Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Oral Health Connections Pilot Program
Affected WAC: 182-535-1270
Description: This rulemaking is necessary to implement Substitute Senate Bill 5883 which directs the agency to develop and implement a three-year pilot program to test the effect that enhanced dental benefits for adult Medicaid clients with diabetes and pregnant Medicaid clients have on access to dental care, health outcomes, and medical care costs. The pilot program must include enhanced reimbursement rates for specific current dental terminology codes for participating providers and an increase in the allowable number of periodontal treatments to up to four per calendar year
Infant Case Management
Affected WAC: 182-533-0370, 182-533-0390
Description: The agency is revising WAC 182-533-0370 to allow an infant’s parent who becomes pregnant during the infant’s ICM eligibility period to receive Maternity Support Services (MSS) and WAC 182-533-0390 to reduce the minimum hours of childbirth education (CBE) instruction required from eight to six.
Family Planning-TAKE Charge programs
Affected WAC: 182-532-500, 182-532-510, 182-532-520, 182-532-530, 182-532-533, 182-532-540, 182-532-550, 182-532-700, 182-532-720, 182-532-730, 182-532-740, 182-532-743, 182-532-745, 182-532-750, 182-532-760, 182-532-780, 182-532-790
Description: The agency is modifying the Family Planning Only Program and Take Charge Program sections to: (1) meet clinical standards, (2) align with current eligibility and provider enrollment policies, and (3) assure compliance with the recently approved federal extension of the Washington Family Planning Only Program (Demonstration Project) granted under the authority of section 1115(a) of the Social Security Act.
Reproductive Health Services
Affected WAC: 182-532-001, 182-532--050, 182-532-100, 182-532-110, 182-532-120, 182-532-123, 182-532-125, 182-532-130, 182-532-140
FQHC and RHC - Payment Methodology (Dental to MCO)
Affected WAC: Chapter 182-548, Chapter 182-549
Description: The agency is revising chapters 182-548 and 182-549 to reflect the changes being made to chapters 182-535 and 182-535A to comply with legislation in SSB 5883, Sec. 213(1)(c) regarding dental managed care plans.
Concurrent care for hospice clients age twenty and younger
Affected WAC: 182-551-1860
Description: The agency is amending WAC 182-551-1860, Concurrent care for hospice clients age twenty and younger, to remove language related to exception to rule and allow for medical necessity review of noncovered services. These changes comply with early and periodic screening, diagnostic and treatment (EPSDT) program rules under 42 CFR, Sec. 441, Subpart B, and WAC 182-534-0100, EPSDT.
Adult palliative care
Affected WAC: 182-551-1010, 182-551-1510, 182-551-1800, 182-551-1810, 182-551-1820, 182-551-1830, 182-551-1840, 182-551-1850
Description: The agency is amending these rules to add palliative services for adults.
Home Health Services
Affected WAC: 182-551-2000, 182-551-2010, 182-551-2020, 182-551-2030, 182-551-2040, 182-551-2100, 182-551-2110, 182-551-2120, 182-551-2122, 182-551-2125, 182-551-2130, 182-551-2140, 182-551-2200, 182-551-2210, 182-551-2220
Description: The agency is amending these rules as a result of federal regulations published in February 2016 under 42 C.F.R. 440, requiring that physicians document the occurrence of a face-to-face encounter (including through the use of telemedicine) within reasonable timeframes when ordering home health services for Medicaid eligible clients. The federal regulations also clarify that home health services are not restricted to clients who are homebound or to services furnished solely in the home. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy. The agency previously filed a Preproposal Statement of Inquiry to begin rulemaking on these sections in 2016 under WSR 16-11-094. The agency withdrew the previously filed Preproposal Statement of Inquiry under WSR 18-05-031 and is rewriting the proposed rules.
Private Duty Nursing
Affected WAC: 182-551-3000, 182-551-3050, 182-551-3100, 182-551-3200, 182-551-3300, 182-551-3400
Description: The agency is revising WAC 182-551-3000 to update the definition of private duty nursing, and to clarify eligibility, provider contract, application and EPSDT information.
Preproposal (CR101) - WSR 15-24-036
Withdrawal (CR101) - WSR 17-07-079
Preproposal (CR101) - WSR 17-08-008
Proposal (CR102) - WSR 17-17-105
Supplemental (CR102) - WSR 18-02-094
Hearing date: 2/6/18
*Comments due by COB
Permanent Adoption (CR103P) - WSR 18-15-010
Home Infusion therapy and parenteral nutrition program
Affected WAC: 182-553-500
Description: The agency is revising this section to allow for coverage of continuous glucose monitoring for adults and pregnant woman who meet certain criteria. This revision aligns align with a recent coverage decision by the Health Technology Clinical Committee.