Apple Health (Medicaid) rulemaking

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

Rule making activities

Description
The agency is amending this rule to add clarifying language to subsection (5)(c). The agency is adding that if the state’s applicable 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.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Description
HCA is removing references to the hospital outpatient ratio of costs-to-charges (RCC) payment method due to the discontinuation of this payment method.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Description
The agency is revising this rule to remove subsection (4)(a) and (4)(b) and revise the language to match 42 CFR Part 447, Subpart C, Payment for Inpatient Hospital and Long-Term Care Facility Services, §447.253(g) Other requirements.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 24-03-100
  • Hearing Date and Comments due by: 2/27/2024
  • Registration required: https://us02web.zoom.us/webinar/register/WN_oPnu_jscTpmcOi88CFPCRQ

Permanent Adoption (CR103P)

Description
The agency is amending this section to replace outdated terms such as “Residential Support Network (RSN)” and “mental health designee,” to delete references to the department of mental health, and to update language regarding authorization and certification for inpatient psychiatric care consistent with the current managed care and administrative services organization (ASO) structure. The agency is also making changes to align with 2SSB 5103, 68th Legislature, 2023 Regular Session. This legislation requires the agency to provide a hospital payment for Apple Health clients who meet the criteria for discharge from a hospital stay to certain facilities but who cannot be discharged because placement is unavailable. This revision provides for the payment of medically necessary ancillary services to be billed by and paid to the hospital separately.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Description
The agency is amending WAC 182-550-2750 to correct a typographical error in a WAC reference. The rule references chapter 246-318 WAC; the correct citation is chapter 246-320 WAC. The agency is repealing WAC 182-550-4700 because the hospital selective contracting program to which it applies ended June 30, 2007. The agency is repealing WAC 182-550-5425 because the upper payment limit program to which it applies ended July 1, 2007. The agency is amending WAC 182-550-1100 by deleting subsection (3)(b) because it applies only to the agency’s selective contracting program that ended June 30, 2007

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Expedited Adoption (CR105)

Permanent Adoption (CR103P)

Description
The agency is revising these rules to align with 2SSB 5103, 68th Legislature, 2023 Regular Session. This legislation requires the agency to provide a hospital payment for Apple Health clients who meet the criteria for discharge from a hospital stay to one of several types of facilities but who cannot be discharged because placement is unavailable. This rulemaking will address the services to be included in the payment for the client’s hospital stay, as well as the services to be billed by and paid to the hospital separately.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 23-18-065
  • Hearing Date and Comments due by: 10/10/2023
  • Registration required: https://us02web.zoom.us/webinar/register/WN_fMyM6MV1SmqpIcKuyrlgYQ

Permanent Adoption (CR103P)

Description
The agency is amending these rules to update terminology, revise rates approved by the Legislature, remove outdated information, and to make other general policy changes.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
HCA is amending WAC 182-550-4400 to change a reference to the chemical-using pregnant (CUP) women program to the substance-using pregnant people (SUPP) program in subsection (2)(b). HCA is also amending subsection (2)(g) to reflect that HCA no longer denies payment for claims grouped to DRG 469 or DRG 470.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)

Description
The agency is amending WAC 182-550-6400 to apply it to all eligible providers and update diabetes education provider criteria and billing requirements.

Agency contacts

Rulemaking contact
Rulemaking status history

Preproposal (CR101)

Description
The agency is amending WAC 182-550-4550 to provide hospitals an administrative day rate for days in which a postpartum client does not meet criteria for acute inpatient level of care but their infant is still an inpatient being observed for potential neonatal abstinence/opioid withdrawal syndrome and the primary and appropriate first line treatment for the infant is continuous care by the parent.

Agency contacts

Rulemaking contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

Permanent Adoption (CR103P)