Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Adjustments to IP Rates/OPPS Rates
Affected WAC: 182-550-3830, 182-550-7500
Description: The agency is amending these rules to align with ESHB 1109, Sec. 211 (14), 66th Legislature, 2019 Regular Session. The agency intends to extend the date for payment increases under the Sole Community Hospital program and to allow for updates to inpatient conversion factors and per diem rates through June 30, 2020.
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.
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.
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.
Affected WAC: 182-501-0200
Description: The agency is revising this section to strike subsection (2)(a) to align with changes in 42 USC 1396a(a)(25)(E) which removed prenatal care from the list of medical services that the agency pays and then seeks reimbursements from a liable third party. State Medicaid agencies must use standard coordination of benefits cost avoidance when processing prenatal services claims.
Wraparound and Intensive Services (WISe)
Affected WAC: 182-501
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.
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.
Program Integrity Requirements
Affected WAC: 182-538A-160
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.
Affected WAC: Chapter 182-502A
Description: The agency is amending this chapter to clarify and revise language to align with federal and state regulations.
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.