HCA responds to hospital questions regarding Medicaid earlier enrollment

April 6, 2016

The Health Care Authority is still in process of providing additional information on its changes to Apple Health enrollment under which clients will be retroactively enrolled in managed care from the beginning of the month. The information will be provided in the form of a Frequently Asked Questions document, generated in response to questions raises by WSHA and WSHA member hospitals. This will supplement the recording of the March 17 webinar and presentation slides posted in its training page.

As of April 1, 2016, Medicaid enrollees are retroactively assigned to a managed care plan as of the beginning of the month the patient is enrolled, rather than at the beginning of the month following enrollment. WSHA and member hospitals are concerned retroactive plan assignment will create issues for cases requiring plan prior authorization or inpatient notification. HCA is requiring the managed care plans to adjust their prior authorization and/or admission notification requirements for these situations to minimize burden and risk for providers but we do not yet know the details on how the various plans will accomplish this or communicate these changes to hospitals and other providers.

HCA indicated hospitals and providers having issues with managed care plans for affected services should send a message to the attention of Gail Kreiger, Manager of Medicaid Monitoring at hcamcprograms@hca.wa.gov. Please let us know as well if you are experiencing additional issues with plan prior authorization or inpatient notification due to the enrollment changes as we will be tracking this issue closely. (Andrew Busz, andrewb@wsha.org)


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