Managed Care - GAU Managed Care Pilot (King & Pierce)

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Managed Care - GAU Managed Care Pilot (King & Pierce)

Revised October 28, 2007

Purpose: Most GAU clients in King and Pierce counties must enroll in managed care with a Community Health Plan of Washington clinic. The clinic will ensure the person receives the current scope of care by providing the medical service or referring the person to other medical providers. GAX clients will remain in fee-for-service medical coverage.

WAC 388-538-063

CLARIFYING INFORMATION

NOTE:
The person is enrolled if the MAID shows "CHPG" in the HMO column.

GAU managed care is provided in King and Pierce County only. See Appendix I for the list of zip codes for the pilot sites.

GAU clients are generally enrolled into managed care the month after being determined eligible. If the date is after Health and Recovery Service Administration's (HRSA) cutoff, the client will be enrolled for the following month. Their medical coverage is fee-for-service when not enrolled in managed care.

WORKER RESPONSIBILITIES
Once eligibility is determined for a GAU client who was or is being admitted to a nursing facility:

If the client is going directly from the hospital, is fee-for-service, or directly applying for placement into the nursing facility, he or she will not be in managed care.

The HCS financial worker needs to notify Amandalei Bennett at bennea@dshs.wa.gov so the case can be exempted from managed care.

Send an email with the person’s name, ACES CLID or PIC code, facility name, admission date, and estimated discharge date to Ms. Bennett.

If the client has been enrolled in GAU Managed Care, he or she will be placed by CHPW. The nursing home will coordinate with CHPW to provide medical services.

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