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Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Affected WAC: 182-550-1050, 182-550-1100, 182-550-1400, 182-550-2650, 182-550-3000, 182-550-2400, 182-550-4300, 182-550-4400
Description: HCA is amending these sections to fix outdated behavioral health references and terminology, to update references to correct state agencies, and other minor housekeeping changes.
Inpatient Psychiatric Services
Affected WAC: 182-550-2600
Pending formal proposal
Filed date: 10/21/2020
Description: The agency is amending this section to replace outdated terms such as “Residential Support Network (RSN)” and “mental health designee,” to delete references to the department of mental health, and to update language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.
Affected WAC: 182-550-3800
Description: This rule is being amended to increase psychiatric per diem rates for community hospitals that serve patients in long-term inpatient psychiatric care.
Managed care choice and assignment
Affected WAC: 182-538-060, 182-538-067
Description: The Health Care Authority (HCA) is amending WAC 182-538-060 and 182-538-067 on an emergency basis in response to the COVID-19 public health emergency. The purpose of these amendments is to help ensure (1) the viability of Apple Health Integrated Managed Care (IMC) plans; (2) adequate performance by the IMC plans; (3) sufficient access to care for Medicaid clients in IMC; and (4) the continued availability of an adequate network of physical and behavioral health providers in IMC plans. Because of COVID-19, the state is experiencing an unprecedented increase in unemployment and a commensurate increase in applications for enrollment in Medicaid. As part of managing this situation, HCA is amending WAC 182-538-060 to limit the auto-assignments of Medicaid clients to IMC plans. In particular, HCA will prevent auto-assignments of new clients to any plan that has a statewide market share of greater than 40% in Apple Health IMC. This rule does not affect voluntary plan choices by clients, the Family Connect policy, or the Plan Reconnect policy. In addition, HCA is amending WAC 182-538-067 to clarify when the agency will adjust the number of its IMC plans, either overall or on a region-to-region basis. In determining whether to make any such adjustment, HCA will consider statutory requirements as well as enrollment needs, the performance of the plans with respect to behavioral health integration, and the promotion of access to care for behavioral health services.
Emergency Adoption (CR103E) - WSR 20-09-113
Preproposal (CR101) - WSR 20-14-056
Filed date: 6/26/2020
Emergency Adoption (CR103E) - WSR 20-17-058
Proposal (CR102) - WSR 20-17-122
Hearing Date: 09/22/2020
*Comments due by: 09/22/2020
Permanent Adoption (CR103P) - WSR 20-20-011
Proof of delivery
Affected WAC: 182-543-2200
Description: The Health Care Authority is revising this section to temporarily eliminate the requirement for date and signature from the Medicaid client or the client’s designee upon delivery of medical equipment and supplies.
Emergency Adoption (CR103E) - WSR 20-08-025
Emergency Adoption (CR103E) - WSR 20-15-107
Emergency Adoption (CR103E) - WSR 20-23-038
Preproposal (CR101) - WSR 20-24-086
Proposal (CR102) - WSR 21-06-114
Withdrawal (CR102) - WSR 21-07-006
Emergency Adoption (CR103E) - WSR 21-07-032
Effective: 03/09/2021 - 07/07/2021
Proposal (CR102) - WSR 21-07-012
Hearing date: 4/27/2021
*Comments due 4/27/2021
Permanent Adoption (CR103P) - WSR 21-10-050
Covered - Positioning devices
Affected WAC: 182-543-3200
Description: The agency is amending this section to (1) reflect new standing frame coverage policy for children age 20 and younger; and (2) align with recent updates to RCW 46.61.687, regarding child restraint system requirements.
Medicaid preferred drug list
Affected WAC: 182-530-3000, 182-530-3100, 182-530-3200, 182-530-4000, 182-530-4100
Filed Date: 08/18/2020
Description: The agency is amending these rules to reflect necessary changes resulting from the implementation of the Apple Health preferred drug list.
Prescription Monitoring Program (Support Act)
Affected WAC: 182-530-1080
Description: The agency intends to establish rules regarding provider use of the qualified prescription drug monitoring program, as required by Section 5042 of the SUPPORT for Patients and Communities Act (Public Law 115-271), prior to prescribing or dispensing scheduled drugs.
Covered OP drugs, devices, and drug-related supplies
Affected WAC: 182-530-2000, 182-530-2100
Description: The agency is replacing the list of covered generic products for the treatment of cough and cold. Under the amended rule, the agency instead covers only those products with a preferred status on the Medicaid preferred drug list (PDL) on the date a prescription is dispensed.
Emergency Adoption (CR103E) - WSR 20-08-118
Preproposal (CR101) - WSR 20-15-034
Filed date: 7/7/2020
Emergency Adoption (CR103E) - WSR 20-16-048
Emergency Adoption (CR103E) - WSR 20-24-049
Proposal (CR102) - WSR 20-23-121
Hearing Date: 12/22/2020
*Comments due by: 12/22/2020
Permanent Adoption (CR103P) - WSR 21-02-004
Billing Requirements - pharmacy claim payment
Affected WAC: 182-530-5000
Description: The agency is amending this rule to revise the signature requirement for pharmacy products dispensed and delivered directly to a Medicaid client or their provider’s office. The proposed rule requires either the client or the provider to sign for delivered products. The new signature requirement ensures proof of delivery for prescriptions sent to a provider’s office, which decreases the potential for Medicaid fraud and duplicate billing.
Emergency Adoption (CR103E) - WSR 20-08-106
Effective: 3/31/2020 - 7/27/2020
Preproposal (CR101) - WSR 20-15-036
Filed date: 7/7/2020
Emergency Adoption (CR103E) - WSR 20-16-049
Emergency Adoption (CR103E) - WSR 20-24-048
Proposal (CR102) - WSR 21-02-072
Hearing date: 2/9/2021
*Comments due by 2/9/2021
Permanent Adoption (CR103P) - WSR 21-05-043