healthy options and health homes may 6, 2012. what is a health home? a “health home” is a...
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Healthy Options and Health Healthy Options and Health Homes Homes
May 6, 2012May 6, 2012
What is a Health Home?What is a Health Home?
• A “Health Home” is a network of community based providers who will work together to provide a continuum of needed services for eligible beneficiaries
• Each Health Home has a lead entity responsible for administrative and oversight functions – Lead entity contracts with Care Coordination
Organizations (CCOs) for service provision– MCOs are considered community based
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Who Can Act as a Qualified Who Can Act as a Qualified Health Home?Health Home?
• An organization such as a Regional Support Network, Area Agency on Aging, Managed Care Organization or other entity with the ability to contract with or form Memorandums of Understanding (MOU) with other community based entities and perform administrative functions.
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Who is Eligible for Health Who is Eligible for Health Homes?Homes?
• Medicaid-only Fee for Service clients• Dual Eligible Fee for Service• Healthy Options Enrollees• Primary Care Case Management
Enrollees
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Managed Care and Health Managed Care and Health Homes Homes
• Managed Care Plans may act as Lead Entity in community based health homes or participate as a provider– Managed care enrollees enrolled in HH
through plan they are enrolled in– Dual Eligible and Fee for Service clients
enrolled by Health Care Authority
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Effective 8-1-2012 Service Areas for Healthy Options, Children’s Effective 8-1-2012 Service Areas for Healthy Options, Children’s Health Insurance Program, Healthy Options Blind/Disabled, and Health Insurance Program, Healthy Options Blind/Disabled, and
Healthy Options Foster Care ProgramsHealthy Options Foster Care Programs
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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
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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
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
Eastern Washington Health Eastern Washington Health Home Coverage AreasHome Coverage Areas
• Coverage Area 6: Adams, Chelan, Douglas, Ferry, Grant, Lincoln, Okanogan, Pend Oreille, Spokane, Stevens and Whitman
– RFA will be released May 10, response due July 12, Contracts start October 1, 2013
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Eastern Washington Health Eastern Washington Health Home Coverage AreasHome Coverage Areas
• Coverage Area 7: Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, and Yakima– RFA Awards announced May 2 for July 1 start
date– Successful respondents:
• Optum Health • United Healthcare Community Plan• Community Health Plan of Washington• Coordinated Care Corporation• SE Washington Aging and Long Term Care
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Section 2703 Health HomesSection 2703 Health Homes
• Section 2703 of the ACA governs Health Homes and includes:– Intensive/comprehensive Care Management– Care Coordination and Health Promotion– Comprehensive transitional care– Individual and family support services– Referral to community and social support
services.– Use of health information technology to link
services
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What are Health Home What are Health Home Services?Services?
Individuals receiving Health Home services will be assigned a Health Home coordinator who will partner with beneficiaries, their families, doctors, and other agencies providing services to ensure coordination across these systems of care.
In addition, the health home coordinator will make in-person visits and be available by telephone to help the individual, their families, and service providers.
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Health Home ServicesHealth Home Services
• Health Home Care Coordinators also ensure appropriate referrals are made, provide education to the enrollee and his/her family about his/her condition, and that transitional services from hospital to home are provided to reduce re-hospitalizations
• Other services available from the Health Homes include assistance with arranging transportation, locating housing and accessing interpreter services
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Questions/InformationQuestions/Information
• More information about Health Homes can be found at:• http://www.hca.wa.gov/Pages/health_homes.aspx
• For questions about managed care contact us at: • [email protected]
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