Apple Health (Medicaid) rulemaking

Description: This rule is being amended to clarify what an “ownership interest” is in the home exclusion rule. Clarification is also needed to explain that property essential to self-support (PESS) does not include intangible personal property other than cash or cash equivalents used in a trade or business.

Description: The agency is revising the definition of alternate living facility (ALF) to include staffed residential facility, group care facility for medically complex children, and children’s state-operated living alternative

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.

Description: The agency is amending this section to add Dental Health Aide Therapists (DHAT) to the list of eligible providers who can be reimbursed for providing services to medicaid clients in tribal facilities. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy.

Description: The agency is striking all references to dental managed care from these sections. Eligible clients will continue to receive their dental services through fee-for-service on and after July 1, 2019.

Description: Recently signed ESHB 1109 directs the agency to not proceed with a managed care dental option, effective July 1, 2019. The agency previously revised these sections in anticipation of having a managed care dental option, effective July 1, 2019, to comply with SSB 5883 (Laws of 2017). This rulemaking strikes the dental managed care option.

Description: The agency is revising this section to reflect changes in covered benefits, and to remove certain authorization requirements to expedite claims processing and the delivery of timely services.

Description: The agency is revising these sections to clarify terms of coverage for orthodontic services. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy.

Description: The agency is revising WAC 182-535-1245 to expand the ABCD program to include children ages 6-12 with disabilities and allow for dentists and dental hygienists who are certified to provide program services to children with disabilities to be paid at the enhanced rate for these children. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy.

Description: The agency is revising these rules to comply with legislation in Substitute Senate Bill 5883 for providing dental services through managed care. The agency is also adding language in Chapter 182-535 WAC for the coverage of teledentistry, as already allow under WAC 182-531-1730.