Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Nonbilling Individual Providers
Affected WAC: 182-502-0006
Description: The agency is amending rules to provide additional options for the provider networks of managed care organizations to enroll with the Health Care Authority in order to comply with 42 C.F.R. 438.602(b).
Exception to rule
Affected WAC: 182-501-0160
Description: The agency is amending WAC 182-501-0160 to clarify that if another rule conflicts with this rule, this rule prevails
Conditions of Payment
Affected WAC: 182-502-0110
Description: The agency is amending WAC 182-502-0110 to clarify prior authorization requirements for dual-eligible clients when their Medicare benefits are exhausted.
Affected WAC: 182-501-0070
Description: The agency is revising this rule to reference hair removal and electrolysis allowed under WAC 182-531-1675.
Experimental and Investigational Services
Affected WAC: 182-531-0050, 182-531-0550
Description: The agency is revising WAC 182-531-0050 to remove the definition of “ADSA,” clarify the definitions of “experimental” and “investigational,” and align the definition of “peer-reviewed medical literature” with other agency rules. WAC 182-531-0550 is being updated to strike redundant subsections and clarify information regarding experimental and investigational services. These revisions do not change current policy. Housekeeping changes were also made in these WACs.
Preproposal (CR101) - WSR 16-07-137
Withdrawal (CR101) - WSR 16-17-004
Preproposal (CR101) - WSR 16-17-094
Proposal (CR102) - WSR 16-24-055
Hearing date: 1/10/17
*Comments due by COB
Supplemental (CR102) - WSR 17-05-092
Hearing date: 3/21/17
*Comments due by COB
Permanent Adoption (CR103P) - WSR 17-09-002
Affected WAC: 182-530-7700, 182-531-0250, 182-502-0006
Description: The agency is amending rules to comply with Section 1902(a)(10)(E) of the Social Security Act that requires changes to payment of Medicare cost sharing for qualified Medicare beneficiaries.
Affected WAC: 182-526-0005, 182-526-0010, 182-526-0020, 182-526-0025, 182-526-0035, 182-526-0040, 182-526-0070, 182-526-0080, 182-526-0085, 182-526-0095, 182-526-0102, 182-526-0115, 182-526-0135, 182-526-0150, 182-526-0155, 182-526-0175, 182-526-0185, 182-526-0195, 182-526-0200, 182-526-0215, 182-526-0221, 182-526-0230, 182-526-0240, 182-526-0245, 182-526-0250, 182-526-0255, 182-526-0270, 182-526-0280, 182-526-0282, 182-526-0284, 182-526-0285, 182-526-0290, 182-526-0300, 182-526-0340, 182-526-0350, 182-526-0360, 182-526-0370, 182-526-0375, 182-526-0380, 182-526-0387, 182-526-0390, 182-526-0415, 182-526-0450, 182-526-0495, 182-526-0500, 182-526-0520, 182-526-0525, 182-526-0540, 182-526-0550, 182-526-0555, 182-526-0560, 182-526-0575, 182-526-0580, 182-526-0595, 182-526-0600, 182-526-0605, 182-526-0640, 182-526-0650
Description: The agency amended these rules to make the hearing process more efficient and streamlined.
Definitions - C
Affected WAC: 182-500-0020
Description: The agency is adding a definition for client in this section.
Continuing a hearing when an appellant is an applicant or recipient
Affected WAC: 182-526-0280
Description: To comply with new federal rules in 42 CFR Part 431, the agency is creating a new section WAC 182-526-0100 to allow for expedited administrative hearings for urgent health care needs. The agency is revising WAC 182-526-0290(4) and (6) to correct an error in the recently filed permanent rules for Chapter 182-526 WAC. In subsection (4), if an appellant fails to appear at the scheduled prehearing conference to address the petition to vacate, the order becomes a final order. The ALJ or review judge does not dismiss the matter with prejudice. In subsection (6), if the petition to vacate is not filed timely or the appellant fails to establish good cause to excuse any default or to reinstate the matter for hearing, the ALJ must issue an initial order, not a final order, dismissing the appeal. In WAC 182-526-0280, the agency is proposing to strike the introductory statement “This section applies to continuance requests made by applicants or recipients.” During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy.
Reinstating a hearing after an order of default or an order of dismissal
Affected WAC: 182-526-0290
Description: The agency recently filed the permanent rules for Chapter 182-526 under WSR 17-05-066, filed February 13, 2017. This emergency rule corrects an error in subsection (4) and (6) of WAC 182-526-0290. In subsection (4), if an appellant fails to appear at the scheduled prehearing conference to address the petition to vacate, the order becomes a final order. The ALJ or review judge does not dismiss the matter with prejudice. In subsection (6), if the petition to vacate is not filed timely or the appellant fails to establish good cause to excuse any default or to reinstate the matter for hearing, the ALJ must issue an initial order, not a final order, dismissing the appeal.