Apple Health (Medicaid) MCO skilled nursing facility admission and authorization process
Dear skilled nursing facility and hospital partners:
As part of ongoing efforts to improve communication and ensure timely client transitions out of acute care settings, The Health Care Authority (HCA), in partnership with the Department of Social and Health Services (DSHS), is providing resource documents to help facility staff navigate Medicaid Managed Care Organization (MCO) skilled nursing facility (SNF) admission and service authorization processes. These resources supplement the information outlined in the Nursing Facility Billing Guide.
HCA contracts with five MCOs to provide healthcare to over two million Washington residents. Each of these MCOs has unique processes for:
- Obtaining initial and ongoing SNF authorizations.
- Exceptional SNF rate approval.
- Facilitating transitions in care.
- Escalating concerns and questions about SNF transitions
The resource documents are being distributed to help front line staff navigate these MCO processes more efficiently. The documents provide step by step guidance and contact information specific to each MCO. A direct link to the document location for each MCO is provided below:
PLEASE NOTE: The timeframes outlined in these documents apply during non-pandemic surge response operations only. COVID-19 pandemic procedures, incentives, and prior authorization overrides remain in effect.
Questions
Please contact the HCA Managed Care Programs mailbox if you have any questions or concerns regarding these documents.
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