WSR 20-15-097
[Filed July 15, 2020, 1:00 p.m.]
Title or Subject: Medicaid State Plan Amendment (SPA) 20-0031 Health Home Rate Structure for the Managed Fee-for-Service (MFFS) Delivery System.
Effective Date: July 16, 2020.
Description: The health care authority (HCA), in conjunction with the department of social and health services (DSHS) aging and long-term care services administration (ALTSA), intends to submit SPA 20-0031 in order to update the methodology used to determine the rates paid for health home services. The health home program is a voluntary care coordination model supported by one-on-one, face-to-face visits with eligible high-risk clients who have multiple chronic conditions. The program is available statewide.
HCA is updating the current payment methodology and rates based on actuarial analysis that reviewed and analyzed actual costs of providing health home services in each tier.
SPA 20-0031 is expected to increase the annual aggregate payment MFFS health home providers by twenty-six percent across the three tiers of service based on frequency of tier submission for payment.
The original three-tier health home rates were established in July 2013 and included a withhold amount for tiers two and three. After program review, the withhold amount was removed from the rates in January 2015 to help increase client engagement. In 2016, HCA reviewed the payment rates and provided a performance incentive payment to the MFFS health home lead entities for meeting an established engagement rate, which was effective July 2017. After an actuarial study completed in 2018, rates were increased, which gave the MFFS health home lead entities an aggregate increase of twenty percent across the three tiers and the performance incentive payment was decreased to five percent for MFFS health home leads who met the engagement threshold.
After review and analysis of the health home rates based on provider experience and cost expenditures, HCA will increase the current rates effective July 16, 2020. The new payment rates will give MFFS health home lead entities an aggregate increase of twenty-six percent across all three tiers based on frequency of tier submission.
HCA would appreciate any input or concerns regarding this SPA. To request a copy when it becomes available or submit comments, please contact the person named below by August 15, 2020. Please note that all comments are subject to public review and disclosure, as are the names of those who comment.
Contact: Nicole Bishop, Medicaid Program Operations and Integrity, 626 8th Avenue S.E., Olympia, WA 98504, Mailstop 45530, phone 360-725-0832, TTY 711, email, website