Apple Health (Medicaid) rulemaking

This page includes all of the current rule making activity for Washington Apple Health (Medicaid)

Rule making activities

Description
The agency is amending these rules to align with Section 11405 of the Inflation Reduction Act (Pub. L. 117-169), which requires states to cover approved adult vaccines recommended by the Advisory Committee on Immunization Practices.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Emergency Adoption (CR103E)

Preproposal (CR101)

Proposal (CR102)

  • WSR 23-20-047
  • Hearing date and Comments due by: 11/7/2023
  • Registration required: https://us02web.zoom.us/webinar/register/WN_EICEeDr8Q0ap3784rr7LVQ

Permanent Adoption (CR103P)

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
HCA is amending WAC 182-531-1400 (6) to update the requirements in subsection (6)(a) with a cross-reference to WAC 182-538D-0200 and to align requirements for professionals treating children with RCW 71.34.020 and WAC 182-538D-0200.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
HCA is amending this rule to explain how HCA updates the state-only composite rate and to clarify language throughout.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
The agency is removing the outdated clinical criteria for coverage of oxygen and is also revising other criteria. The clinical criteria in the current rules are more restrictive than Medicare’s current clinical criteria, which causes providers to request prior authorization more frequently than necessary. Under this rulemaking, the agency plans to align the rules with Medicare’s current requirements.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
The agency is amending these rules to provide medical nutrition therapy for eligible adult Medicaid clients. The agency is also updating the program names for alien emergency medical (AEM) and Take Charge referenced in WAC 182-501-0060, consistent with the current names for those programs.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
The agency is amending these rules to provide more precise language to define the program parameters and ensure consistency. Specifically, the agency is proposing to amend:
• 182-546-5000(4) to clarify this section pertains to a client’s freedom of access to health care, but that doesn’t require the agency to cover transportation at a higher cost in order to meet the client’s personal choice of medical provider.
• 182-546-5100 to add a definition for Against Medical Advice (AMA), fix WAC reference in Ambulance definition, and remove definitions for extended stay and short stay.
• 182-546-5550 to add in a new subsection (1)(b) regarding against medical advice discharges and a new subsection (1)(k) for standalone pharmacy trips.
• 182-546-5600(3)(b) to clarify the agency may pay for transportation for a client to a pharmacy to obtain Medicare Part D prescriptions if the prescriptions are billable to Medicaid and not paid for by Medicare Part D
• 182-546-5800(1) to clarify that out of state requests require a minimum of 7 days’ notice before the client’s travel.
• 182-546-5900(4) to clarify the reasonable cost of lodging and meals is measured against the state per diem of the location where the client is receiving covered medical services and striking subsections (4)(a), (4)(b), and (4)(c).

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
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.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Description
The agency intends to lower the minimum eligibility age for community support services from age eighteen to age sixteen. This will allow more people to receive supportive housing services that aim to reduce homelessness and improve health outcomes.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 23-21-068
  • Hearing Date and Comments due by: 11/21/2023
  • Registration required: https://us02web.zoom.us/webinar/register/WN_F8flPPyoSyqDs-EZHwgrLQ

Permanent Adoption (CR103P)

Description
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.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)