Apple Health (Medicaid) rulemaking

The agency is adopting
this new rule to establish eligibility criteria for the Civil Transition Program, which is a state-funded, fee-for-service program
that requires the Department of Social and Health Services (DSHS) to provide wraparound services and supports in
community-based settings, which may include residential supports, to persons who have been found not competent to stand
trial due to an intellectual or developmental disability, dementia, or traumatic brain injury. This Apple Health program is for
persons who are not eligible for any other Apple Health program and will provide state-funded categorically needy coverage.
This program implements a portion of RCW 10.77.202, which became effective December 1, 2023. The agency established
WAC 182-538B-180 through an emergency rule filed under WSR 23-24-052 and refiled under WSR 24-08-051. The purpose
of this rulemaking is to make that rule permanent and to renumber it as WAC 182-508-0200. DSHS is engaged in rulemaking
on this subject. DSHS filed a preproposal statement of inquiry under WSR 23-24-046 and established emergency rules under
WSR 24-05-046.

HCA is amending this rule to clarify requirements for proof of delivery of all medical equipment and supplies.

The agency is amending WAC 182-543-3300. Rule updates will include updated medical necessity criteria based on evidence review(s).

The agency is amending this rule to update medical equipment, supplies, & appliances definitions to align with industry standard.

HCA is amending these rules to change the medical necessity criteria for hospital beds and to clarify the process for submitting prior authorization requests to HCA.

The agency amended WAC 182-543-5700 to correct the number for a form titled Medical Necessity for Wheelchair
Purchase for Nursing Facility Clients. The correct form number is HCA 19-0006.

HCA is removing all instances of “automated maximum allowable cost” and “AMAC” from WAC 182-530-7150 and repealing WAC 182-530-8150. HCA is no longer using AMAC as a reimbursement method.

The agency is revising this rule in accordance with the Settlement Agreement in the case of National Association
of Chain Drug Stores, et al., v. Washington State Health Care Authority, et al. (Case No. 51489-3-II) and for the
purpose of ensuring the continuation of federal Medicaid funding.

HCA is amending these rules to add clarity and provide more detail on program requirements for how fee-for-service drugs must be billed to HCA for providers that are subject to the 340B program requirements.

The agency is revising these rules to change the title of the rule section to Enhanced reimbursement – medication for opioid use disorder (MOUD). The agency is also revising the section to clarify the requirements for receiving the enhanced reimbursement for MOUD.