Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Scope of Services
Affected WAC: 182-501-0060
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.
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.
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.
Premium payment program
Affected WAC: Chapter 182-558
Description: The agency is amending Chapter 182-558 WAC to clarify and update eligibility criteria for clients receiving premium assistance subsidies for comprehensive health insurance.
Medical Assistance definitions - N
Affected WAC: 182-500-0075
Description: The agency is amending this rule as a result of federal regulations published February 2016 under 42 C.F.R. Part 440. The agency is adding a definition for “nonphysician practitioners,” a term which will be used in two WAC chapters to be amended in separate rulemaking actions as a result of the February 2016 federal regulations. The agency previously filed a Preproposal Statement of Inquiry in 2016 to begin rulemaking on this and other sections under WSR 16-11-094. The agency subsequently withdrew the previously filed Preproposal Statement of Inquiry under WSR 18-05-031 and is rewriting the proposed rule.
Affected WAC: 182-502A-0201, 182-502A-0301, 182-502A-0401, 182-502A-0601, 182-502A-0701, 182-502A-0801, 182-502A-0901, 182-502A-1001
Description: The agency is amending Chapter 182-502A, Program integrity, to update definitions and clarify processes.
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).
Appellants representation in the hearing
Affected WAC: 182-526-0155
Description: The agency is amending this rule to allow a limited exception to the requirement that an attorney representing an appellant in a hearing must file a notice of appearance. The exception would apply to an attorney representing an appellant who was also the person that originally requested the appellant’s hearing.
Administrative Hearings - ICF/IID
Affected WAC: 182-526-0005
Description: The agency is amending this chapter to add administrative hearing rules for actions related to intermediate care facilities for individuals with intellectual disabilities (ICF/ID), in alignment with federal regulations.
Orders of default; Orders of dismissal
Affected WAC: 182-526-0284, 182-526-0285
Description: The agency is revising WACs 182-526-0284 and -0285 to align with the changes proposed in WAC 182-526-0290 which were made to be consistent with the Administrative Procedures Act.