Apple Health (Medicaid) rulemaking

The agency is revising these rules to allow for reimbursements of professional services for home infusions.

The agency is amending these rules as the payments for outlier enhancements have exceeded the budget neutral amount calculated during the 2021 hospital rebasing period. An increase in the outlier threshold will allow the state to bring payments more in line with the budget neutral total calculated in 2021.

Updating chemical-using pregnant (CUP) women to substance-using pregnant people (SUPP). The revision allows for alignment with agency standard language.

The agency is amending these rules to remove reference to “other medical necessary services” to align with SHB 2051.

The agency is striking outdated subsection citations in WAC 182-550-5000 and striking the definition of DSH reporting data file (DRDF) in WAC 182-550-4900 as it is no longer applicable and is a term that is not used within the chapter. These changes clarify the rules without changing their effect.

To clarify language without changing the rules effect. Updating method of notice from first class mail to email. This revision allows for quicker
notification to providers and is less costly.

The agency is revising these two sections to update outdated terminology (fair hearings to administrative hearings) and also to remove the outdated options for requesting prior authorization.

The agency is amending these rules as an overall housekeeping project. Additionally, the agency is removing definitions for “base year” and “uninsured patient”, removing “with special needs” language from low-income clients, updating the abbreviation of the medicaid inpatient utilization rate from MIPUR to MIUR to align with CMS, updating WAC cross referencing, standardizing language, removing language that the DSH application is posted to the agency’s website, updating that the agency will use the medicare cost report rather than the DRDF to determine a hospital’s MUIR, removing DSH programs no longer funded and not part of the program, and audit requests for additional information must be received 10 days from the initial notification. Also updating the
name of the “provider data summary schedule (PDSS)” to “schedule of annual reporting requirements (SARR).”

The agency is amending these rules to align with RCW 48.43.815; and moving specific revenue categories/subcategories from noncovered to covered.