Apple Health (Medicaid) rulemaking

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 adding Independent Diagnostic Testing Facilities as a provider type.

HCA is amending these rules to align them with current policies and practices.