Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.
Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Washington apple health - Application processing times
Affected WAC: 182-503-0060
Description: The agency is making housekeeping changes only. WAC 182-503-0060(2) contains cross-references to WAC 182-503-0005(2) which need to be changed to WAC 182-503-0005(8). The agency will also edit the rule to replace instances of “WAH” with “apple health.
Health care services provided outside the state of Washington—General provisions
Affected WAC: 182-501-0180
Effective date: 12/17/2020
Description: Reasons why rules on this subject may be needed and what they might accomplish: The agency is amending WAC 182-501-0180 so it applies to both fee-for-service clients and clients enrolled in a managed care organization (MCO).
Affected WAC: 182-502-0016
Description: The agency is creating a new section within this chapter to meet the Centers for Medicare and Medicaid Services (CMS) milestone requirement 3 regarding the agency’s Section 1115 Substance Use Disorder (SUD) Waiver Implementation Plan. Milestone 3 requires the adoption of rules reflecting the requirement that residential treatment facilities offer medication assisted treatment access on-site or facilitate off-site access. The agency is also initiating this rulemaking to implement provisions of RCW 71.24.585 related to behavioral health agencies and medication assisted treatment. Initially this rulemaking was proposed as a new section 182-502-0016a. The agency decided to add the proposed language into the existing WAC section, 182-502-0016, instead of creating a new section.
Emergency Adoption (CR103E) - WSR 20-10-011
Preproposal (CR101) - WSR 20-10-012
Emergency Adoption (CR103E) - WSR 20-17-137
Emergency Adoption (CR103E) - WSR 21-01-126
Emergency Adoption (CR103E) - WSR 21-09-032
Proposal (CR102) - WSR 21-07-067
Hearing date: 4/27/2021
*Comments due 4/27/2021
Permanent Adoption (CR103P) - WSR 21-10-081
Medical and dental coverage – Fee-for-service (FFS) prior authorization - Determination process for payment
Affected WAC: 182-501-0165
Description: The agency (HCA) is updating WAC 182-501-0165 to further implement full integration of behavioral health in HCA’s Medicaid program by removing the term “mental health” and replacing it with the term “behavioral health.” This change will ensure clarity that clients receiving behavioral health services under HCA’s Medicaid fee-for-service program receive appropriate notices and opportunities for hearings based on adverse benefit decisions resulting from prior authorization. Many legislative changes have occurred this decade, including integrating substance use disorder services with delivery of mental health disorder treatments known as “behavioral health,” the transition of behavioral health from the Department of Social and Health Services (DSHS) to the Washington State Health Care Authority (HCA) through Second Engrossed Substitute House Bill 1388, Chapter 201, Laws of 2018, then the full integration of physical and behavioral health purchasing and administration in Engrossed Second Substitute Senate Bill 5432, Chapter 325, Laws of 2019.
Wraparound and Intensive Services (WISe)
Affected WAC: 182-501-0215
Description: This rulemaking is required to comply with and provide ongoing guidance related to the requirements that ensure the quality of the WISe service delivery model.
Affected WAC: 182-501-0125
Description: The agency is amending this rule to update and replace references to health maintenance organizations (HMOs) with current terminology.
Administrative hearings and appeals
Affected WAC: 182-51-1800, 182-526-0005, 182-70-110, 182-70-655, 182-70-660, 182-526-0195, 182-526-0203, 182-526-0205, 182-526-0206
Hearing date: 5/11/2021
Description: Revisions to these sections are necessary due to the revisions HCA is making to WAC 182-526-0005, Purpose and scope, which HCA filed a CR-101 under WSR 20-11-072 on May 20, 2020. Consistency is needed between Chapters 182-51, 182-70, and 182-526 WAC regarding hearings and appeals.
Applied Behavioral Analysis (ABA)
Affected WAC: 182-501-0060, 182-531A-0100, 182-531A-0200, 182-531A-0400, 182-531A-0500, 182-531A-0600, 182-531A-1100
Emergency rules adopted
Description: In WAC 182-531A, the agency is revising these rules to remove the age limits for applied behavioral analysis (ABA) and update language to remove child or children and replace with client. In WAC 182-501-0600, the agency is updating the “N” (No) to a “Y” (Yes) in the ABA covered services table for ABP 21+, CN 21+ and MN 21+
Presumptive eligibility for HCS HCB waiver
Pending formal proposal
Filed date: 3/8/2021
Description: The agency is creating new sections in chapters 182-513 and 182-515 WAC to create presumptive eligibility for long-term care in home when a client is discharged home from an acute care hospital or state hospital diversion.
Determining a client's financial participation in the cost of care for long-term care in a medical institution
Affected WAC: 182-513-1380
Description: The agency is revising this section to f ix a broken hyperlink for Apple Health income and resource standards. No other changes are being proposed to this section. This is strictly a housekeeping change.