2025年2月14日 · This section contains information about the grievance and appeal system and the right to an agency administrative hearing for MCO enrollees. See WAC 182-538-111 for information about PCCM enrollees.

2019年11月27日 · 182-538B-110 Grievance and appeal system and agency adminis-trative hearing. (1) Introduction. This section contains information about the managed care organization (MCO) grievance and appeal system and the agency's administrative hearing process for enrollees under the behavi.

Client is in an in-home setting receiving wraparound services: The MCO is only responsible for the state funded portion of the total rate (50% or less depending on the program). • CFC only or CFC+COPES: MCO pays 44% • MPC: MCO pays 50%

Qualifications to become a primary care case manage-ment (PCCM) provider. Payments to managed care organizations (MCOs). Payments for primary care case management (PCCM) providers. Scope of care for managed care enrollees. Scope of service for PCCM enrollees. Managed care emergency services.

Providers must know and comply with applicable regulations (WAC and/or RCW) regarding Advance Directives. Implementing Advance Directed as appropriate to their available services. MCOs may request provider assistance in obtaining copies of Advance Directives.

(1) To provide physical or behavioral health services under the apple health IMC contract, a managed care organization (MCO) must: (a) Contract with the agency; and (b) Contract with an agency-contracted behavioral health administrative service organization (BH-ASO) that maintains an adequate provider network to deliver services to clients in ...

Community Behavioral Health Support services are individually tailored services designed to help clients acquire, retain, restore, and improve the self-help, socialization, and adaptive skills necessary to reside successfully in community-based settings. Supportive Supervision is part of the new CBHS benefit. What is Supportive Supervision?

This section contains information about the grievance and appeal system and the right to an agency administrative hearing for MCO enrollees. See WAC 182-538-111 for information about PCCM enrollees.

Washington Administrative Code (WAC) 182-501-0135 authorizes contracted MCOs to review Apple Health client records and enroll them in a PRC program. See PRC WAC 182-501-0135 for additional provider assignments. This guide will be updated and sent to the MCOs whenever the guide is updated with any new PRC guidelines. Compliance

Scope of care for integrated managed care enrollees and managed care organization benefit administration requirements. Scope of Care. (1) An enrollee in integrated managed care (IMC) is eligible only for the scope of services that are covered based on the apple health program (eligibility program) in which they are enrolled.