WSR 13-18-032
(Medicaid Program)
[Filed August 28, 2013, 10:31 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 13-14-115.
Title of Rule and Other Identifying Information: WAC 182-557-0050 Health homes—General.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at or directions can be obtained by calling (360) 725-1000), on October 8, 2013, at 10:00 a.m.
Date of Intended Adoption: Not sooner than October 9, 2013.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, delivery 626 8th Avenue, Olympia, WA 98504, e-mail, fax (360) 586-9727, by 5:00 p.m. on October 8, 2013.
Assistance for Persons with Disabilities: Contact Kelly Richters by September 30, 2013, TTY (800) 848-5429 or (360) 725-1307 or e-mail
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Strike subsection (5) of this section.
Reasons Supporting Proposal: The language was not approved by the Centers for Medicare and Medicaid Services (CMS) in the agency's state plan.
Statutory Authority for Adoption: RCW 41.05.021, chapter 316, Laws of 2011 (SSB 5394).
Statute Being Implemented: RCW 41.05.021.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Wendy Barcus, HCA, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1306; Implementation and Enforcement: Alison Robbins, HCA, P.O. Box 45530, Olympia, WA 98504-5530, (360) 725-1634.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has analyzed the proposed rules and concludes they do not impose more than minor costs for affected small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
August 28, 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.))