Apple Health (Medicaid) rulemaking

The agency is revising these two sections to update outdated terminology (fair hearings to administrative hearings) and also to remove the outdated options for requesting prior authorization.

The agency is amending these rules as an overall housekeeping project. Additionally, the agency is removing definitions for “base year” and “uninsured patient”, removing “with special needs” language from low-income clients, updating the abbreviation of the medicaid inpatient utilization rate from MIPUR to MIUR to align with CMS, updating WAC cross referencing, standardizing language, removing language that the DSH application is posted to the agency’s website, updating that the agency will use the medicare cost report rather than the DRDF to determine a hospital’s MUIR, removing DSH programs no longer funded and not part of the program, and audit requests for additional information must be received 10 days from the initial notification. Also updating the
name of the “provider data summary schedule (PDSS)” to “schedule of annual reporting requirements (SARR).”

The agency is amending these rules to align with RCW 48.43.815; and moving specific revenue categories/subcategories from noncovered to covered.

The agency is amending 182-550-1900 and 182-550-2100 to update which transplant procedures are covered and where the transplants can be performed. The agency is also repealing WAC 182-550-2200 Transplant requirements – COE, as this section will no longer be necessary due to the changes being proposed to 182-550-1900 and 182-550-2100. As a result of these changes, the agency is also amending WAC 182-531-0650 and 182-531-1750.

The agency is amending 182-550-5130 to remove subsections (5) and (6). The agency does not distribute any state funded grants for IMD DSH; there is no state money allocated to IMD. The agency is repealing 182-550-5210, 182-550-5220, and 182-550-5380; old information – the programs have not been funded by the legislature for over ten years.

The agency is amending these rules to reduce the sole community hospital rate multiplier to 1.25, effective July 1, 2024.

The agency is amending these rules to provide more general language due to frequent changes of percentages and dollar amounts.

The agency is amending this rule to add gender affirming surgery services to being exempt from DRG payment.

The agency is amending WAC 182-550-1500 to allow for the payment of outpatient services in the following revenue code categories: “Partial hospitalization – Less intensive,” “Partial hospitalization – Intensive,” and “Intensive outpatient services – Psychiatric.

The agency amended this rule to add clarifying language to subsection (5)(c). The agency added that if the state’s
applicable federal medical assistance percentage (FMAP) is 0%, the amount derived in subsection (5)(b) is multiplied by the
lowest Washington state specific medicaid FMAP in effect at the time of claim payment.