Apple Health (Medicaid) rulemaking

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

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
Asset Verification System
Affected WAC: 182-503-0050, 182-503-0055, 182-503-0080
Description: As required by 42 U.S.C. 1396w, the agency is creating a new WAC to create an asset verification program to determine or redetermine the eligibility of an individual for Apple Health.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 19-07-054
Filed: 3/20/19
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
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
Premium payment program
Affected WAC: 182-558-0010, 182-558-0020, 182-558-0030, 182-558-0050, 182-558-0060
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 18-06-037
Filed: 3/1/18
Proposal (CR102) - WSR 19-08-018
Hearing date: 5/7/19
*Comments due by 5/7/19
Permanent Adoption (CR103P) - WSR 19-11-129
Effective: 6/22/19
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 18-05-066
Filed 2/16/18
Proposal (CR102) - WSR 18-19-102
Hearing date: 10/23/18
*Comments due by COB
Permanent Adoption (CR103P) - WSR 18-24-023
Effective: 1/1/19
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).
Agency contact:
Katie Pounds, rule writer
360-725-1346
Preproposal (CR101) - WSR 17-07-049
Filed: 3/9/17
Withdrawal (CR101) - WSR 18-10-029
Effective: 4/24/18
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 19-06-027
File date: 2/28/19
Proposal (CR102) - WSR 19-11-074
Hearing date: 6/25/19
*Comments due by 6/25/19

Pages