Apple Health (Medicaid) rulemaking

The agency is amending WAC 182-552-0400 to update medical necessity criteria based on evidence reviews.

The agency is amending WAC 182-545-200 to expand payment criteria for occupational therapy.

In response to SB 5228, Section 2, Chapter 113, Laws of 2023, HCA is amending WAC 182-545-200 to state that HCA pays for outpatient rehabilitation services provided to eligible clients when provided by licensed or certified behavioral health agencies as part of a mental health or substance use disorder treatment program. HCA is also amending this rule to add separate limits for clients needing occupational therapy to treat behavioral health conditions.

The agency is amending this rule
to extend the expiration date for the ambulance transport fund from July 1, 2024 to July 1, 2028 to align with RCW 74.70.901
(SB 5122, Chapter 11, Laws of 2023).

The agency is repealing
these rule sections because they contain redundant and or outdated language and cross reference(s) to nonexistent rules.
The same information can be found within Title 182 or within another agency’s rules. Detailed information is listed below:
WAC 182-556-0100 - References chapter 388-877B which is no longer in existence. Chemical dependency is also an
outdated term. WAC 182-502-0002 includes substance use disorder professionals for the treatment of substance use
disorders, as well as mental health providers and peer counselors. WAC 182-501-0060(6)(d) includes behavioral health
services in the coverage table, and WAC 182-501-0065(2) also includes behavioral health services. Behavioral health is
defined in WAC 182-538D-0200. Therefore, this rule section should be repealed and is no longer necessary.
WAC 182-556-0300 – Personal care services is listed in WAC 182-501-0060(6)(d), under the coverage table, and is also
referenced in WAC 182-501-0065(2)(bb), Health care coverage – Description of service categories. Therefore, this rule
section is not necessary and should be repealed.
The following sections should be repealed as they are no longer necessary and the information is found in other rule(s):
WAC 182-556-0400(1) – See WAC 182-550-1900(2).
WAC 182-556-0400(2) – See WAC 182-540-005 and 182-540-015 under the Kidney Disease Program and Kidney Center
Services, Chapter 182-540 WAC
WAC 182-556-0400(3) – See WAC 182-550-1100(4) Hospital care – General
WAC 182-556-0400(4) – See WAC 182-533-0701, 182-533-0730, and 182-550-1100(5)(a)
WAC 182-556-0400(5) – Outdated language and cross references that no longer exist. See WAC 182-501-0060)(d) and
WAC 182-501-0065(2)(c) for Behavioral health services.
WAC 182-556-0400(6) – See WAC 182-531-0200(6)
WAC 182-556-0400(7) – See WAC 182-501-0065, 182-550-5800, 182-531-1700
182-556-0600 – See WAC 182-531-1400
The agency is also changing the title of this chapter to Chiropractic Services (reflecting the remaining section in this chapter).
See the agency’s other rulemaking, filed under WSR 24-13-055, regarding chiropractic services.

The agency is amending WAC 182-527-2742 to add a new subsection (1)(e) to except from estate recovery state-only funded Guardianship and Conservatorship Assistance Program services.

The agency is amending this rule to clarify: 1) which Medicaid recipients are eligible for the health home program; and 2) that people with third-party medical coverage are ineligible for this program.

The agency is amending this section to update Early Periodic Screening Diagnosis and Treatment program language consistent with the rulemaking filed
under WSR 25-02-069 on December 23, 2024. The agency is also amending this section to remove outdated language.

The agency is proposing to add a new subchapter IV, titled Medical Respite Program, under Chapter 182-551 WAC Alternative to Hospital Services.

The agency is proposing to add a new subchapter IV, titled Medical Respite Program, under Chapter 182-551 WAC Alternative to Hospital Services.