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Apple Health (Medicaid) rulemaking

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

Proof of delivery
Affected WAC: 182-543-2200
Pending formal proposal
WSR 20-24-086
Filed: 11/25/2020
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
7/16/2020-11/09/2020
Emergency Adoption (CR103E) - WSR 20-23-038
11/10/2020-03/10/2021
Preproposal (CR101) - WSR 20-24-086
Filed: 11/25/2020
Health care services provided outside the state of Washington—General provisions
Affected WAC: 182-501-0180
Formally proposed
WSR 20-23-064
Effective date: 12/17/2020
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
Proposal (CR102) - WSR 20-20-066
Hearing date: 11/10/2020
*Comments due by 11/10/2020
Permanent Adoption (CR103P) - WSR 20-23-064
Effective date: 12/17/2020
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
Medical and dental coverage – Fee-for-service (FFS) prior authorization - Determination process for payment
Affected WAC: 182-501-0165
Formally proposed
WSR 20-14-057
Effective:7/27/2020
Description: The agency (HCA) is updating WAC 182-501-0165 to further implement full integration of behavioral health in HCA’s Medicaid program by removing the term “mental health” and replacing it with the term “behavioral health.” This change will ensure clarity that clients receiving behavioral health services under HCA’s Medicaid fee-for-service program receive appropriate notices and opportunities for hearings based on adverse benefit decisions resulting from prior authorization. Many legislative changes have occurred this decade, including integrating substance use disorder services with delivery of mental health disorder treatments known as “behavioral health,” the transition of behavioral health from the Department of Social and Health Services (DSHS) to the Washington State Health Care Authority (HCA) through Second Engrossed Substitute House Bill 1388, Chapter 201, Laws of 2018, then the full integration of physical and behavioral health purchasing and administration in Engrossed Second Substitute Senate Bill 5432, Chapter 325, Laws of 2019.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 20-05-090
Filed date: 2/19/2020
Proposal (CR102) - WSR 20-10-010
Cancelled
*Comments due by 6/9/2020
Proposal (CR102) - WSR 20-11-003
Hearing date: 6/23/2020
*Comments due 6/23/2020
Permanent Adoption (CR103P) - WSR 20-14-057
Effective:7/27/2020
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
Withdrawn
WSR 20-22-031
Effective: 10/26/2020
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
Withdrawal (CR101) - WSR 20-22-031
Effective: 10/26/2020
Administrative Hearings purpose and scope
Affected WAC: 182-526-0005
Pending formal proposal
WSR 20-11-072
Filed date: 5/20/2020
Description: The Health Care Authority (HCA) is revising this section to include Chapter 182-70 WAC, All payer health care claims database, and new Chapter 182-51 WAC, Washington Prescription Drug Pricing Transparency Program, as chapters that this section applies to. New rules for the Washington Prescription Drug Pricing Transparency Program are being promulgated under WSR 20-03-078. HCA also intends to clarify in this section that rules in Chapter 182-526 WAC do not apply to the school benefits board found in Chapter 182-32 WAC.
Agency contact:
Jason Crabbe, rule writer
360-725-9563
Preproposal (CR101) - WSR 20-11-072
Filed date: 5/20/2020
Patient review and coordination (PRC)
Affected WAC: 182-501-0135
Pending formal proposal
WSR 20-22-041
Filed date: 10/28/2020
Description: The agency is revising this section to clarify that a client with private full coverage insurance is not reviewed or placed into the Patient Review and Coordination (PRC) program unless the client does not have pharmacy coverage. In this situation, if the client qualifies for PRC and is placed into the PRC program, the restriction is only to a pharmacy.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 20-22-041
Filed date: 10/28/2020
Washington Apple Health Exception to Rule
Affected WAC: 182-503-0090
Pending formal proposal
WSR 20-21-013
Filed date: 10/09/2020
Description: The agency is amending WAC 182-503-0090 to specify the Department of Social and Health Services administrations responsible for processing exceptions to rule related to long-term services and supports programs. The agency is also making nonsubstantive changes for consistency with other agency rules.
Agency contact:
Brian Jensen, rule writer
360-725-0815
Preproposal (CR101) - WSR 20-21-013
Filed date: 10/09/2020
Personal needs allowance (PNA) and room and board standards in a medical institution and ALF
Affected WAC: 182-513-1105
Accepting comments
WSR 20-24-035
Hearing Date: 1/5/2021
Description: The agency is amending these rules to increase the personal needs allowance from $70.00 to $71.12 effective January 1, 2021. Funding is approved for this increase which affects those receiving long-term services and supports in medical institutions and alternate living facilities
Preproposal (CR101) - WSR 20-20-107
Filed date: 10/06/2020
Proposal (CR102) - WSR 20-24-035
Hearing Date: 1/5/2021
*Comments due by 1/5/2021

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