WAC 182-557-0050. Health home — General

(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 habilitation 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 provider(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.