Below are some frequently asked questions specifically for providers on the Apple Health Core Connections program. Click here to view as a PDF.
Why was this new program created?
The Apple Health Foster Care (AHFC) program known as Apple Health Core Connections is a new managed care program that will provide coordinated health care services for children and youth in foster care, extended foster care, adoption support, and young adult alumni of the foster care program.
As directed by the state legislature, the Health Care Authority (HCA) will move children in fee-for-service Medicaid (ProviderOne) into a managed care plan. Through a competitive bidding process, the HCA selected Coordinated Care as the statewide plan to provide AHFC services.
The new program will provide:
- A collaborative approach to serving this vulnerable population by working with the Children’s Administration to ensure better coordination of care for enrollees and involve the child’s parents, caregivers, health care providers and social workers.
- Contracted providers with access and technology to securely share medical information.
- Access to clinical experts and training to support providers caring for children who have experienced trauma, abuse and neglect.
- Improved access to care by establishing a medical home with an assigned primary care provider for Apple Health Core Connections members.
- Smooth health care transitions as children and youth move from home to foster care, between placements, hospitals or other institutional settings.
What services will be covered in this program?
Coordinated Care will cover all Medicaid managed care health services including: physical health, routine vision, pharmacy, and outpatient behavioral health for low to moderate behavioral health needs.
The benefits will be the same Washington Apple Health (Medicaid) benefits the child previously received, with some additional programs that Coordinated Care designed specifically for Apple Health Core Connections members.
Who will be enrolled automatically in the program?
Automatic enrollees include:
- Children and youth in out-of-home dependencies (foster care placement)
- Extended Foster Care under age 21
- Children and youth receiving Adoption Support (without comparable private health insurance. If a child has other private full medical insurance they will remain in fee-forservice)
- Young adults between 18 and 26 years old who were in foster care on their 18th birthday, or were older than 18 when they left the foster care program.
- Alaska Native and American Indian children and youth in foster care may choose to enroll in the Apple Health Core Connections program but will not be automatically enrolled.
- Children enrolled in the Medically Intensive Children’s Program
- Juvenile Rehabilitation (JR)
- Detention Facility, incarcerated
- Unaccompanied Minor program
- Voluntary Placement Programs (VPP)
- Dual Medicaid and Medicare eligible, In Hospice
- From another state and not 4E eligible placed in WA
How can I verify eligibility?
Children in foster care are enrolled with Apple Health Core Connections, with same dayeligibility, retroactive to the first day of the month. You can verify eligibility through the provider portal at Provider.CoordinatedCareHealth.com. You can also call provider services at 1-844-354-9876.
When verification is delayed, an interim voucher will serve as proof of the child’s eligibility as an Apple Health Core Connections enrollee. A provider may receive an interim voucher from either a social worker or caregiver. Please do not withhold health care services, including the filling of prescriptions, based on lack of verified eligibility in the ProviderOne or Coordinated Care provider portal for a child in foster care.
The billing, coverage, and reimbursement policies applicable for children enrolled in Medicaid apply to services provided to a child in foster care with an interim voucher. Providers will be paid by Coordinated Care. If for any reason the child is in foster care and remains on the HCA fee-for-service Apple Health program, Coordinated Care will assist providers in submitting for payment to HCA.
How can I get more info and/or join the network?
For more information, call 1-844-354-9876 and select the “providers” option. For information on joining the Coordinated Care network you can:
- Email us at JoinFosterCareNetwork@CoordinatedCareHealth.com
- Call 253-442-1344
If I already contract with Coordinated Care, can I serve members enrolled in this program?
Yes. If you have a Medicaid contract with Coordinated Care, no additional contracting is needed. Continue to bill us the same way for any Medicaid member. Provider Services at 1-877- 644-4613 is available regarding any Coordinated Care member.
Do we need to do anything differently as a Coordinated Care provider when seeing children in the Apple Health Core Connections program?
There are two important appointment standard requirements for children in foster care:
- An appointment with a primary care provider within 5 days of being initially placed into care.
- An EPSDT exam within 30 days of being placed into care. It is important that this appointment happens quickly and the report is provided to the DSHS Children’s Administration Child Health and Education Tracking (CHET) worker within the 30-day time frame.
I am currently treating a patient who will automatically be in Apple Health Core Connections on April 1, but I am not contracted with Coordinated Care. Can I still provide services during the transition to a new provider?
All new members to Apple Health Core Connections have a 90-day continuity of care period for any care that began prior to joining Apple Health Core Connections. During this 90-day period, 100% Medicaid reimbursement will be provided to Medicaid providers who are willing to bill Coordinated Care.
If you decide not to join our network, we will work with you and the member on transitioning care to a provider in the Coordinated Care network.
I treat children and young adults who are currently enrolled in another managed care plan, and I have received prior authorizations for services after April 1, 2016. What will happen now?
Coordinated Care will be receiving information from the other managed care plans prior to April 1, on existing authorizations and services. We are working with the other managed care plans to ensure a smooth transition of services that started prior to joining the new program. On April 1, your patients will begin coverage in the Apple Health Core Connections program with Coordinated Care.
Will dental services be provided through Coordinated Care?
