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November 2024 Provider News - Bonus Edition

Date: 11/18/24

In this issue: 

  • Provider Alert - HCA Managed Care Rate Increase Document Information and Clarification

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Provider Alert

Provider Alert: HCA Managed Care Rate Increase Document Information and Clarification

We understand you have received information from the HCA in the following link (PDF). Below, we would like to clarify the key details of these changes and what they mean for you regarding any rate increases.

Key Rate Increases

  1. Professional Services: Professional services in healthcare billing refer to medical services provided directly by healthcare professionals, such as physicians, nurse practitioners, physician assistants, and specialists. These services are distinct from facility services, which are related to the infrastructure or administrative operations of a healthcare facility.
    • Effective July 1, 2024
    • Rates for essential professional services set to at least 65% of Medicare (pediatric and adult care) and 100% of Medicare for maternity services.
  2. Primary Care: Refers to the first level of healthcare that serves as the initial point of contact for individuals seeking medical attention. It involves comprehensive, accessible, and continuous care focused on general health maintenance, disease prevention, early diagnosis, and management of common illnesses or conditions.
    • Effective January 1, 2025
    • Rates for primary care services will increase by 2% above Medicaid Fee-for-Service (FFS) rates.
  3. Programs for Assertive Community Treatment (PACT): Programs for Assertive Community Treatment, a model of care designed to provide comprehensive, community-based mental health services to individuals with severe and persistent mental illnesses. PACT aims to support individuals who have difficulty engaging in traditional mental health services and are at high risk of hospitalization, homelessness, or incarceration.
    • Effective January 1, 2025
    • 7% increase for PACT services, in addition to earlier increases. NOTE: You would have already received previous increases for PACT.
  4. Mental Health and Social Determinants of Health (SDOH) Screening: Mental health and social determinants of health (SDoH) screening refers to processes used to identify mental health concerns and social factors that may affect an individual's overall health and well-being. These screenings aim to ensure early intervention, provide targeted support, and address barriers to health equity.
    • Effective January 1, 2025
    • Rate increases for mental health and SDOH screenings now apply to all ages.
  5. Private Duty Nursing (PDN), Home Health, and Medically Intensive Children’s Program (MICP): Private Duty Nursing refers to continuous, skilled nursing care provided to individuals with complex medical needs in their homes or other non-institutional settings. Home Health encompasses short-term medical and therapeutic care provided at home for individuals recovering from illness, injury, or surgery, or managing chronic conditions. The Medically Intensive Children’s Program (MICP) is a specialized program in Washington State that provides in-home nursing care for children (birth to age 18) with complex medical needs.
    • Effective January 1, 2025
    • 7.5% increase for Home Health and MICP, with set hourly increases for RN and LPN in PDN services.

Important Notes

  • Provider Impact: Providers will receive no less than the updated FFS fee schedules, though the exact impact may vary based on your contract with Managed Care Organizations (MCOs).
  • State-Directed Payment: HCA directed MCOs to align these increases with updated FFS rates. There are no new State Directed Payments for Behavioral Health outside of the above listed services i.e. PACT, SDOH Screening.

For further clarification, please contact Jessica.l.molberg@coordinatedcarehealth.com and refer to HCA as needed.

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