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Apple Health (Medicaid) rulemaking

This page includes all of the current rule making activity for Washington Apple Health (Medicaid)

Third-party resources
Affected WAC: 182-501-0200
Formally proposed
Effective: 8/6/2020
Description: The agency is amending this section to implement requirements in the Bipartisan Budget Act of 2018 which requires state Medicaid agencies to use cost-avoidance on labor, delivery, and postpartum care claims. The Bipartisan Budget Act of 2018 also delayed the implementation of a provision in the Bipartisan Budget Act of 2013 that allowed payment up to 90 days for claims associated with medical support enforcement, rather than 30 days under the previous law. The agency is revising this section to implement this provision, now amended to 100 days, rather than 90, by the Medicaid Services Investment and Accountability Act of 2019.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 20-05-055
Filed date: 2/14/2020
Proposal (CR102) - WSR 20-09-080
Hearing date: Cancelled
Proposal (CR102) - WSR 20-10-105
Hearing date: 6/23/2020
*Comments due 6/23/2020
Permanent Adoption (CR103P) - WSR 20-15-015
Effective: 8/6/2020
MAGI Income
Affected WAC: 182-509-0320, 182-509-0335, 182-509-0345, 182-509-0350, 182-509-0355, 182-509-0300
Formally proposed
Effective date: 09/18/2020
Description: The agency is amending these WACs to: 1) align income exemptions with the Internal Revenue Code; 2) clarify noncountable income provisions; and 3) remove provisions that are no longer applicable. Additionally, the agency is repealing three sections from Chapter 182-509 because: • MAGI programs do not count the income from employment and training described in WAC 182-509-0345. • Rules regarding needs-based assistance from other agencies or organizations set out in 182-509-0350 have been moved to 182-509-0320. • Gifts and inheritances listed in 182-509-0355 are already identified in 182-509-0320.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 19-17-057
Filed 08/19/19
Proposal (CR102) - WSR 20-06-051
Hearing date: Cancelled
Withdrawal (CR102) - WSR 20-08-054
Effective: 3/25/2020
Proposal (CR102) - WSR 20-09-033
Hearing date: Cancelled
Proposal (CR102) - WSR 20-10-108
Hearing date: 6/23/2020
* Comments due 6/23/2020
Permanent Adoption (CR103P) - WSR 20-17-136
Effective date: 09/18/2020
Medical definitions
Affected WAC: 182-500-0015, 182-500-0050
Expedited adoption
Filed: 7/8/2021
Description: HCA is amending these sections to correct outdated behavioral health terminology, to update references to correct state agencies and other minor housekeeping changes.
Agency contact:
Michael Williams, rule writer
360-725-1346
Expedited Adoption (CR105) - WSR 21-15-013
Filed: 7/8/2021
Oral health connections pilot project
Affected WAC: 182-535-1270
Withdrawn
Effective: 07/15/2021
Description: The agency is amending these rules to extend the program through December 31, 2023, or until pilot funds are completely dispersed, whichever comes first. Additionally, age limits and dual eligibility exclusions are being removed. The enhanced rate will now include an additional periodic exam and adult prophylaxis as well as one fluoride varnish application, and one silver diamine fluoride treatment.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 21-13-155
Filed date: 06/22/2021
Withdrawal (CR101) - WSR 21-15-061
Effective: 07/15/2021
Access to baby and child dentistry (ABCD) program
Affected WAC: 182-535-1245
Pending formal proposal
Filed date: 06/11/2021
Description: The agency is amending these rules align with SSB 5976.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 21-13-050
Filed date: 06/11/2021
Orthodontic services
Affected WAC: 182-535A-0010, 182-535A-0040, 182-535A-0050, 182-535A-0060
Formally proposed
Effective: 01/01/2022
Description: The agency is amending these rules to remove all references to interceptive treatment. This change is necessary to align with the planned discontinuance of the CDT code for interceptive treatment, effective January 1, 2022 by the American Dental Association’s Council of Dental Benefit Program’s Code Maintenance Committee.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 21-10-096
Filed date: 05/05/2021
Proposal (CR102) - WSR 21-14-047
Hearing date: 08/10/2021
*Comments due 08/10/2021
Permanent Adoption (CR103P) - WSR 21-18-006
Effective: 01/01/2022
Dental - related services
Affected WAC: Chapter 182-535
Formally proposed
Effective: 08/02/2021
Description: The agency is amending these rules to: *Add and remove definitions. *Remove “including periodontal charting” from the comprehensive oral evaluation definition. *Remove diagnostic casts from covered diagnostic tests and examination. *Add “and implants” to prophylaxis covered services. *Remove tobacco cessation as a covered service under the Dental program. *Add “glass ionomer” to sealant covered preventative services. *Change limitations for replacement of restorations by clarifying “replacement of a cracked or broken restoration within a 6- month period by the same provider is considered part of the global payment of the initial restoration and will not pay separately.” *Change stainless steel crowns for permanent posterior teeth no longer have age limitations or require prior authorization. *Add clarification that all replacement dentures and replacement partial dentures require prior authorization and the need for the replacement must be medically necessary. *Add language for coverage of alveoloplasty to include “only in conjunction with the preparation of dentures or partials” and remove “prior authorization is not required.” *Add limitation for full mouth scaling to a 12-month period. *Change nondental providers to medical providers and other housekeeping updates as necessary.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 21-05-010
Filed date: 2/4/2021
Proposal (CR102) - WSR 21-10-095
Hearing date: 06/08/2021
*Comments due 06/08/2021
Permanent Adoption (CR103P) - WSR 21-14-055
Effective: 08/02/2021
Family planning only programs - Covered services
Affected WAC: 182-532-530
Pending formal proposal
Filed date: 08/26/2021
Description: HCA is amending this rule to add the HPV vaccine as a covered service under the Family planning only program.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 21-18-067
Filed date: 08/26/2021
Maternity support services - Professional staff qualifications and interdisciplinary team
Affected WAC: 182-533-0327
Formally proposed
Effective: 3/27/2021
Description: The agency is amending this rule to replace "Chemical Dependency Professional" with "Substance Use Disorder Professional". This change aligns with RCW 18.205.020.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 20-24-036
Filed date: 11/20/2020
Proposal (CR102) - WSR 21-03-075
Hearing date: 2/23/2021
*Comments due 2/23/2021
Permanent Adoption (CR103P) - WSR 21-06-042
Effective: 3/27/2021
Coverage for Doulas
Affected WAC: 182-502-0002, 182-531-0100, 182-533-0650
Withdrawn
Effective: 10/5/2020
Description: ESSB 6168, Ch. 357, Sec. 211(32), Laws of 2020 requires the Health Care Authority (HCA) to reimburse maternity services provided by doulas.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 20-17-113
Date Filed: 08/17/2020
Withdrawal (CR101) - WSR 20-20-096
Effective: 10/5/2020