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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 182. Health Care Authority |
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Chapter 182-538A. Washington apple health fully integrated managed care (FIMC). |
Section 182-538A-130. Exemptions and ending enrollment in fully integrated managed care (FIMC).
Latest version.
- (1) Fully integrated managed care (FIMC) and behavioral health services only (BHSO) are mandatory for individuals in FIMC regional service areas. The medicaid agency enrolls a client into either FIMC or BHSO, depending on eligibility.(2) WAC 182-538A-060 applies to disenrollment and choice.(3) A client may end enrollment in FIMC if:(a) The client has comparable coverage; or(b) The client's request to end enrollment is approved by the agency under one of the following circumstances:(i) The enrollee moves out of the FIMC regional service area;(ii) Medically necessary care is unavailable from the MCO including, but not limited to, when:(A) The MCO does not, because of moral or religious objections, deliver the service the enrollee seeks; or(B) The enrollee needs related services performed at the same time and not all related services are available within the network and the enrollee's primary care provider or another provider determines receiving the services separately would subject the enrollee to unnecessary risk.(4) If an enrollee ends enrollment in FIMC, the agency enrolls the enrollee in BHSO if the enrollee is eligible.
Rules
182-538A-060,