Apple Health (Medicaid) rulemaking

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.

HCA is revising these rules to
provide an adult chiropractic benefit, in alignment with Engrossed Substitute Senate Bill 5693, Section 211(95) and ESSB
5187, Sec. 211(43). In addition, the agency is adding rules to provide adult acupuncture benefits, in alignment with ESSB
5693, Sec. 211 (94) and ESSB 5187, Sec. 211(42). HCA is revising WAC 182-501-0070 to remove acupuncture,
naturopathy, and chiropractic for adults from noncovered services.

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.

The agency is amending this rule to include state-funded long-term care services provided in an intermediate care facility for individuals with intellectual disabilities authorized by the Washington State Department of Social and Health Services, Developmental Disabilities Administration.

The agency is amending this rule to update a statutory citation.

The agency is amending
this rule to comply with statutory program requirements in RCW 74.09.340.

The agency is amending WAC 182-508-0001 and 182-512-0920 to remove the maximum age restriction for apple health for workers with disabilities (HWD) categorically needy (CN) coverage. This change is consistent with amendments made to RCW 74.09.540 and WAC 182-511-1050 effective January 1, 2020.

The agency is amending WAC 182-513-1110 on an emergency basis to remove presumptive eligibility for longterm
services and supports in an alternate living facility.

The agency is amending WAC 182-513-1100 to define Intensive Behavioral Health Treatment Facility (IBHTF) as a residential treatment facility licensed under chapter 246-337 WAC, and add additional definitions related to long-term services and supports.

The agency is amending WAC 182-509-0220 to specify that Medicare savings programs do not have a resource limit, which is consistent with section 211(40), chapter 475, Laws of 2023 and WAC 182-517-0100 as amended under WSR 22-21-043. The agency is amending WAC 182-519-0050 to correct a website address for the Washington apple health income and resource standards chart and update the medically needy income level and federal benefit rate.