rules Affected by this Order: Amending WAC 182-557-0050.
Statutory Authority for Adoption: RCW 41.05.021, SSB 5394.
Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: The language in WAC 182-557-0050(5) is not approved by the Centers for Medicare and Medicaid Services in the agency's state plan. State receipt of federal funds could be jeopardized without immediate adoption of this rule.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 1, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: July 3, 2013.
Kevin M. Sullivan
Rules Coordinator
AMENDATORY SECTION (Amending WSR 13-12-002, filed 5/22/13, effective 7/1/13)
WAC 182-557-0050 Health home—General. (1) The agency's health home program provides patient-centered care to beneficiaries who:
(a) Have a least one chronic condition as defined in WAC 182-557-0100;
(b) Be at risk of a second chronic condition with a minimum predictive risk score of 1.5; and
(c) Are at risk for high health costs, avoidable admissions to institutional care settings, and poor health outcomes.
(2) Health homes offer six care coordination activities to assist the beneficiary in self-managing his or her condition and navigating the health care system:
(a) Comprehensive or intensive care management including, but not limited to, assessing participant's readiness for self-management, promoting self-management skills, coordinating interventions tailored to meet the beneficiary's needs, and facilitating improved outcomes and appropriate use of health care services;
(b) Care coordination and health promotion;
(c) Comprehensive transitional care between care settings including, but not limited to, after discharge from an inpatient facility (hospital, rehabilitative, psychiatric, skilled nursing, substance use disorder treatment or residential habilitation setting);
(d) Individual and family support services to provide health promotion, education, training and coordination of covered services for beneficiaries and their support network;
(e) Referrals to community and support services; and
(f) Use of health information technology (HIT) to link services between the health home and beneficiaries' providers.
(3) The agency's health home program does not:
(a) Change the scope of services for which a beneficiary is eligible under medicare or a Title XIX medicaid program;
(b) Interfere with the relationship between a beneficiary and his or her chosen agency-enrolled provider(s);
(c) Duplicate case management activities the beneficiary is receiving from other providers or programs; or
(d) Substitute for established activities that are available through programs administered through the agency or other state agencies.
(4) Qualified health home providers must:
(a) Contract with the agency to provide services under this chapter to eligible beneficiaries;
(b) Accept the terms and conditions in the agency's contract;
(c) Be able to meet the network and quality standards established by the agency;
(d) Accept the rates established by the agency; and
(e) Comply with all applicable state and federal requirements.
(((5) The agency reserves the right to not contract with any otherwise qualified health home provider.))