Apple Health (Medicaid) rulemaking

The agency is updating the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) chapter to align with guidance from the Centers for Medicare & Medicaid Services.

The agency is amending its rules to increase the income standards for pregnancy and postpartum groups from 193% to 210% of the federal poverty level. This
increase is consistent with legislative directives in chapter 213, Laws of 2024 (2E2SSB 5580).

The State Supplemental Operating budget (section 211 (34), Chapter 376, Laws of 2024, (ESSB 5950)), included funding for the Health Care Authority (HCA) to implement a birth doula benefit for Apple Health (Medicaid) clients. HCA is developing rules in Chapter 182-533 WAC and amending WAC 182-502-0002 to accomplish this.

The agency is amending this rule to expand screening and preventative services for certain sexually transmitted infections during a client visit focused on family planning.

RCW 74.09.830 provides full-scope coverage for 12 months postpartum for pregnant or postpartum persons. This coverage is more generous than and thus replaces the limited scope “Family planning only – Pregnancy related program.” The agency intends to remove language related to this superseded program from chapter 182-532 WAC.

The agency is adding a new section describing system requirements for electronic visit verification (EVV) for home health care services.

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

The agency is striking outdated subsection citations in WAC 182-550-5000 and striking the definition of DSH reporting data file (DRDF) in WAC 182-550-4900 as it is no longer applicable and is a term that is not used within the chapter.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.