WSHA and member hospitals have expressed concerns regarding the Health Care Authority’s (HCA) changes to Apple Health enrollment. As of 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. WSHA and member hospitals are concerned retroactive plan assignment will create issues on 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 provided a general overview of the changes via a webinar on March 17. A recording of the webinar and presentation slides has been posted its training page. Since there was no opportunity to ask questions during the webinar, HCA plans to address scenarios and concerns that have been posed by hospitals in a detailed set of Frequently Asked Questions, which it is currently working on. WSHA has encouraged providers to submit questions directly to HCA and also hosted a conference call where hospital staff provided HCA with additional input. We do not know when the FAQ will be completed but expect HCA will make it available before April 1. 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 firstname.lastname@example.org. 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, email@example.com)