Apple Health (Medicaid) rulemaking

The agency intends to establish rules regarding eligibility determinations for the CBHSS program, which helps certain people with supervision and skills restoration services.

The agency is creating a new section in chapter 182-513 WAC to create presumptive eligibility for long-term services and supports authorized by Home and Community Services in home and alternate living facilities.

The agency is amending this rule to make language less restrictive in subsection (5)(c) from covering a “case study when done in conjunction with limited or comprehensive orthodontic treatment only” to a “case study when done in conjunction with orthodontic treatment.”

The agency is amending this rule to increase the allowable number of periodontal treatments to up to four per 12-month period for Apple Health eligible clients, ages 21 and over, with a current diagnosis of diabetes. Effective January 1, 2024, periodontal maintenance is allowed once every three months when criteria is met.

The agency is amending these rules to (1) Correct an incorrect WAC subsection reference in 182-535-1098(4)(c). Subsection (4)(c) indicates refer to WAC 182-535-1094(3) and should be 182-535-1094(4); (2) Remove subsection (2)(f)(x), replacement of agency-purchased prosthodontics, from WAC 182-535-1100 Not covered. Dentures are a covered service.

The agency is amending this rule to remove subsection (4)(e) to be less restrictive for providers using removable appliances as part of orthodontic treatment. The agency is also removing “with an alveolar process involvement” from subsection (1)(a) to eliminate limiting clients who have a cleft lip to those with an alveolar process involvement.

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 The agency intends to remove language related to this superseded program from chapter 182-532 WAC.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 amending this rule to include criteria to allow agency-approved online classes with a one-on-one check-in with the client and qualified CBE
provider during or after the online classes have been completed by the client.