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PROVIDER ALERT
This is the second
of three Provider Alerts
on the Health Care Authority’s (the agency’s) future Washington Apple Health
managed care enrollment policy.
Beginning April 1, 2016, the agency will implement a new managed care
enrollment policy that enrolls clients into an agency-contracted managed care
organization (MCO) the same month that they are determined eligible as a new or
renewing client. This new policy will eliminate a person being placed
temporarily in fee-for-service while they are waiting to be enrolled in an MCO
or reconnected with a prior MCO.
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New clients are those initially applying for benefits or those with changes in their
existing eligibility program that consequently make them eligible for Apple
Health Managed Care.
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Renewing clients are those who have been enrolled with an MCO but
have had a break in enrollment and have subsequently renewed their eligibility.
This change will
require providers to know when a client is successfully enrolled with an
MCO. MCOs will have retroactive authorization and notification policies
in place.
Clients currently in
fee-for-service or who are currently enrolled in an MCO are not affected by
this change. Clients in
fee-for-service who have a change in their eligibility program may be enrolled
into Apple Health Managed Care depending on the program. In those cases, the
new enrollment policy will apply.
Upcoming webinar
A webinar is scheduled
for March 17, 2016. All interested stakeholders are invited to attend. A
recorded version of the webinar will be available by March 28, 2016. Instructions
on how to participate in the webinar will be shared in a future notice.
Send in questions for webinar and Q&A document
The agency welcomes
stakeholder questions. These questions will be used in the webinar and in a
pre-implementation Q&A document. Send questions to hcamcprograms@hca.wa.gov.
The agency will send another notice to providers on March
15th regarding this new enrollment policy.
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