WSR 13-02-072


[ Filed December 31, 2012, 11:23 a.m. ]


     Title or Subject: Health Homes Medicaid State Plan Amendment.

     Effective Date: April 1, 2013.

     Description: Medicaid state plan amendment for health homes and the rate structure for the fee-for-service (FFS) and primary care case management (PCCM) delivery system.

     The health care authority is planning to submit a medicaid state plan amendment regarding health homes as described below. Consideration paid to successful applicants for health home services provided under a resultant contract shall be paid at a monthly encounter rate for FFS and PCCM participating beneficiaries. Payment for eligible managed care beneficiaries is built into the Healthy Options capitation rate and no additional payment will be made for their contractually required health homes when implemented on April 1, 2013.

FFS and PCCM Health Home Program Payment Rates

Stage of Care Coordination Total Rate Rate Net of Withhold Total Admin. Withhold Portion of Admin Admin. 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 Participant per Month

$172.61 $169.16 $17.26 $3.45 $13.81
Low-Level Health Home Care Coordination

     Per Month with an Encounter

$67.50 $66.15 $6.75 $1.35 $5.40

     Any contracts awarded as a result of this solicitation are contingent upon the availability of funding. The rates are subject to change based on legislative direction or appropriation.

     Legislative authority granted through SSL [SSB] 5394 requires that funding for health homes remains budget neutral.

     Health homes are a new set of 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 election [elect] this option under the medicaid state plan. Coverage will be statewide, to improve the delivery of health care and social services. Health home services will be available to both managed care and FFS 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, 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; and

     6. The use of health information technology to link services, as feasible and appropriate.

     This notice is being published in the Washington State Register (WSR). Proposed changes are available for viewing at the health home web site -

     Written comments may be sent to Becky McAninch-Dake at and 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, 626th [626] 8th Avenue S.E., Olympia, WA 98501, Mailstop 45530, phone (360) 725-1642, TDD/TTY 711 or 1-800-848-5429, fax (360) 753-7315, e-mail, web site