Apple Health (Medicaid) rulemaking

This page includes all of the current rule making activity for Washington Apple Health (Medicaid)

Rule making activities

Description
The agency is amending WAC 182-504-0035 to allow for telephonic eligibility renewals. This project and Continuous Child coverage are being combined at the CR-102 stage because they both amend 182-504-0035.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 23-20-051
  • Hearing Date and Comments due: 11/7/2023
  • Registration required: https://us02web.zoom.us/webinar/register/WN_EICEeDr8Q0ap3784rr7LVQ

Permanent Adoption (CR103P)

Description
HCA is adding mental health counselor associates, social worker associates, and marriage and family therapist associates as provider types eligible to provide covered health care services to eligible clients.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Description
The agency is amending medical assistance definitions to add a person’s resources to the reasonable compatibility processes for eligibility renewals.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 23-19-052
  • Hearing Date and Comments due by: 10/24/2023
  • Registration required: https://us02web.zoom.us/webinar/register/WN_FvUlfbhASZWrHPKvhuxmvA

Permanent Adoption (CR103P)

Description
The agency intends to develop rules to align with Sec. 1902(a)(25)(I) of the Consolidated Appropriations Act of 2022 (CAA, 2022; P.L. 117-103). The rules will bar liable third-party payers from refusing to pay for a service or item furnished to a Medicaid-eligible person if the service or item did not receive prior authorization under the third-party payer’s rules.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 23-18-085
  • Hearing Date and Comments due by: 10/10/2023
  • Registration required: https://us02web.zoom.us/webinar/register/WN_fMyM6MV1SmqpIcKuyrlgYQ

Permanent Adoption (CR103P)

Description
The agency is amending these rules to update language in WAC 182-502-0030 to remove the term “agreement” from the WAC title and replace it with “enrollment.” The agency is also removing “core provider agreement” (CPA) from subsection (1) and replacing it with “enrollment” to provide clarity that all providers (not just those with a CPA) are subject to the rules. Additionally, the agency will update the WAC reference in subsection (1)(a)(ii) from WAC 246-934-100 to Chapter 246-16 WAC to align with the correct Department of Health (DOH) definition of sexual misconduct. The agency will amend the definition of provider in WAC 182-500-0085 to include servicing providers, nonbilling providers, providers with a CPA, and providers with other contracts with the Medicaid agency. The agency will also update the term “performing provider” to “servicing provider” in WACs 182-531-0250, 182-530-1000, and 182-502-0005 to align with consistent agency language.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 23-18-088
  • Hearing Date and Comments due by: 10/10/2023
  • Registration required: https://us02web.zoom.us/webinar/register/WN_fMyM6MV1SmqpIcKuyrlgYQ

Permanent Adoption (CR103P)

Description
The agency is amending this rule to correct a typographical error.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Expedited Adoption (CR105)

Permanent Adoption (CR103P)

Description
HCA is amending WAC 182-501-0135 to: (a) change the time period in which a client may request an administrative hearing from 90 days to 120 days, (b) state that HCA may determine on a case-by-case basis that a client may obtain certain prescription items at any pharmacy, and (c) add that HCA may remove a client from PRC placement if the client has successfully stabilized due to the utilization of treatment medications, including but not limited to, Buprenorphine.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
The agency is amending this rule to specify that the agency’s applied behavior analysis program does not pay for services provided by a client’s parent, guardian, caregiver, or other support person.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Description
The agency is amending these rules to: (1) Remove language referencing a Center of Excellence (COE) as a facility rather than an individual provider; for the purposes of this chapter, COE means an individual provider. (2) Update the COE definition in 182-531A-0200. (3) Add physician assistants and naturopaths to the list of eligible providers who can diagnose autism spectrum disorder. (4) Add additional clarification and requirement that ARNPs, physicians, physician assistants, and naturopaths must complete the required COE training authorized by the agency. Additionally, physician assistants and naturopaths, in order to be recognized as a COE by the agency, must submit a signed COE attestation form, HCA 13-0009, to the agency. (5) Remove subsection (12)(b) – The attestation form regarding ABA qualifications, HCA 13-0008, is not required by the certified behavior technician. (6) Clarify in 182-531A-0800(6) all COEs must be enrolled with the agency and all COEs providing services to clients enrolled with an MCO must also be contracted with the MCO per the MCO contract specifications in accordance with 42 CFR 438.14 to be reimbursed for fee-for-service or managed care organization (MCO) services. (7) Add housekeeping changes such as updating the term “clinician” to “provider” for language consistency and the term “order or ordered” to “prescribed or prescription” to align with standard of language that ABA therapy is a prescription.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
The agency is amending this rule to correct a typographical error.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Expedited Adoption (CR105)