Apple Health (Medicaid) rulemaking

The agency is amending this rule to add behavioral health support specialist to the list of eligible providers.

The agency reorganized rules related to enrollment and payment into proper sections, adding clarity, and removing the reconsideration process. WAC 182-502-0005 was revised to allow for back dating on the provider enrollment application and the nonbilling provider language was moved into this section from WAC 182-502-0006. WAC 182-502-0006 was repealed and incorporated into the other sections. WAC 182-502-0010 was updated to clarify requirements for nonbilling providers and requirements for servicing providers. WAC 182-502-0012 was revised to reflect that if the agency denies a request for enrollment, there is no longer a reconsideration process, but the provider can reapply. WAC 182-502-0030 added “failure to submit or failure to retain adequate documentation” to clarify that failed documentation can be considered a significant risk factor that can affect the provider’s credibility or honesty. WAC 182-502-0040 was revised to reflect that terminations for convenience are the agency’s final decision and there is no reconsideration process. WAC 182-502-0050 was revised to add a cross reference to Chapter 182-502A WAC for additional information for disputes regarding overpayment. WAC 182-502-0100 was revised to add language that providers must be enrolled with the agency to receive payment for health care services and other section additions include payment language that was removed from the previously listed WACs and moved to 182-502-0100.

HCA amended these rules to add advanced social worker associates, independent clinical social worker
associates, marriage and family therapist associates, and mental health counselor associates as provider types eligible to
provide covered health care services to eligible clients. In WAC 182-502-0002, HCA replaced social workers with advanced
social workers and independent clinical social workers.
The agency also added community behavioral health support services provider facilities to the list of eligible provider types in
WAC 182-502-0002. HCA filed a preproposal statement of inquiry (CR-101) under WSR 22-09-074 to develop new rules in
Title 182 regarding the Community Behavioral Health Support Services (CBHS) program. This rulemaking was postponed
after necessary funding for the program was not provided. On March 18, 2024, HCA filed the proposed rule (CR-102) for the
new CBHS program under WSR 24-07-072 followed by the rule-making order (CR-103P) on April 30, 2024, under WSR 24-
10-081.

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.

The agency is amending chapter 182-526 WAC to update its regulations related to the service of a petition for judicial review.

The agency is amending WAC 182-526-0020 to clarify the meaning of good cause for applicants and recipients with rights to adjudicative proceedings.

The agency is amending
this rule to clarify language regarding service by mail.

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

The agency is amending WAC 182-531A-0900, Applied behavior analysis (ABA) – Covered services, 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.

In WAC 182-501-0070, the agency removed naturopathy from the noncovered services list.
In WAC 182-502-0002, the agency added Birth Doula as an eligible provider type. This is necessary to support a separate rulemaking filed under WSR 24-10-016, on April 19, 2024. The agency also added Behavior Health Support Specialist (BHSS) as an eligible provider type. This is necessary to support a separate rulemaking filed under WSR 24-16-024, on July 26, 2024.
As a result of a recent Office of Financial Management (OFM) directive, the Health Care Authority (HCA) is pausing implementation of coverage for adult chiropractic and acupuncture services planned for 1/1/2025.
The following proposed rule sections filed under WSR 24-19-096 will not be adopted at this time:
182-502-0003 Noneligible provider types
182-531-0150 Noncovered physician-related and health care professional services- General and administrative
182-556-0200 Chiropractic services
182-556-0250 Acupuncture services (New)