Apple Health (Medicaid) rulemaking

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 is amending existing rules related to diabetes education. The agency is proposing to move the current diabetes education rule out of chapter 182-550 WAC and into a new chapter 182-564 because the diabetes education program is not restricted to outpatient hospitals. The agency is updating curriculum requirements to align them with Washington State Department of Health requirements for this program. The agency is also removing outdated billing requirements.

The agency is correcting Washington Administrative Code cross citations. The proposed rule corrects typographical errors without changing the rule’s effect.

The agency is amending this rule to align it with applicable federal government regulations and simplify the managed care organization (MCO) appeal process
by removing the requirement that the MCO confirm an oral appeal in writing and removing the requirement that the MCO acknowledge receipt of each appeal in writing.

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.

The agency is amending these rules to clarify and update the coverage criteria for medical equipment for clients who receive Medicaid-funded care in nursing facilities and other housekeeping changes.

The agency is amending WAC 182-543-2000 to amend the medical equipment and supplies provider requirements.

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