Washington

Washington has long embraced the PCMH model of care delivery through both private and public sector initiatives. Beginning in the 1990's, partnerships between pediatricians, families, and the Washington State Department of Health Children with Special Health Care Needs Program were established to build the concepts of the medical home into primary care pediatric practices. In 2008, the Substitute House Bill 2549 authorized the creation of the state's first medical home learning collaborative for qualified primary care practices serving children and adults.  Substitute Senate Bill 5891 established several medical home reimbursement pilot projects including a multi-payer medical home demonstration project.  State law, Chapter 48.150 RCW, specifies that a direct primary care medical home must be integrated with an issuer’s Qualified Health Plan (QHP). If a QHP filing contains a direct primary care medical home, then the Health Benefit Exchange will recognize the Office of Insurance Commissioner’s approval of the plan to confirm that the medical home is integrated with the QHP.

The HealthPath Washington partnership between the State of Washington and the Centers for Medicare & Medicaid has decided to discontinue implementation of the capitated managed care project. This project was created to integrate medical, behavioral health, and long term services so that benefits could be delivered through managed care organizations.

The Washington Healthcare Improvement Network (WHIN) offers services to primary care clinicians and practice teams to develop health/medical homes, manage care for patients with multiple chronic conditions and improve care transitions. WHIN also serves:

  • Behavioral health teams that plan to collaborate with primary care.
  • Care/case managers or coordinators who are part of a health/medical home team.
  • Pharmacists that plan to collaborate with primary care.
  • Naturopathic doctors and consultant specialty providers on a case-by-case basis.

State PCMH Activity

CHIPRA MAPCP Dual Eligible 2703 SPA CPC SIM Award PCMH QHP PCMH Legislation Private Payer

Multi-Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Washington State Multi-Payer Medical Home Reimbursement Pilot Multi-Payer Statewide

State Legislation

Legislation Status Year
Substitute Senate Bill 5891

This bill established several medical home reimbursement pilot projects including a multi-payer medical home demonstration project.

Expired 2009
Substitute House Bill 2549

This bill authorized the creation of the state's first medical home learning collaborative for qualified primary care practices serving children and adults.

Expired 2008

State Facts:

Population:
6,862,300
Uninsured Population:
11%
Total Medicaid Spending FY 2013: 
$8.2 Billion 
Overweight/Obese Adults:
61.4%
Poor Mental Health among Adults: 
37.3%
Medicaid Expansion: 
Yes 

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