The Health Care Authority is planning significant changes to Apple Health enrollment. Under a new policy effective April 1, 2016, enrollees will be 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. See the HCA provider alert. HCA plans a webinar to provide more detail of the changes on March 17, 2016.
WSHA staff met with HCA staff to express our concerns with this policy and additional burdens it might place on hospitals if they are unable to get payment or have additional paperwork for procedures that require prior authorization or prior notification. HCA is requiring the managed care plans to adjust their prior authorization and/or admission notification requirements for these situations. HCA staff strongly assured us they plan to make this new policy work without additional burdens on the providers. Gail Krieger, Manager, Medicaid Monitoring and Quality of Care, at HCA said she would be policing implementation.
HCA has requested WSHA gather questions from hospitals so they can be addressed and communicated in the materials and webinar. At WSHA’s request, HCA staff also agreed to participate in in a conference call with interested hospital staff prior to the webinar to get a better understanding of concerns. If you have specific questions, concerns or examples of cases you wish HCA to consider, or are interested in participating in a conference call on this topic, please contact Andrew Busz at (206) 216-2533 or andrewb@wsha.org.
