Apple Health (Medicaid) rulemaking

The agency is amending WAC 182-504-0035 to allow for telephonic eligibility renewals. This project and Continuous Child coverage are being combined at the CR-102 stage because they both amend 182-504-0035.

The agency is amending this rule to allow for back dating on the provider enrollment application.

HCA is adding mental health counselor associates, social worker associates, and marriage and family therapist associates as provider types eligible to provide covered health care services to eligible clients.

The agency is amending medical assistance definitions to add a person’s resources to the reasonable compatibility processes for eligibility renewals.

The agency intends to develop rules to align with Sec. 1902(a)(25)(I) of the Consolidated Appropriations Act of 2022 (CAA, 2022; P.L. 117-103). The rules will bar liable third-party payers from refusing to pay for a service or item furnished to a Medicaid-eligible person if the service or item did not receive prior authorization under the third-party payer’s rules.

The agency is amending these rules to update language in WAC 182-502-0030 to remove the term “agreement” from the WAC title and replace it with “enrollment.” The agency is also removing “core provider agreement” (CPA) from subsection (1) and replacing it with “enrollment” to provide clarity that all providers (not just those with a CPA) are subject to the rules. Additionally, the agency will update the WAC reference in subsection (1)(a)(ii) from WAC 246-934-100 to Chapter 246-16 WAC to align with the correct Department of Health (DOH) definition of sexual misconduct. The agency will amend the definition of provider in WAC 182-500-0085 to include servicing providers, nonbilling providers, providers with a CPA, and providers with other contracts with the Medicaid agency. The agency will also update the term “performing provider” to “servicing provider” in WACs 182-531-0250, 182-530-1000, and 182-502-0005 to align with consistent agency language.

The agency is amending
this rule to clarify language regarding service by mail.

The agency is amending this rule to correct a typographical error.

HCA is amending WAC 182-501-0135 to: (a) change the time period in which a client may request an administrative hearing from 90 days to 120 days, (b) state that HCA may determine on a case-by-case basis that a client may obtain certain prescription items at any pharmacy, and (c) add that HCA may remove a client from PRC placement if the client has successfully stabilized due to the utilization of treatment medications, including but not limited to, Buprenorphine.

The agency is amending this rule to specify that the agency’s applied behavior analysis program does not pay for services provided by a client’s parent, guardian, caregiver, or other support person.