If you are displaced or affected by wildfire, all Washington Apple Health and PEBB/SEBB medical plans are allowing prescription refills before the refill date.
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)

Coverage for Doulas
Affected WAC: 182-502-0002, 182-531-0100, 182-533-0650
Pending formal proposal
WSR 20-17-113
Date Filed: 08/17/2020
Description: ESSB 6168, Ch. 357, Sec. 211(32), Laws of 2020 requires the Health Care Authority (HCA) to reimburse maternity services provided by doulas.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 20-17-113
Date Filed: 08/17/2020
Continuing requirements
Affected WAC: 182-502-0016
Emergency rules adopted
WSR 20-17-137
Effective: 08/18/2020-12/16/2020
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.
Agency contact:
Michael Williams, rule writer
360-725-1346
Emergency Adoption (CR103E) - WSR 20-10-011
Effective: 4/24/2020-8/17/2020
Preproposal (CR101) - WSR 20-10-012
Filed:4/24/2020
Emergency Adoption (CR103E) - WSR 20-17-137
Effective: 08/18/2020-12/16/2020
Covered OP drugs, devices, and drug-related supplies
Affected WAC: 182-530-2000
Emergency rules adopted
WSR 20-16-048
Effective: 7/28/2020-11/25/2020
Description: The agency is replacing the list of covered generic products for the treatment of cough and cold. Under the amended rule, the agency instead covers only those products with a preferred status on the Medicaid preferred drug list (PDL) on the date a prescription is dispensed.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Emergency Adoption (CR103E) - WSR 20-08-118
Effective: 3/31/2020-7/27/2020
Preproposal (CR101) - WSR 20-15-034
Filed date: 7/7/2020
Emergency Adoption (CR103E) - WSR 20-16-048
Effective: 7/28/2020-11/25/2020
Billing Requirements - pharmacy claim payment
Affected WAC: 182-530-5000
Emergency rules adopted
WSR 20-16-049
Effective: 7/28/2020-11/25/2020
Description: The Health Care Authority is temporarily removing the requirement to obtain a signature from the Medicaid client or the client’s designee upon receipt of pharmacy products dispensed and delivered directly to a client.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Emergency Adoption (CR103E) - WSR 20-08-106
Effective: 3/31/2020 - 7/27/2020
Preproposal (CR101) - WSR 20-15-036
Filed date: 7/7/2020
Emergency Adoption (CR103E) - WSR 20-16-049
Effective: 7/28/2020-11/25/2020
Proof of delivery
Affected WAC: 182-543-2200
Emergency rules adopted
WSR 20-15-107
7/16/2020-11/13/2020
Description: The Health Care Authority is revising this section to temporarily eliminate the requirement for date and signature from the Medicaid client or the client’s designee upon delivery of medical equipment and supplies.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Emergency Adoption (CR103E) - WSR 20-08-025
3/20/2020-7/15/2020
Emergency Adoption (CR103E) - WSR 20-15-107
7/16/2020-11/13/2020
Children's Washington apple health with premiums
Affected WAC: 182-505-0215
Formally proposed
WSR 19-21-103
Effective: 1/1/2020
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 Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 19-13-058
Filed: 6/14/19
Proposal (CR102) - WSR 19-18-066
Hearing date: 10/8/19
*Comments due by 10/8/19
Permanent Adoption (CR103P) - WSR 19-21-103
Effective: 1/1/2020
Health care services provided outside the state of Washington—General provisions
Affected WAC: 182-501-0180
Pending formal proposal
WSR 20-10-077
Filed date: 5/4/2020
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).
Agency contact:
Jason Crabbe, rule writer
360-725-9563
Preproposal (CR101) - WSR 20-10-077
Filed date: 5/4/2020
Program Integrity
Affected WAC: 182-502A-0101, 182-502A-0201, 182-502A-0301, 182-502A-0401, 182-502A-0501, 182-502A-0601, 182-502A-0701, 182-502A-0801, 182-502A-0901, 182-502A-1001, 182-502A-1101
Formally proposed
WSR 20-02-100
Effective: 1/31/2020
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 date: 4/3/19
Proposal (CR102) - WSR 19-23-096
Hearing date: 12/24/19
*Comments due by 12/24/19
Permanent Adoption (CR103P) - WSR 20-02-100
Effective: 1/31/2020
Wraparound and Intensive Services (WISe)
Affected WAC: 182-501-0215
Formally proposed
WSR 20-15-026
Effective: 8/7/2020
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.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 19-15-146
Filed date: 7/24/19
Proposal (CR102) - WSR 20-09-014
Hearing date: Cancelled
Proposal (CR102) - WSR 20-10-107
Hearing date: 6/23/2020
*Comments due 6/23/2020
Permanent Adoption (CR103P) - WSR 20-15-026
Effective: 8/7/2020
Advance Directives
Affected WAC: 182-501-0125
Pending formal proposal
WSR 19-06-029
Date Filed: 2/28/19
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

Pages