No. Dental will continue to be accessed through Apple Health fee-for-service Medicaid using the ProviderOne card.
Will Coordinated Care pay for mental health services?
Mental health services for mild to moderate mental health concerns, such as depression or anxiety, are covered and will be coordinated within the Coordinated Care network. Services for more serious mental health conditions are offered through a Behavioral Health Organization (BHO) with the support of their Coordinated Care behavioral health care coordinator. Coordinated Care will screen members to determine if they meet BHO access to care standards and make a referral to BHO services.
How will children in foster care be referred preferentially to mental healthcare centers/providers trained in evidence-based therapies and Trauma Informed Care (TIC)?
Coordinated Care’s behavioral health team has national experience in evidence-based and promising practices for children in the child welfare system. We are working to expand our behavioral health provider network, and find providers who are trained in evidence-based practices and TIC.
We will work with providers, caregivers, social workers and stakeholders to identify and build relationships with providers who deliver TIC. Coordinated Care has also hired a team of community educators who will provide training on evidence-based practices, TIC, and other relevant topics to providers and the community.
How will Apple Health Core Connections provide care to children and youth with complex healthcare needs?
Our health care coordination model is tailored to the complex health and social/behavioral needs of our members. The model provides a scalable, intensive service coordination role with full integration of physical and behavioral health roles. The health care coordination team is based on an Integrated Care Coordination Team (ICCT) model using a multidisciplinary approach—coordinating across the health and child welfare system—to deliver care management and coordination services, with a health care coordinator assigned as the team lead and single point of contact.
For complex member needs, the team lead will be a nurse or behavioral health clinician, dependent upon the primary needs. Outreach will be conducted as frequently as needed, and the member will stay with the care coordinator in complex care management for as long as needed.
When a child in foster care returns to their biological parents, will they remain with Coordinated Care, or change plans?
Biological parents have the option to keep their child with Coordinated Care if the family is eligible for Medicaid. While a child in their own home (after the dependency is closed) will not be part of the Apple Health Core Connections program, they could remain with Coordinated Care and receive many of the same benefits.
How will Coordinated Care address the transfer of foster children's health information?
Coordinated Care is building a health information system that will serve as a community health record for enrollees. Once fully operational, the system will have:
- Summarized, user-friendly, printable, electronic community health records
- Role-based and secure user access (only users designated by DSHS/CA can access), with restricted access to sensitive cases
- A centralized source for contact information for enrollees, providers, caregivers, social workers/caseworkers, care managers and authorized representatives
- A list of filled medications, with drug interaction checking
- Enrollee history: past health care visits that include the description of service, treating provider, diagnosis and service date
In addition, young adults leaving the program can take their information with them through Microsoft Health Vault.
What if I have questions about filing a claim?
Coordinated Care Provider Services staff can help you with filing a claim. They will answer your questions about claim status and payments and assist with appeals. Call Provider Services at 1-877-644-4613.
What kind of training is available to providers on this program?
Our team of community educators has partnered with DSHS to provide Apple Health Core Connections overview training statewide. They also offer specialized topic training for your staff. Our library of topics includes in-person and web-based instruction on Trauma Informed Care, resiliency, behavior management and much more. If your agency is interested in having a Community Educator present a program overview or specialized topic training for staff or foster parents, please contact Danielle Cannon, firstname.lastname@example.org.
Our Provider Relations team will also host regular events for providers with information about contracting with Apple Health Core Connections. Please check our schedule of provider events for updates.
Who does a hospital bill for newborn coverage?
If the mom is an Apple Health Core Connections member:
- When child is born they are connected to mom’s ID until they receive their own ProviderOne ID. The provider should bill Coordinated Care.
- If the newborn doesn’t get a ProviderOne ID, then coverage is only through the end of the month in which the first 21 days of life occur. (For example if a child is born on the 20th of a month, they are covered through end of the following month.) You may bill Coordinated Care for services provided in that timeframe.
- If the mother is no longer eligible to be an Apple Health Core Connections member after she gives birth, the newborn coverage ends with mom’s coverage. While that coverage is in place, you may bill Coordinated Care.
- If a newborn remains in the custody of their mother, that baby is enrolled in Apple Health Medicaid. Depending on the county they are in, it may not be Coordinated Care. We will coordinate with the Foster Care Medical Team (FCMT) to ensure the child is enrolled with another MCO.
- If the mom is enrolled in Apple Health Core Connections, and the child is removed from her custody and put into state custody, the child will be enrolled in Apple Health Core Connections. Providers should bill Coordinated Care.
If the mom is an enrollee of different MCO or fee for service:
- If the newborn is taken into state custody, they are covered by Apple Health Core Connections. Providers should bill Coordinated Care.
Where can I find more resources on working with children who have experienced trauma, abuse and neglect?
Please check our Training Materials page for a variety of online resources on trauma, abuse and neglect. Coordinated Care provides interactive web based trauma focused training for both providers and caregivers through Foster Care EDU at www.coordinatedcarehealth.com/envolveu
Our community educators have community training on topics related to trauma, abuse and neglect. Additional resources on childhood trauma can be found at www.nctsn.org, www.nfpaonline.org, and www.acestoohigh.com.