Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
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.
Affected WAC: 182-550-2590, 182-550-2600, 182-550-2900, 182-550-4550
Description: The agency is amending these rules to clarify that pharmacy and pharmacy services may be billed when a client is admitted under administrative status for inpatient hospital stays.
Provider Preventable conditions (PPC) - Payment policy
Affected WAC: 182-502-0022
Description: Correcting where hospitals must report other provider preventable condition (OPPC) associated with an established Medicaid client in subsection (6)(d)(i), and correcting a web address in . Also correcting a bad web address in subsection (6)(d)(ii).
Bariatric Surgery Rates
Affected WAC: 182-550-3000, 182-550-3470, 182-550-4400, 182-550-4800
Description: The agency is modifying these sections to remove the bariatric fixed case rate. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy.
Affected WAC: 182-550-2900, 182-550-2950
Description: The agency is amending this chapter to include a section that describes the parameters for the 14-day potentially preventable readmissions.
Hospital payments - Diagnosis-related group (DRG)
Affected WAC: 182-550-3600, 182-550-3700, 182-550-3800, 182-550-4800
Description: The agency is amending these rules to align with Medicare changes to outlier transfer pricing and to reflect changes to the rebasing process and inpatient and outpatient payment methodologies.
Inpatient Hospital 14 day readmits
Affected WAC: 182-550-2900, 182-550-3000, 182-550-3840
Description: The agency is repealing WAC 182-550-3840 and reinserting previous rule language regarding 14-day readmissions into WAC 182-550-2900 and 182-550-3000. The agency is making these changes because it has determined that restoring the 14-day readmission rule is the most clinically sound and cost-effective approach to managing readmissions.
Inpatient Psychiatric Services
Affected WAC: 182-550-2600
Description: The agency is amending this rule to bring it into compliance with federal regulations, and to update and clarify policy regarding authorization of inpatient behavioral health services. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy.
Fully integrated managed care and choice
Affected WAC: 182-538A-060, 182-538A-130
Description: The agency is revising WAC 182-538A-060, Fully integrated managed care and choice, to remove language indicating that enrollment in a behavioral health services only (BHSO) managed care organization (MCO) is mandatory for American Indian and Alaska native (AI/AN) clients and their descendants.
Affected WAC: Chapter 182-538
Description: The agency is revising this chapter to reflect recent legislative requirements under SSB 5883 to contract with licensed dental health plans or managed health care plans to provide managed dental care services on a statewide basis.