Apple Health (Medicaid) rulemaking

Description: The agency is amending these rules to reflect necessary changes resulting from the implementation of the Apple Health preferred drug list.

Description: The agency is creating a new section within this chapter to meet the Centers for Medicare and Medicaid Services (CMS) milestone requirement 3 regarding the agency’s Section 1115 Substance Use Disorder (SUD) Waiver Implementation Plan. Milestone 3 requires the adoption of rules reflecting the requirement that residential treatment facilities offer medication assisted treatment access on-site or facilitate off-site access. The agency is also initiating this rulemaking to implement provisions of RCW 71.24.585 related to behavioral health agencies and medication assisted treatment.

Description: The agency is replacing the list of covered generic products for the treatment of cough and cold. Under the amended rule, the agency instead covers only those products with a preferred status on the Medicaid preferred drug list (PDL) on the date a prescription is dispensed.

Description: The Health Care Authority is temporarily removing the requirement to obtain a signature from the Medicaid client or the client’s designee upon receipt of pharmacy products dispensed and delivered directly to a client.

Description: The Health Care Authority is revising this section to temporarily eliminate the requirement for date and signature from the Medicaid client or the client’s designee upon delivery of medical equipment and supplies.

Description: During the 2017 legislative session, the Washington State Legislature passed Engrossed House Bill (EHB) 2242 which created the School Employees’ Benefits Board (SEBB) health insurance benefit beginning January 1, 2020. The availability of this benefit, beginning January 1, 2020, means these children no longer meet the definition of targeted low income children under 42 CFR 357.310, and will not be eligible for the Children’s Health Insurance Program (CHIP), also known as Washington Apple Health with Premiums Program.

Description: Reasons why rules on this subject may be needed and what they might accomplish: The agency is amending WAC 182-501-0180 so it applies to both fee-for-service clients and clients enrolled in a managed care organization (MCO).

Description: The agency is amending this chapter to clarify and revise language to align with federal and state regulations.

Description: This rulemaking is required to comply with and provide ongoing guidance related to the requirements that ensure the quality of the WISe service delivery model.

Description: The agency is amending this rule to update and replace references to health maintenance organizations (HMOs) with current terminology.