Current through Register Vol. 24-18, September 15, 2024
(1)
The agency's health home program provides patient-centered care to participants
who:
(a) Have at least one chronic condition
as defined in WAC
182-557-0100; and
(b) Are at risk of a second chronic condition
as evidenced by a minimum predictive risk score of 1.5.
(2) The health home program offers six care
coordination activities to assist participants in self-managing their
conditions and navigating the health care system:
(a) Comprehensive or intensive care
management including, but not limited to, assessing participant's readiness for
self-management, promoting self-management skills, coordinating interventions
tailored to meet the participant's needs, and facilitating improved outcomes
and appropriate use of health care services;
(b) Care coordination and health
promotion;
(c) Comprehensive
transitional care between care settings including, but not limited to, after
discharge from an inpatient facility (hospital, rehabilitative, psychiatric,
skilled nursing, substance use disorder treatment or residential habil-itation
setting);
(d) Individual and family
support services to provide health promotion, education, training and
coordination of covered services for participants and their support
network;
(e) Referrals to community
and support services; and
(f) Use
of health information technology (HIT) to link services between the health home
and participants' providers.
(3) The agency's health home program does
not:
(a) Change the scope of services for
which a participant is eligible under medicare or a Title XIX medicaid
program;
(b) Interfere with the
relationship between a participant and his or her chosen agency-enrolled
pro-vider(s);
(c) Duplicate case
management activities the participant is receiving from other providers or
programs; or
(d) Substitute for
established activities that are available through other programs administered
by the agency or other state agencies.
(4) Qualified health home providers must:
(a) Contract with the agency to provide
services under this chapter to eligible participants;
(b) Accept the terms and conditions in the
agency's contract;
(c) Be able to
meet the network and quality standards established by the agency;
(d) Accept the rates established by the
agency; and
(e) Comply with all
applicable state and federal requirements.
Statutory
Authority:
RCW
41.05.021. WSR 13-21-048, §182-557-0050,
filed 10/11/13, effective 11/11/13. Statutory Authority:
RCW
41.05.021 and
2011 c
316 . WSR 13-12-002, §182-557-0050, filed
5/22/13, effective 7/1/13. WSR 11-14-075, recodified as §182-557-0050,
filed 6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.500,
74.09.520, and 2007 c 259, §
4. WSR 07-20-048, § 388-557-0050, filed 9/26/07, effective 11/1/07. WSR
13-21-003, §182-557-0050, filed 10/3/2013, effective
11/3/2013
