Apple Health (Medicaid) rulemaking

The agency is amending this rule to include criteria to allow agency-approved online classes with a one-on-one check-in with the client and qualified CBE
provider during or after the online classes have been completed by the client.

The agency is adding a new section describing system requirements for electronic visit verification (EVV) for home health care services.

The agency is reviewing these rules and may amend them as needed to comply with the CURES Act of 2016; Public Law 114-255, which implements the electronic visit verification (EVV) requirement for home health care service claims to be paid. In addition, HCA is amending Chapter 182-551 WAC to update the rules to be consistent with the other rules for administration of the medicaid program.

The agency is amending these rules to reduce the sole community hospital rate multiplier to 1.25, effective July 1, 2024.

The agency is amending these rules to provide more general language due to frequent changes of percentages and dollar amounts.

The agency is amending this rule to add gender affirming surgery services to being exempt from DRG payment.

The agency is amending WAC 182-550-1500 to allow for the payment of outpatient services in the following revenue code categories: “Partial hospitalization – Less intensive,” “Partial hospitalization – Intensive,” and “Intensive outpatient services – Psychiatric.

The agency amended this rule to add clarifying language to subsection (5)(c). The agency added that if the state’s
applicable federal medical assistance percentage (FMAP) is 0%, the amount derived in subsection (5)(b) is multiplied by the
lowest Washington state specific medicaid FMAP in effect at the time of claim payment.

HCA is removing references to the hospital outpatient ratio of costs-to-charges (RCC) payment method due to the discontinuation of this payment method.

The agency is revising this rule to remove subsection (4)(a) and (4)(b) and revise the language to match 42 CFR Part 447, Subpart C, Payment for Inpatient Hospital and Long-Term Care Facility Services, §447.253(g) Other requirements.