STATE OF WASHINGTON



center31912900STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services DivisionPO Box 45600, Olympia, WA 98504-560013811251857375HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINH20-105 – ProcedureDecember 17, 2020TO:Home and Community Services (HCS) Division Regional AdministratorsArea Agency on Aging (AAA) DirectorsFROM:Bea Rector, Director, Home and Community Services DivisionSUBJECT:Managed Care contacts for coordination of Apple Health physical and behavioral health care benefits and escalation process.Purpose:Provide direction to HCS/ AAA Field staff for case coordination when a client’s support needs require coordination with the Managed Care Organization (MCO) to address barriers and assist the client to access their medically necessary physical and behavioral health benefits under Apple Health. Inability to access these benefits may result in unsuccessful care planning and access to community based services.Background:In January 2020, the Washington State Apple Health managed care plans became integrated statewide. Integration requires the managed care plans to provide and coordinate physical and behavioral health care* for their enrollees. *Dental care remains fee for service and is not covered by the Apple Health managed care plans.There are five Apple Health managed care plans contracted with the HCA. HCA assures the managed care plans are compliant with Centers for Medicaid and CHIP Services (CMCS) rules and their contractual obligations to coordinate Medicaid benefits for Apple Health eligible individuals in Washington.Clients who have Medicare or private insurance may be enrolled with an Apple Health managed care plan for Behavioral Health Services Only (BHSO).What’s new, changed, or Clarified:HCS/AAA in coordination with the managed care plans have established a care coordination contact list and an escalation process. ACTION:When an HCS/AAA client enrolled in managed care needs assistance to coordinate their health care services and access to appropriate treatment, the CM must assist the client and their guardian, if applicable, to request “care coordination” from the client’s Apple Health MCO (including clients who have managed care only for behavioral health services). If you need assistance with acute hospital or skilled nursing facility transitional care activities please refer to the contacts in MB H20-029 Process for Coordinating with MCOs on Acute Hospital and Skilled Nursing Facility Discharges the escalation process for transitional care requests will follow the same process below. A Transitions of Care and Care coordination contact list can be found on the HCS/AAA/AAA intranet website. To request care coordination, the CM may send a secure email* to the client’s MCO to request care coordination and assistance to address barriers the client is experiencing to access medically necessary care covered by Apple Health. Email addresses for the five Apple Health plans are: Molina Healthcare of Washington, Inc. (MHW)Community Health Plan of Washington (CHPW)Coordinated Care of Washington (CCW)United Healthcare Community Plan (UHC)Amerigroup (AMG)*Emails from the DSHS URL (@dshs.) identifies the requestor as a DSHS employee and meets HIPAA requirements to request care coordination on behalf of a HCS/AAA client. When making a care coordination request include the following in your email:In the Email “Subject” line, provide the reason for care coordination request. For example: Mental health treatmentDurable medical equipmentNeeds Primary Care ProviderIn the body of the email, provide the following information:Client NameClient ProviderOne ID: (9-digit number ending in WA)Date of Birth Residence Type CM Name and Contact InformationSummary of client barrier/issue/needIf you do not receive a response or assistance with your request timely, the CM should discuss the case with their supervisor to determine if escalation is needed. Sent a second email to the MCO with ‘escalation’ in the title of the email.If the CM and supervisor do not receive a response they may determine escalation to HCS HQ is needed when issues are not resolved. If the CM supervisor determines that escalation to HQ is appropriate, the CM supervisor will submit the original email communication and escalation with the MCO to Ethan.Leon@dshs. and use the following format: In the Email “Subject” line, In the Email “Subject” line, provide the Barrier to Access issue. For example, issues related to: Mental health treatmentDurable medical equipmentNeeds Primary Care ProviderIn the body of the email, provide the following information:Client NameClient ProviderOne ID: (9-digit number ending in WA)Date of Birth Residence Type CM Name and Contact InformationName and contact information for MCO case manager (if applicable)Summary of barrier/issue Once the request for escalation is received, HCS HQ will outreach with HCA to discuss the identified barrier to access. Based upon the type of request, the case manager and supervisor will be notified regarding next steps. Related REFERENCES:WAC 182.501.0060Apple Health Covered Benefit InformationATTACHMENTS:n/aCONTACT(S):Kelli EmansIntegration Unit ManagerKelli.Emans@dshs.360.764-3017Ethan LeonManaged Care Policy AnalystEthan.Leon@dshs.360.725.3566 ................
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