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

providers2

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.

3

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

4

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

5

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

6

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

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

7

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

8

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

9

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.

10

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

11

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: • hcamcprograms@hca.wa.gov

12