Apple Health (Medicaid) rulemaking

The agency is proposing to add a new subchapter IV, titled Medical Respite Program, under Chapter 182-551 WAC Alternative to Hospital Services.

The agency is proposing to add a new subchapter IV, titled Medical Respite Program, under Chapter 182-551 WAC Alternative to Hospital Services.

The State Supplemental Operating budget (section 211 (103), Chapter 296, Laws of 2022, (ESSB 5693)), included funding for HCA to implement a community health worker benefit for Apple Health (Medicaid) clients. HCA is developing rules in new Chapter 182-562 WAC to accomplish this.

The agency is amending this rule to correct the number of service hours identified in the eligibility criteria for Tier 4 and Tier 5 community behavioral health
support services.

HCA is amending WAC 182-501-0213, Case management services, and writing new rules under new Chapter 182-563 WAC to provide limited coverage for certain services for incarcerated individuals up to 90 days before their expected release date. This rulemaking aligns with Washington’s Medicaid Transformation Project 2.0, in accordance with Section 1115(a) of the Social Security Act and the Consolidated Appropriations Act (CAA).

The agency is developing rules for the Washington Health-Related Social Needs (HRSN) services program. Under the Washington State Section 1115 Medicaid Demonstration wavier, the HRSN services program allows qualifying Medicaid enrollees to receive evidence-based, non-medical services to address unmet, adverse social conditions that contribute to poor health. The agency plans to have new rules to implement:
• Nutritional supports for people who screen positive for certain chronic conditions or for people post-discharge from a hospital, institutional, or congregate setting who screen positive for food insecurity or need assistance to maintain nutrition goals;
• Caregiver respite services that provide temporary, short-term supervision and services usually furnished by a caregiver to people whose caregivers need relief or who have trouble finding alternative affordable care; and
• Environmental accessibility, remediation, and adaptation services to provide physical changes to a home that promote health, safety, or independence to people who meet certain chronic conditions and whose health has been impacted by their living conditions.

The agency is developing rules for a statewide Certified Community Behavioral Health Clinic (CCBHC) model as directed by ESSB 5167 Sec 214 (43), 69th Legislature, 2025 Regular Session, and cost-based rates and standards for CCBHC certification. CCBHCs are outpatient, community-based clinics that provide a comprehensive range of mental health and substance use disorder services to people
seeking care.

The agency is developing rules for Accountable Communities of Health (ACHs) to establish Community Care Hubs provided through the Washington State Health-Related Social Needs (HSRN) services program. Under the Washington State Section 1115 Medicaid Demonstration waiver, the HSRN services program allows qualifying Medicaid enrollees to receive evidence-based, non-medical services to address unmet, adverse social conditions that contribute to poor health. The Community Care Hubs provide community based care coordination, known as Social Care Support service, and support the delivery of other approved HRSN services.

The agency is developing rules to implement housing transition navigation services provided through the Washington State Health-Related Social Needs (HSRN) services program. Under the Washington State Section 1115 Medicaid Demonstration waiver, the HSRN services program allows qualifying Medicaid enrollees to receive evidence-based, non-medical services to address unmet, adverse social conditions that contribute to poor health. The housing transition navigation services program provides short-term assistance to remove barriers in order to obtain or maintain affordable housing. The agency is developing rules to implement rent/temporary housing services provided through the Washington State Health-Related Social Needs (HSRN) services program. Under the Washington State Section 1115 Medicaid Demonstration waiver, the HSRN services program allows qualifying Medicaid enrollees to receive evidence-based, non-medical services to address unmet, adverse social conditions that contribute to poor health. The rent/temporary housing benefit provides stable independent living situations for people transitioning out of institutional care or congregate settings who are homeless or at risk of homelessness. Payment
may cover rent and/or short-term temporary stays for up to six months.

To create a new chapter which establishes the Medicaid agency’s: (1) requirements for enabling a tribal clinic to receive the agency’s all-inclusive rate (AIR); (2) reimbursement methodology for receiving the AIR; and (3) process to appeal decisions related to the AIR.