June 2024 Provider News - Bonus Edition (2024)

Date: 06/10/24

In this issue:

AppleHealth Expansion-Coordinated Care Webinars, WSHA Webinar, Provider Manual Update, Interpreter Services Request Form, FAQ, HCA published links

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Apple Health Expansion

Webinars

Apple Health Expansion Lunch & Learn - Coordinated Care is hosting a Lunch & Learn via Zoom on Tuesday, from 11:00-12:00pm. Come meet us and learn more about Apple Health Expansion and Coordinated Care’s benefits!

Tuesday, June 18, 2024, 11:00 am – 12:00 pm

Agenda:

Meet our Community Relations Team
Apple Health Expansion
Benefit Updates
- Coordinated Care’s Value-Added Benefits for this population
Q&A

REGISTRATION LINK.

After registering, you will receive a confirmation email containing information about joining the meeting.

Purpose: To provide information about Apple Health Expansion and Coordinated Care’s benefits for this population to health agencies and community organizations prior to June 20th AHE enrollment date. We believe keeping our partners informed and being available for questions during this crucial time would benefit our members. You will have the opportunity to meet members of Coordinated Care’s team and get an understanding of their unique roles in how they can support you and your organization.

Who should attend? Any community partner that provides services to individuals and families in need. We recognize that many people hold multiple responsibilities and that your time is valuable. We are dedicated to making this a beneficial and positive experience.

Navigators or Patient Coordinators
Community Based Organizations
WIC and Maternal Service
Community Program Coordinators

Apple Health Expansion Provider Lunch & Learn – Coordinated Care is hosting a Lunch and Learn via Zoom on Tuesday, June 25^th from 12:00pm (noon) to 1:00pm.

Tuesday, June 25, 2024, 12:00 pm (noon) – 1:00 pm

Agenda:

Apple Health Expansion Overview
Benefits Overview
Interpreter Services
Identify a Member in ProviderOne
Resources

REGISTRATION LINK.

After registering, you will receive a confirmation email containing information about joining the meeting.

Purpose: To provide information about Apple Health Expansion and Coordinated Care’s benefits for this population to Providers and Healthcare Organizations. We believe keeping our partners informed and being available for questions during this crucial time would benefit our members.

Who should attend? Any Provider that provides services to individuals and families in need. We recognize that many people hold multiple responsibilities and that your time is valuable. We are dedicated to making this a beneficial and positive experience.

Washington State Hospital Association (WSHA) Webinar: Apple Health Expansion – Thursday, June 20^th, 12:00pm (noon)

REGISTRATION LINK.

Coordinated Care Provider Manual Update

Updates will be made to the Provider Manual on 7/1/2024 to reflect the changes of the Apple Health Expansion population.

Please use this link after the 7/1/2024 update to find the latest version of the Provider Manual in the Apple Health (Medicaid) Manual and Guides Section.

Interpreter Services Request Form – Coming Soon!

The updated Interpreter Services Request Form can soon be found in the Apple Health (Medicaid) Forms Section on the Provider Resources Page of the Coordinated Care Website.

Coordinated Care & Apple Health Expansion FAQs

What are the details of Open Enrollment for Apple Health Expansion?

Who is eligible?

Washington residents age 19+, with income under 138% of the federal poverty level, who do not qualify for other Apple Health programs based on their immigration status, are not pregnant or did not have a pregnancy end in the last 12 months, and who are not eligible for qualified health plans with advance premium tax credits or federally funded medical assistance programs.
Immigrants who have not met the five-year waiting period to become eligible for Apple Health are not eligible for Apple Health Expansion. Reference the HBE’s Guide to Health Insurance for Immigrants in Washington State here (PDF).

When does Open Enrollment start?

Open Enrollment begins on June 20, 2024, at 8:00 a.m.

How to apply?

Enrollment pathways for people ages 19-64:

Online at www.wahealthplanfinder.org
In-person through a Navigator
Call 1-855-923-4633

Enrollment pathway for people ages 65+:

Online at www.washingtonconnection.org
In person at a DSHS CSO

What health plan options are there?

Enrollees may choose any Managed Care plan that offers Apple Health Expansion in their region. Coordinated Care is available statewide in all regions and offers Apple Health Expansion coverage. Here is a service area map for Apple Health Expansion. If an enrollee does not select a Managed Care plan, HCA will auto-assign them to a Managed Care plan.

What happens if the program fills to capacity?

Once the Apple Health Expansion program is full (13,000 spots), denial letters will be sent from HBE to those who apply informing them the cap has been met. The letters will include other helpful information about programs they may be eligible for. At this time, there will not be a waitlist for Apple Health Expansion.

GENERAL

If an individual is already enrolled in a Qualified Health Plan (QHP), how will this population be transitioning to Apple Health Expansion?

They will be automatically transferred with no actions needed if they meet all Apple Health Expansion eligibility criteria.

What if the individual is already enrolled in an MCO that offers Apple Health Expansion?

The HCA/HBE will automatically map the individual to the MCO affiliated with their QHP.

What if the member has an Ambetter PCP?

