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Apple Health (Medicaid) rulemaking

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

Hospital services
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
Formally proposed
Effective: 08/21/2021
Description: HCA is amending these sections to fix outdated behavioral health references and terminology, to update references to correct state agencies, and other minor housekeeping changes.
Agency contact:
Michael Williams, rule writer
360-725-1346
Expedited Adoption (CR105) - WSR 21-11-081
Filed date: 05/18/2021
Permanent Adoption (CR103P) - WSR 21-15-128
Effective: 08/21/2021
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Description: The agency is amending this section to replace outdated terms such as “Residential Support Network (RSN)” and “mental health designee,” to delete references to the department of mental health, and to update language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.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 20-21-106
Filed date: 10/21/2020
Rebasing
Affected WAC: 182-550-3800
Formally proposed
Effective: 2/6/2021
Description: This rule is being amended to increase psychiatric per diem rates for community hospitals that serve patients in long-term inpatient psychiatric care.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 20-18-097
Filed date: 9/2/2020
Proposal (CR102) - WSR 20-24-116
Hearing Date: 1/5/2021
*Comments due by 1/5/2021
Permanent Adoption (CR103P) - WSR 21-02-087
Effective: 2/6/2021
Managed care choice and assignment
Affected WAC: 182-538-060, 182-538-067
Formally proposed
Effective: 10/25/2020
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.
Agency contact:
Brian Jensen, rule writer
360-725-0815
Emergency Adoption (CR103E) - WSR 20-09-113
Effective:4/16/2020-8/11/2020
Preproposal (CR101) - WSR 20-14-056
Filed date: 6/26/2020
Emergency Adoption (CR103E) - WSR 20-17-058
Effective: 8/12/2020-10/24/2020
Proposal (CR102) - WSR 20-17-122
Hearing Date: 09/22/2020
*Comments due by: 09/22/2020
Permanent Adoption (CR103P) - WSR 20-20-011
Effective: 10/25/2020
Proof of delivery
Affected WAC: 182-543-2200
Formally proposed
Effective: 05/29/2021
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.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Emergency Adoption (CR103E) - WSR 20-08-025
3/20/2020-7/15/2020
Emergency Adoption (CR103E) - WSR 20-15-107
7/16/2020-11/09/2020
Emergency Adoption (CR103E) - WSR 20-23-038
11/10/2020-03/08/2021
Preproposal (CR101) - WSR 20-24-086
Filed: 11/25/2020
Proposal (CR102) - WSR 21-06-114
Withdrawal (CR102) - WSR 21-07-006
Effective: 3/4/2021
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
Effective: 05/29/2021
Covered - Positioning devices
Affected WAC: 182-543-3200
Formally proposed
Effective: 8/14/2020
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.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 20-03-094
Filed: 1/13/2020
Proposal (CR102) - WSR 20-12-068
Virtual hearing date: 7/7/2020
*Comments due 7/7/2020
Permanent Adoption (CR103P) - WSR 20-15-072
Effective: 8/14/2020
Medicaid preferred drug list
Affected WAC: 182-530-3000, 182-530-3100, 182-530-3200, 182-530-4000, 182-530-4100
Withdrawn
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 20-15-035
Filed date: 7/7/2020
Withdrawal (CR101) - WSR 20-17-134
Filed Date: 08/18/2020
Prescription Monitoring Program (Support Act)
Affected WAC: 182-530-1080
Formally proposed
Effective: 10/01/2021
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 20-11-040
Filed date: 5/14/2020
Proposal (CR102) - WSR 21-06-097
Hearing date: 4/6/2021
*Comments due 4/6/2021
Permanent Adoption (CR103P) - WSR 21-13-099
Effective: 10/01/2021
Covered OP drugs, devices, and drug-related supplies
Affected WAC: 182-530-2000, 182-530-2100
Formally proposed
Effective: 1/23/21
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Emergency Adoption (CR103E) - WSR 20-08-118
Effective: 3/31/2020-7/27/2020
Preproposal (CR101) - WSR 20-15-034
Filed date: 7/7/2020
Emergency Adoption (CR103E) - WSR 20-16-048
Effective: 7/28/2020-11/22/2020
Emergency Adoption (CR103E) - WSR 20-24-049
Effective: 11/23/2020-3/23/2021
Proposal (CR102) - WSR 20-23-121
Hearing Date: 12/22/2020
*Comments due by: 12/22/2020
Permanent Adoption (CR103P) - WSR 21-02-004
Effective: 1/23/21
Billing Requirements - pharmacy claim payment
Affected WAC: 182-530-5000
Formally proposed
Effective: 3/14/2021
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.
Agency contact:
Melinda Froud, rule writer
360-725-1408
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
Effective: 7/28/2020-11/22/2020
Emergency Adoption (CR103E) - WSR 20-24-048
Effective: 11/23/2020-3/23/2021
Proposal (CR102) - WSR 21-02-072
Hearing date: 2/9/2021
*Comments due by 2/9/2021
Permanent Adoption (CR103P) - WSR 21-05-043
Effective: 3/14/2021