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 provider alert. HCA will send out additional notification and plans a webinar for March 17, 2016.
WSHA has concerns regarding how the policy will work and is seeking additional information from HCA. In particular, WSHA and hospitals are concerned regarding the burden and risk of retroactive plan utilization management requirements, particularly for services requiring prior authorization and/or admission notification. HCA has requested WSHA’s assistance in compiling a list of questions from hospitals. If you have specific concerns or examples of cases that may be problematic, please contact Andrew Busz.