Coordinated Care is taking steps to ensure PCP consistency and assign the member to the same PCP for their Apple Health Expansion coverage.

If the individual does not meet Apple Health Expansion eligibility criteria, there is no change; the individual stays with their QHP.

If an individual has a Washington Healthplanfinder account, but are NOT currently enrolled in a Qualified Health Plan (QHP,) what will they need to do?

Log in to their account,
Confirm their information is up to date, and
Submit their application beginning at 8:00 a.m. on June 20, 2024.

If the member becomes incarcerated, are they termed from the Apple Health Expansion program?

If a member is incarcerated, their eligibility for Apple Health Expansion will be suspended but not terminated.

What happens to the member’s coverage if they become documented?

If an Apple Health Expansion member’s circ*mstances change, and they no longer meet the eligibility criteria for Apple Health Expansion, they should apply at Washington Healthplanfinder for other health care coverage options.

Will new or separate plan(s) be created to manage enrollees of the Apple Health Expansion program? If so, will there be a new name or how will members be identified on their ID Card?

Apple Health Expansion members will have the same ID card as any other Apple Health member. Most benefits and services are the same. Providers will need to look in ProviderOne to confirm which coverage the member has, check the “Plan/PCCM name field.”

BENEFITS & SERVICES

Will Value-Added Benefits (VABs) offered by Coordinated Care be included for this program?

Coordinated Care will offer applicable Value-Added Benefits (VABs) and health incentives to Apple Health Expansion members, these include My Health Pays, Coordinated Care Harvest Bucks, and $100 towards adult eyeglasses or contacts. More information about My Health Pays, Coordinated Care Harvest Bucks and eyeglass benefit at CoordinatedCareHealth.com/benefits.

(Note: My Health Pays—members begin earning rewards on 7/1/24 but may experience a delay in receiving rewards earned in the first few months due to system configurations.)

Will the Apple Health Expansion program mirror Medicaid benefits (both medical and behavioral health)?

Apple Health Expansion will mirror most Apple Health (Medicaid) benefits for physical health care including pharmacy and behavioral health care services.

Apple Health Expansion will not cover Health Homes; Intensive Behavioral Supportive Supervision; or any benefits operated by other state agencies including Intermediate Care Facilities (DSHS), Private Duty Nursing (DSHS/DDA), Behavioral Rehabilitative Services (DCYF), Medicaid Personal Care (DSHS), Community First Choice (DSHS), and HIV Case Management (DOH).

More information in the Provider Manual and Benefits Grid on the Manuals, Forms, and Resources webpage under Apple Health (Medicaid) Manual and Guides at CoordinatedCareHealth.com.

Are dental benefits included?

Dental benefits mirror Apple Health (Medicaid) for benefits available to adults ages 21+ and benefits available to young adults ages 19-20. Like Apple Health (Medicaid), services that are NOT medically necessary (e.g., cosmetic procedures) are not covered under Apple Health Expansion. Learn more about dental benefits on the Health Care Authority webpageand on Coordinated Care’s dental webpage.

What are the steps for getting an interpreter if one is needed?

Interpreter Services for provider visits and when calling Coordinated Care are available.

Providers may request an interpreter by:

Option 1: Emailing the Interpreter Request form (that can soon be found in the Apple Health (Medicaid) Forms Section on the Provider Resources Page of the Coordinated Care Websiteto InterpreterRequests@centene.com.
Option 2: Calling Provider Services and ask for an interpreter for the Apple Health Expansion member. Provider Services will ask a few intake questions and submit for scheduling. A scheduler will call back with the availability of interpreters to complete the scheduling.

Members may request an interpreter through their provider or Coordinated Care can assist.

When members call Coordinated Care and need support in a language other than English or Spanish they can select “0” to get connected directly to our Member Services team and get support with an interpreter.

BILLING, PAYMENTS, PROVIDER PORTAL

Will Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) receive enhancement payments for Apple Health Expansion?

No, FQHCs and RHCs will not receive the enhancement payments for AHE members. The one exception will be Tribal FQHCs.

Will the Apple Health Expansion population have any impact on Capitation agreements?

Members of Apple Health Expansion will be included in any Capitation payments.

What impact will the Apple Health Expansion population have on Value Based Agreements (VBAs) and P4P/P4Q programs?

The Apple Health Expansion population will not be included in VBA's or Pay for Performance (P4P) in 2024.

Will EEV 271 Response Plan Description show enrollees on this program & how will it display?

Please refer to the below screen shot for how it will display in 271.

How can Apple Health Expansion members be identified in Provider One (eligibility)?

Provider One will have Apple Health Expansion records in the MCO section, similar to how Behavioral Health Services Only benefits are displayed. Please see the screen shot below:

If you need information on using Provider One,the HCA website has more information located here.

How can Apple Health Expansion members be identified in the Coordinated Care Provider Portal?

In the Coordinated Care Provider Portal, the individual patient eligibility check result screen will display in the “Product Name” field. Please see screen shot below:

Primary Care Physicians (PCPs), can also see this information in the downloaded Patient Roster where Apple Health Expansion will be indicated in the Plan product field.

HCA Published Links