Purpose: The proposed rules provide for accountable communities of health to establish community care hubs provided through the Washington state health-related social needs (HRSN) services program. Under the Washington state section 1115 medicaid demonstration waiver, the HRSN services program allows qualifying medicaid enrollees to receive evidence-based, nonmedical services to address unmet adverse social conditions that contribute to poor health. The community care hubs provide community-based care coordination, known as social care support service, and support the delivery of other approved HRSN services.

(1) Washington state has nine accountable communities of health (ACHs), as defined in RCW 82.04.43395, each of which operates a regional community care hub. In addition, the federally recognized tribes in Washington operate a statewide native hub to support the delivery of whole-person care coordination.

(2) An eligible person may access any community care hub in the state of Washington. The community care hubs also work closely with managed care organizations, providers, and community partners to identify and engage apple health clients who are likely to have multiple health and social needs.

(3) Community care hubs provide case management, outreach, and education services to qualifying Washington apple health clients across Washington state.

(4) Subject to available funds, allowable expenditures are covered up to the medicaid agency's financial limit, as determined by the agency.

(5) This subchapter applies to the portion of health-related social needs (HRSN) services the agency administers through community care hubs.

"Clinical-risk factor" means physiological conditions that increase the likelihood of poor health outcomes.

"Community care hub (CCH)" means one of the nine regional centers managed and operated by one of the nine accountable communities of health (ACH). Each CCH organizes and supports a regional network of community-based organizations providing community-based care coordination and services to address health-related social (HRSN) needs. The medicaid agency contracts with the ACHs to provide the HRSN screening and referral service.

"Health-related social needs (HRSN)" means unmet, adverse social conditions (e.g., housing instability, homelessness, nutrition insecurity) that contribute to a person's poor health and result from underlying social determinants of health (conditions in which people are born, grow, work, and age).

"Social risk factor" means a social condition that negatively impacts a person's health and contributes to poor health outcomes and health inequities.

To be eligible to receive covered services through community care hubs, a person must be enrolled in Washington apple health and:

(1) Meet one or more of the following social risk factors:

(a) Be homeless or at risk of homelessness, as defined by 24 C.F.R. § 91.5, except for the annual income requirement in 24 C.F.R. § 91.5 (1)(i);

(b) Meet the U.S. Department of Agriculture's (USDA) definition of low food security or very low food security;

(c) Be experiencing poverty or near poverty, as defined by income below 200 percent of the federal poverty level (FPL); or

(d) Screen positive for a health-related social need; and

(2) Have at least one of the following clinical risk factors:

(a) Complex behavioral health needs;

(b) Developmental disability needs;

(d) Experienced interpersonal violence;

(e) Repeated emergency department use and crisis encounters;

(f) Be pregnant or up to 12 months postpartum; or

(g) Be a child age six or younger who currently has at least one of the following conditions:

(i) Malnutrition, risk of developmental or growth delay, or impairment because of insufficient nutrition as a clinical risk factor for case management related to nutrition services only;

(ii) Child maltreatment, as defined by the Centers for Disease Control and Prevention. (See https://www.cdc.gov/violence-prevention/?CDC_AAref_Val=https://www.cdc.gov/violenceprevention/pdf/%2520CM_Surveillancea.pdf);

(iii) Is a child with a special health care need (CYSHCN) as defined by the Health Resources and Services Administration. (See https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn);

(iv) Low birth weight;

(v) A mental health condition; or

(vi) Health conditions, including behavioral health and developmental syndromes, stemming from trauma, child abuse, and neglect; or

(h) Be an adult age 65 or older who currently has at least one of the following:

(i) Two or more chronic conditions as defined in RCW 74.09.010;

(ii) Social isolation, which may place the person at risk for early death, neurocognitive disorders, sleep disruption, cardiovascular disease, or elder abuse;

(iii) Malnutrition as a clinical risk factor for case management related to nutrition services only;

(iv) Health conditions, including behavioral health and developmental syndromes, stemming from trauma, child abuse, and neglect; or

(v) Requires assistance with activities of daily living as defined in WAC 182-565-0110 or instrumental activities of daily living as defined in WAC 388-106-0010; or

(i) Be eligible under one of the following programs:

(i) Medicaid personal care (MPC) as described in WAC 388-106-0210;

(ii) Nursing facility care services as described in WAC 388-106-0355; or

(iii) Long-term care services as described in WAC 388-106-0045.

Community care hubs provide the following covered services:

(1) Screen clients for health needs and health-related social needs (HRSN);

(2) Check clients' eligibility to receive the case management, outreach, and education service;

(3) Refer clients to providers, community partners, or organizations that will address their HRSNs;

(4) Follow up to ensure clients' connection to services and completion of interventions;

(5) Track client outcomes;

(6) Provide technical assistance and capacity support to community partners or community-based organizations (CBOs); and

(7) Provide navigation assistance for benefit applications or referrals to HRSN services or other federal, state, and local community programs.