WA Awards Regional Contracts To Integrate Behavioral Care

Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care. 

By Lauren Flynn Kelly, Managing Editor

June 8, 2017 Volume 23 Issue 11

As part of an ongoing effort to regionalize Medicaid purchasing and provide Apple Health Medicaid beneficiaries with the full continuum of physical and behavioral health services through managed care by 2020, the Washington state Health Care Authority (HCA) has notified subsidiaries of Anthem, Inc., Centene Corp. and Molina Healthcare, Inc. of its intent to award Fully Integrated Managed Care (FIMC) contracts in the North Central Region. The new FIMC program includes a separate contract for behavioral health “wraparound” services, which are not traditionally covered under Medicaid managed care.

Anthem’s Amerigroup Washington, Molina Healthcare of Washington, Inc. and Centene’s Coordinated Care Corp. were selected by the state to provide fully integrated behavioral and physical health services in the counties of Chelan, Douglas and Grant. Under the new FIMC program, MCOs will provide mental health and substance use disorder services that are currently delivered by behavioral health organizations in the region, as well as provide additional benefits to Medicaid beneficiaries that would not otherwise be covered by Medicaid, such as services funded solely by the state legislature, with no federal matching funds.

In addition, select individuals such as dually eligible Medicare and Medicaid beneficiaries who receive medical services through the state’s fee-for-service system will be eligible to receive behavioral health services-only through their choice of MCO. The majority of Medicaid enrollees in the region, however, will be enrolled in the FIMC program, estimates the state. The two-year contracts are slated to begin on Jan. 1, 2018.

This is the second region the state is transitioning to FIMC; further expansion is planned. Molina and Community Health Plan in April 2016 became the first MCOs selected by the HCA to provide integrated services in the Southwest region of Washington.

The results of a separate procurement for behavioral health administrative services organizations (ASOs) were expected on June 9. Under that contract, ASOs will serve another 66,000 members in the North Central region and work closely with the integrated MCOs, according to research and consulting firm Health Management Associates.

For more information, visit www.hca.wa.gov.

https://aishealth.com/archive/nman060817-04?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=113437465