WSR 16-18-001
[Filed August 24, 2016, 12:40 p.m.]
Title or Subject: Medicaid State Plan Amendment (SPA) 16-0026 Health Homes.
Effective Date: January 1, 2017.
Description: Medicaid SPA for health homes and the rate structure for the fee-for-service (FFS) delivery system.
The health care authority (HCA), in conjunction with the department of social and health services, aging and long-term care services administration (ALTSA), intends to submit SPA 16-0026 in order to add King and Snohomish counties to the health home program. The health home program is a voluntary care coordination delivery model that is supported by one-on-one, face-to-face visits with high-risk clients who have multiple chronic conditions. Currently HCA and ALTSA operate the health home program as a joint program in thirty-seven counties of Washington state. The addition of King and Snohomish counties will make the program statewide.
Contracted health home services providers will be paid a monthly encounter rate for fee-for-service participating beneficiaries. Payment for eligible managed care beneficiaries is built into the apple health managed care organizations' capitation rate and no additional payment is made for their contractually required health homes.
Stage of Care Coordination
Total Rate
Total Admin.
Tier One - Outreach, Engagement, and Health Action Plan
Per Participate [Participant]
Tier Two - Intensive Health Home Care Coordination
Per Participate [Participant] per Month
Tier Three - Low-Level Health Home Care Coordination
Per Month with Encounter
Fee-for-service health home rates were set in July 2013 and included the above three tiers of payment for providing health home services, including a withhold for tiers two and three. In January 2015, HCA removed the withhold from the rates. The above rates reflect the 2015 revision to the rates. The rates are expected to remain the same effective January 1, 2017.
No increase or decrease in annual aggregate expenditures is anticipated. The above rates have been modeled for the addition of King and Snohomish counties in the health home program for 2017 and remain budget neutral.
The SPA is in the development process; therefore a copy is not yet available for review. To contact the agency for additional information and a copy of the SPA when it becomes available, please contact Becky McAninch-Dake, Division of Medicaid Program Operations and Integrity, 626 8th Avenue S.E., Olympia, WA 98504, mailstop 45530, phone (360) 725-1642, e-mail, web site