This week, we reviewed the Washington Health Care Authority’s (HCA’s) request for proposals (RFP) for the North Central Regional Service Area (RSA) transition to Fully Integrated Managed Care (FIMC) under the Apple Health Medicaid program. Under the RFP, HCA will contract with fully integrated Medicaid managed care organizations (MCOs) – integrating physical and behavioral health – for the North Central RSA, which consists of Chelan, Douglas, and Grant counties. HCA previously issued a FIMC RFP for Clark and Skamania counties in the second half of 2015. The state eventually intends to transition all counties to the Apple Health FIMC model. Awarded MCOs will begin serving the North Central RSA on January 1, 2018. There are more than 66,200 Apple Health members in the North Central RSA as of February 2017.
The RFP indicates that nearly all Medicaid beneficiaries in the North Central RSA will be covered under the FIMC program. Apple Health currently covers most populations, including individuals who are aged, blind, and disabled (ABD) and HCBS waiver beneficiaries.
Additionally covered under the FIMC program will be select individuals receiving behavioral-health- services-only through their choice of MCO while continuing to receive medical services through HCA’s fee-for-service system. These behavioral-health-services-only (BHSO) eligibility categories include:
- Dual eligibles
- Apple Health foster care children
- Individuals residing in an IMD (Institution for Mental Disease)
- Medically needy spenddown enrollees, pregnant women who are not citizens of the U.S., and individuals with other health coverage, but eligible for BHSO.
American Indian/Alaska Native populations are exempted from mandatory Apple Health enrollment, but may voluntarily enroll in the FIMC program.
Behavioral Health Integration
Successful bidders will be awarded two contracts: one for Apple Health – FIMC, and one for the Behavioral Health Services Wraparound contract. The Behavioral Health Services Wraparound contract integrates non-Medicaid funded mental health and substance use disorder (SUD) services funded by block grants and state-only funds, which are currently provided by the behavioral health Regional Service Network, the county, or SUD residential treatment providers. A full list of mental health/SUD services is provided in the sample Wraparound contract.
At this time, HCA is accepting bids only from health plans with current Apple Health contracts, although plans are not required to currently serve enrollees in the North Central RSA.
A mandatory non-binding letter of intent must be submitted to HCA by March 1, 2017, with proposals due on April 5, 2017. The state intends to announce successful bidders on May 11, 2017, with contract negotiations to follow. FIMC operations will begin on January 1, 2018.
|Letter of Intent (LOI) Due||March 1, 2017|
|Questions Due to HCA||March 13, 2017|
|HCA Responses to Questions||March 23, 2017|
|Proposals Due||April 5, 2017|
|Preliminary Award Announcement||May 11, 2017|
|Contract Negotiations Begin||July 1, 2017|
|Implementation||January 1, 2018|
RFP Evaluation Process
The RFP evaluation process places the highest weight on responses around care coordination, behavioral health access, management, and network. More than 22 percent of all available points are based on medical, mental health, and SUD provider network adequacy.
Contract Awards/Term of Contract
HCA intends to award contracts to two MCOs, but allows for the potential of a third award. Contracts will be in effect for two years, from January 1, 2018, through December 31, 2019. However, HCA may extend the contracts beyond this date at their discretion.
Existing Apple Health Market
Molina Healthcare is the largest Apple Health MCO in the North Central RSA at this time, with just over 50 percent of the market. Community Health Plan of Washington and Centene’s Coordinated Care Corporation combine to cover another 40 percent of the market. Enrollment in the table below is as of February 1, 2017. All of the major Apple Health MCOs in Washington have a presence in the North Central RSA.