Changes Coming to Washington Apple Health

Changes Coming to Washington Apple Health

Starting in 2019, Apple Health (Medicaid) plans will cover behavioral health treatment services, in addition to the already covered physical health services. Read on to find out what this means for Apple Health clients and what you need to know to answer their questions.

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IMC Workgroups

Three workgroups have been established to help move the work forward.

  1. Early Warning System: Develop recommendations for an Early Warning System that allows a feedback loop and triage process to identify and resolve system issues as they arise.

  2. IT/EHR: Identify and resolve IT/EHR issues including but not limited to MCO/ASO billing capacity, EHR compatibility, provider data reporting requirements, technical assistance needed by providers.

  3. Communications: Provide recommendations and work to engage the consumer sector in system change efforts related in integrated managed care. Ensure that consumers maintain confidence and continuity in the care they are receiving. Ensure smooth transition to IMC through the development of clear communication materials, client notifications, and transparent transition processes.

Composition: Open to any Spokane, Pend Oreille, Stevens, Ferry, Lincoln, and Adams stakeholders who are interested in participating.  Representation from the following organizations will be strongly encouraged.

Authority: These are not a decision-making bodies, but will provide recommendations that will ensure concerns surrounding IMC are addressed and resolved in the Spokane region.

Meetings: Held no less than monthly through January 2019. All meetings will have an option to participate via teleconference for those unable to attend in person. BHT staff, in collaboration with workgroup members, HCA and the SCRBHO, shall be responsible for establishing the agenda. Notes for all meetings will be provided by BHT staff within two weeks of each meeting.

Standard Indicators for Early Warning System

This list is provided by the Health Care Authority (HCA). You can view the entire presentation here.

Provider Payments (Provided by MCO’s)

  • BH claims received by MCO’s
  • BH claims rejected by MCO’s
  • Reasons for rejections

EDIE Data (Provided by HCA/AIM team)

  • ED Utilization
  • ED Utilization for client with past BH diagnosis
  • Portion of ED visits with BH diagnosis

State Hospitals- WSH and ESH (Provided by HCA)  

  • Average Daily census
  • Discharges
  • Forensic flips  

Crisis System (Provided by BH-ASO )

  • Crisis Hotline Calls
    • # of incoming calls
    • # calls answered
    • # call answer timeliness (within 30 seconds)
    • Average speed of answer
    • Abandonment rate
  • DHMP response time
  • # ITA investigations and outcome
    • Detention
    • Discharge with referral
    • Voluntary admit
  • # of no bed reports
  • # of single bed certifications