Response needed: Rural health clinics may elect direct payment of encounter rates by Medicaid managed care plans

October 5, 2017

The Washington Health Care Authority (HCA) is implementing a change to enable a rural health clinics to request to get paid their encounter rate by the Medicaid managed care plans rather than the current combination of plan payment, enhancement payments, and reconciliation process. RHCs must notify HCA promptly of their desire to be paid their encounter rate in order for the change to be effective as of January 1, 2018. To elect the change for CY 2018, RHCs must notify HCA by sending the linked form via email to Clinics that do not promptly notify HCA promptly of their request will continue to be paid under the current process for 2018. According to HCA, about 80 clinics have already requested that they be paid their encounter rate.

This change was ordered by the legislature as part of a budget bill proviso. The new mechanism should enable many clinics to significantly reduce the dollar amount subject to the delay and uncertainty of reconciliation process. HCA has already begun rulemaking to update WAC 182-549-1450 to support the new process.  WSHA is currently reviewing the changes and plans to comment. (Andrew Busz,


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