Apple Health (Medicaid) rulemaking

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

Managed Care
Affected WAC: Chapters 182-538, 182-538A, 182-538B, 182-538C, 182-538D
Description: This rulemaking is required to implement Engrossed Second Substitute Senate Bill 5432 which directs the agency to fully implement behavioral health integration for January 1, 2020, by: 1) removing behavioral health organizations from law; 2) clarifying the roles and responsibilities among the Health Care Authority, the Department of Social and Health Services, and the Department of Health; and 3) clarifying the roles and responsibilities of behavioral health administrative services organizations and the Medicaid managed care organizations; and 4) making technical corrections related to the behavioral health system.
Agency contact:
Amy Emerson, rule writer
360-725-1348
Preproposal (CR101) - WSR 19-13-090
Filed: 6/18/19
Children's Washington apple health with premiums
Affected WAC: 182-505-0215
Description: During the 2017 legislative session, the Washington State Legislature passed Engrossed House Bill (EHB) 2242 which created the School Employees’ Benefits Board (SEBB) health insurance benefit beginning January 1, 2020. The availability of this benefit, beginning January 1, 2020, means these children no longer meet the definition of targeted low income children under 42 CFR 357.310, and will not be eligible for the Children’s Health Insurance Program (CHIP), also known as Washington Apple Health with Premiums Program.
Agency contact:
Valerie Smith, rule writer
360-725-1344
Preproposal (CR101) - WSR 19-13-058
Filed: 6/14/19
HWD Updates to Health Workers with Disabilities
Affected WAC: 182-511-1000
Description: The agency is revising these rules to comply with the requirements of SHB 1199.
Agency contact:
Valerie Smith, rule writer
360-725-1344
Preproposal (CR101) - WSR 19-13-059
Filed: 6/14/19
Enrollment, Termination and Reapplying for Participation
Affected WAC: 182-502-0012, 182-502-0040, 182-502-0060
Description: The agency is amending WAC 182-502-0012(5) and WAC 182-502-0040(2) to allow providers to request the agency to reconsider agency decisions to deny enrollment applications, and to request the agency to reconsider terminations of a provider agreement for convenience. The reconsideration process being added to 182-502-0012 is a separate process from the reconsideration process in Chapter 182-526 WAC and separate from the dispute resolution process in WAC 182-502-0050. The agency is amending WAC 182-502-0060 to remove subsections (1) and (2) that prohibit providers from reapplying for participation after the agency denies enrollment or removes a provider from participation. The agency has determined that the rules need to be amended to allow for due process and for reporting purposes.
Agency contact:
Amy Emerson, rule writer
360-725-1348
Preproposal (CR101) - WSR 19-11-097
Filed: 5/20/19
Program Integrity Requirements
Affected WAC: 182-538A-160, Chapter 182-502A
Description: The agency is updating the rules for program integrity activities related to managed care to align with federal rules. As part of this rulemaking, the agency intends to repeal WAC 182-538A-160 and replace it with revisions to Chapter 182-502A.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 19-11-036
Filed 5/9/2019
Program Integrity
Affected WAC: Chapter 182-502A
Description: The agency is amending this chapter to clarify and revise language to align with federal and state regulations.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 19-08-089
Filed: 4/3/19
Advance Directives
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 19-06-029
Date Filed: 2/28/19
Scope of Services
Affected WAC: 182-501-0060, 182-501-0065
Description: The agency is amending WAC 182-501-0060, Health care coverage—Program benefit packages—Scope of service categories to implement E2SSB 5179, which restores coverage of hearing instruments for adults.
Agency contact:
Jason Crabbe, rule writer
360-725-9563
Preproposal (CR101) - WSR 19-02-021
Filed: 12/21/18
Emergency Adoption (CR103E) - WSR 19-02-022
Effective: 12/21/18-4/28/19
Emergency Adoption (CR103E) - WSR 19-10-009
Effective: 4/19/19-8/17/19
Proposal (CR102) - WSR 19-10-027
Hearing date: 6/4/19
*Comments due 6/4/19
Permanent Adoption (CR103P) - WSR 19-14-020
Effective: 7/25/19
Continuing requirement
Affected WAC: 182-502-0016
Description: The agency is updating this section to provide notice to providers and support enforcement of compliance with state and federal requirements related to the operations of entities receiving more than $5 million in Medicaid payments annually, including but not limited to such entities providing information about the False Claims Act and establishing written policies for employees.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 18-23-082
Filed: 11/19/18
Provider enroll, termination
Affected WAC: 182-502-0012, 182-502-0040, 182-502-0060
Description: The agency is WAC 182-502- 0012(5) and WAC 182-502-0040(2) to allow the dispute resolution process under WAC 182-502-0050, with the exception of WAC 182-502-0050(6), for providers who are denied enrollment, and for terminations of a provider agreement for convenience. The agency is amending WAC 182-502-0060 to remove subsections (1) and (2) that prohibit providers from reapplying for participation after the agency denies enrollment or removes a provider from participation. The agency has determined that the rules need to be amended to allow for due process and for reporting purposes.
Agency contact:
Amy Emerson, rule writer
360-725-1348
Preproposal (CR101) - WSR 18-14-098
Filed: 7/3/18
Withdrawal (CR101) - WSR 19-11-070
Effective: 5/16/19

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