Apple Health (Medicaid) rulemaking

The agency is amending WAC 182-512-0500 to exclude from the calculation of available resources fully and partially paid burial space purchase agreements. The agency may make additional, nonsubstantive changes so that the rule is easier to understand and apply.

The agency anticipates filing rules to: (1) Revise the TSOA application process; and (2) Upon CMS approval of the 1115 Renewal Application, amend rules regarding income and resource limits.

Chapter 182-561 WAC is a new chapter to establish the Community Behavioral Support Services (CBHS) benefit.
The CBHS benefit assists eligible clients with obtaining the skills necessary to reside successfully in home and communitybased
settings. The chapter includes the eligibility criteria for clients; Apple Health rules requiring medical necessity do not
apply to this benefit. The chapter also includes CBHS provider requirements, eligible diagnoses, covered services, and the
appeal process. Additionally, the agency is amending WAC 182-501-0065 to include CBHS as a service category.

The agency is creating a new section in chapter 182-513 WAC to create presumptive eligibility for long-term services and supports authorized by Home and Community Services in home and alternate living facilities.

The agency is amending this rule to make language less restrictive in subsection (5)(c) from covering a “case study when done in conjunction with limited or comprehensive orthodontic treatment only” to a “case study when done in conjunction with orthodontic treatment.”

The agency is amending this rule to increase the allowable number of periodontal treatments to up to four per 12-month period for Apple Health eligible clients, ages 21 and over, with a current diagnosis of diabetes. Effective January 1, 2024, periodontal maintenance is allowed once every three months when criteria is met.

The agency is amending its rules to increase the income standards for pregnancy and postpartum groups from 193% to 210% of the federal poverty level. This
increase is consistent with legislative directives in chapter 213, Laws of 2024 (2E2SSB 5580).

The State Supplemental Operating budget (section 211 (34), Chapter 376, Laws of 2024, (ESSB 5950)), included funding for the Health Care Authority (HCA) to implement a birth doula benefit for Apple Health (Medicaid) clients. HCA is developing rules in Chapter 182-533 WAC and amending WAC 182-502-0002 to accomplish this.

The agency is amending this rule to expand screening and preventative services for certain sexually transmitted infections during a client visit focused on family planning.

RCW 74.09.830 provides full-scope coverage for 12 months postpartum for pregnant or postpartum persons. This coverage is more generous than and thus replaces the limited scope “Family planning only – Pregnancy related program.” The agency intends to remove language related to this superseded program from chapter 182-532 WAC.