Managed Care ChangesBasic Health and Healthy

OptionsAlison RobbinsWashington State Health Care Authority September 18, 2012

Procurement Process

• Conducted in 2011 – 2012• New contracts signed March 2012• Program changes implemented July

1, 2012• Exiting Plans: Group Health

Cooperative, Regence BlueShield, Asuris NW Health, Kaiser, Columbia United Providers.

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Healthy Options Plans for 2012

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• Amerigroup/Real Solutions

• Community Health Plan of Washington

• Coordinated Care Corporation

• Molina Healthcare of Washington

• UnitedHealth Care Community Plan

Effective 8-1-2012 Service Areas for Healthy Options, Children’s Health Insurance Program,

Healthy Options Blind/Disabled, and Healthy Options Foster Care Programsas of 6-5-12

Garfield

Pend Oreille

Spokane

Walla Walla Asotin

Columbia

Stevens

Whitman

Ferry

Lincoln

Franklin

Adams

Douglas

Grant

Benton

Yakima

Klickitat

Chelan

San Juan

Whatcom Okanogan

Skagit

King

Kittitas

Snohomish

LewisPierce

Skamania

ClallamIsland

Clark

Cowlitz

KitsapMason

Wahkiakum

Pacific

Jefferson

Grays Harbor

AMG CCC CHP MHC UHC

CCCCHP MHCUHC

CCCCHP MHCUHC

CHPCCC MHCUHC

CCC CHP MHCUHC

CCCMHCUHC

CHPMHCUHC

CCC CHP MHC UHCAMG

CCCCHPMHCUHC

CCCCHP MHCUHC

AMG CCC CHP MHC UHC

CHPMHC

AMG CCC MHCUHC

CCC UHC

CHPCCC MHCUHCAMG

AMG CCC CHP MHC UHC

AMG CCC CHP MHC UHC

MHC

AMG CCC CHP MHC

AMG CHP MHCAMG CCC CHP UHC

AMG CCC CHP MHC UHC

CCCUHC

CHP MHCUHC CCC

CCCCHP MHCUHC

CHPMHC

CCCUHC

AMG CCC CHP MHCUHC

CCC CHP MHC UHCAMG

CHP MHCUHCAMG

County enrollment in managed care is voluntary.

Thurston

CCC UHC

AMG CHP MHCCCC

AMG CCC CHP MHC UHC

AMG CCC MHC UHC

AMGMHCUHC

CCCCHP MHCUHC

AMG CCC CHP MHC UHC

CCC, CHP, MHC, UHC

AMG CCC MHC

Division of Developmental Disabilities

• Enrollment in Healthy Options will not impact:– The services you are currently receiving

from DDD– Your case management with DDD– Your eligibility for DDD

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Medicaid Healthcare Services

• Fee for Services • Healthy Options managed care

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Medicaid Managed Care

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• Health Plans must ensure:– Guaranteed access to a Primary Care

Provider– Choice of multiple Primary Care

Providers and Specialists– 24/7 access to a Nurse Advice Line– Coordination of care among providers

and systems of care: for example, between medical and mental health systems

– Prescription coverage

Ensuring plan readiness

• Comprehensive readiness reviews of each health plan• Examination of contractual and quality requirements

• Bi-weekly plan training sessions• Bi-weekly individual health plan meetings• Ad hoc meetings as requested

• Bi-weekly network development assessment

• Agency staff response to plan questions• Review of plan materials

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New Eligible Clients

New population added to managed care: • Categorically Needy SSI Blind and Disabled:

• Medicaid Only• Mandatory Enrollment – must enroll in managed

care unless client meets exemption requirement

• Voluntary enrollment for foster care children• Foster children may enroll but are not required to

enroll

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Exempt from Managed CareMedicaid Only, Blind/Disabled clients will enroll except clients:• Living in institutional settings • Enrolled in Chronic Care Management Programs• Enrolled in the Program of All-Inclusive Care for the

Elderly (PACE)• On hospice• American Indians/Alaska Natives• Enrolled in the Washington Medicaid Integration

Partnership (WMIP)• Enrolled in the Medically Intensive Children’s Program

(MICP)• Third Party Insurance

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Healthy Options enrollment process

• Clients receive:• Notice of enrollment in a health plan and

instructions on how to change plans;• Enrollment Handbook with information about

Healthy Options• Enrollment form

• Enrollments effective the first of the following month: Changes for November 1 can be made until October 30.

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How you can help• Know what to tell clients

• Check eligibility for Healthy Options• Find out which plan(s) each doctor or specialist

contracts with:• Help determine appropriate plan • Help enrolling in or changing plans• Help clients contact providers or plan for help

coordinating care• Report issues to the plan and/or HCA

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Care Management Expectations of Plans

Stronger contractual requirements• To assist new enrollees:

• Rxs written prior to enrollment • Get care from non-par providers or new PCP

• Transitional care requirements to mitigate risk of re-hospitalization/re-institutionalization

• Care coordination with focus on integrated care between physical and behavioral health

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Care Management Expectations

• Intensive Care Management for enrollees with special health care needs (ESHCN)• Identification of ESHCN• Initial Health Screen-Initial Health Assessment• Treatment plans

• Quality Assurance and special programs

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Managed Care Facts

• Enrollees:– May change plans every month – most

don’t– Are allowed to get second opinions

through the plan– New Enrollees: May keep current

prescriptions, care plans and providers for 90 days or until accessed by the new plan

– There is no balance billing; no co-pays for Medicaid clients15

Exemption/Disenrollment

• WAC 182-538-130 currently undergoing revision;

• Requests reviewed on case by case basis by HCA medical consultant

• Clients who contact MACSC will be directed to work with the plan to receive services

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Third Party Insurance

• What is “Third Party Insurance”– Third party insurance provides insurance benefits

comparable to Healthy Options – it may be Medicare, TriCare, or an insurance like Group Health or Premera

• Clients with third party insurance are exempt from enrollment in Healthy Options• Call 1-800-562-3022 ext. 16134

• Monday 7:30 – 4:30• Tuesday – Friday 7:30 – 1:00

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How to Enroll

• Medicaid clients can make plan choices now by using the ProviderOne system

• https://www.waproviderone.org/client

• Call the IVR at 1-800-562-3022

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Health Plan Contact Information

Customer Service: 1-877-542-8997Website: www.uhccommunityplan.com Provider Line - 1-877-542-9231Website: http://www.uhccommunityplan.com/health-professionals

Customer Services: 1-800-600-4441Website: www.amerigroup.comProvider line - 1-800-454-3730Website: http://washington.joinagp.com

Customer Service: 1-800-440-1561Website: www.chpw.orgProvider line - 1-800-440-1561Website: http://www.chpw.org/for-providers/

Customer Service: 1-877-644-4613Website: www.coordinatedcarehealth.com Provider line - 1-877-644-4613Website: http://www.coordinatedcarehealth.com/for-providers/become-a-provider/

Customer Service: 1-800-869-7165Website: www.molinhealthcare.com Provider line - Phone: 1-800-869-7175Website: http://www.molinahealthcare.com/medicaid/providers/wa/Pages/home.aspx

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Questions

• Basic Health and Healthy Options Managed Care• http://www.hca.wa.gov/managed_care

• Healthy Options• http://hrsa.dshs.wa.gov/HealthyOptions/

• Basic Health• http://www.basichealth.hca.wa.gov

• Contact us:• Managed Care mailbox: hcamcprograms@hca.wa.gov

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