Model managed care contracts

Managed care

The Apple Health (Medicaid) managed care contracts (for reference only) identify the requirements and guidelines managed care organizations (MCO) must follow when providing access to health care services.

Model contracts (for reference only)

• Apple Health Expansion (AHE) contract (updated 9/3/24)
• Apple Health integrated foster care (IFC) contract (updated 7/1/24)
• Apple Health integrated foster care (IFC) - behavioral health services wrap-around contract (updated 7/1/24)
• Apple Health - Integrated Managed Care (IMC) contract (updated 7/1/24)
• Apple Health - Integrated Managed Care (IMC) - behavioral health services wrap-around contract (updated 7/1/24)

State Medicaid Agency Contract (SMAC)

The State Medicaid Agency Contract (SMAC) identifies the requirements and guidelines Medicare Advantage (MA) Health Plans must follow when serving the dual-eligible individuals, allowing care coordination between Medicare and Apple Health (Medicaid) services.

SMAC model contract (for reference only)

• Model State Medicaid Agency Contract (SMAC) (effective January 1, 2024)

Behavioral Health Administrative Services Organization (BH-ASO)

Model BH-ASO contracts (for reference only) identify the requirements and guidelines behavioral health administrative organizations must follow when providing access to behavioral health crisis services and supports to Medicaid and non-Medicaid individuals.

BH-ASO model contract (for reference only)

• Behavioral health administrative services organization contract (updated 7/1/24)

BH-ASO contract deliverable naming conventions

• BH-ASO contract deliverable naming conventions (updated 9/5/24)

BH-ASO report template

• Assisted outpatient treatment quarterly report (updated 10/22/24)
• BHDS behavioral health agency quarterly submission report (new 11/21/24)
• CBHEF quarterly expenditure report (updated 10/1/24)
• Co-responder report
• CJTA quarterly progress report
• Crisis housing voucher log (King and Thurston/Mason only)
• Crisis triage stabilization increasing inpatient report
• Crisis system metrics report (updated 2/28/24)
• Data shared with external entities report
• E&T Discharge planner report (updated 1/1/24)
• FBG annual progress report
• FYSPRT gift card purchase and distribution tracker (updated 7/1/24)
• Grievance adverse determination appeals (updated 7/1/24)
• Juvenile treatment court
• Mobile rapid response crisis report (updated 1/1/24)
• MHBG project plan
• Non-Medicaid expenditure report
• Non-Medicaid spending plan
• Peer bridger monthly report
• Peer bridger participant treatment engagement report
• Peer pathfinder jail transition report log
• Regional crisis forum report (new 7/1/24)
• Recovery Navigator Program
• SABG capacity management
• SABG project plan
• Supplemental data daily submission notification
• Supplemental data monthly certification letter
• Systems of care MRSS quarterly (Carelon/Pierce and Spokane) (updated 11/26/24)
• Trueblood enhanced crisis stabilization quarterly report (King only)
• Trueblood enhanced crisis stabilization services staff details (King only)
• Trueblood enhanced crisis stabilization/triage quarterly report (Carelon, Salish, Thurston/Mason and Spokane only) (updated 11/26/24)
• Trueblood enhanced crisis stabilization/triage services staff details (Carelon, Salish, Thurston/Mason and Spokane only) (updated 11/26/24)
• Trueblood misdemeanor diversion fund report (updated 7/1/24)
• Youth behavioral health navigator MDT monthly tracking (updated 7/1/24)
• Youth behavioral health navigator quarterly report