Apple Health (Medicaid) rulemaking

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.

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.

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)

Under Washington’s Medicaid Transformation Project 2.0 in accordance with Section 1115(a) of the Social Security Act, HCA is amending these sections to provide reentry services before the beneficiary’s expected date of release.

The agency is correcting Washington Administrative Code cross citations. The proposed rule corrects typographical errors without changing the rule’s effect.

The agency is amending WAC 182-507-0130 and WAC 182-509-0001 to update the income and resource eligibility standards for the refugee medical assistance program.

The agency is amending WAC 182-503-0535 and WAC 182-507-0135 to update the parole period for certain persons from Ukraine to qualify for refugee medical assistance. This change is required by federal law. The agency filed an emergency rule under WSR 24-16-047 to give this change immediate effect.

The agency is amending WAC 182-504-0015 and WAC 182-505-0225 so that the agency does not terminate
Children’s Health Insurance Program (CHIP) coverage for nonpayment of premiums during a child’s continuous eligibility
period and does not condition or delay enrollment on payment of unpaid premiums.

The agency is amending these rules to remove food assistance from the calculation of income when determining a person’s eligibility for Washington Apple Health Supplemental Security Income (SSI)-related medical programs. These amendments are consistent with changes to federal rules regarding the treatment of food assistance within the SSI program, effective September 30, 2024.