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Apple Health (Medicaid) rulemaking

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

Drugs purchased under the Public Health Service (PHS) Act
Affected WAC: 182-530-7900
Formally proposed
Effective: 5/1/2021
Description: The agency is revising this section to clarify that as part of participation in the 340B program, providers must agree, via an annual attestation form, that all claims for Washington Apple Health clients in both fee-for-service and managed care are subject to their respective 340B rules. The agency is amending subsection (4) to include under the Medicaid fee-for-service program.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 19-14-098
Filed: 7/2/19
Proposal (CR102) - WSR 20-02-073
Hearing date: 2/4/2020
Comments due: 2/4/2020
Proposal (CR102) - WSR 21-01-021
Hearing date: 1/26/2021
*Comments due: 1/26/2021
Permanent Adoption (CR103P) - WSR 21-08-021
Effective: 5/1/2021
Payment method for physician services-General and billing modifiers
Affected WAC: 182-531-1850
Pending formal proposal
Filed date: 07/20/2021
Description: Engrossed Substitute Senate Bill 5092, Sec. 211, (34)-(36), directs HCA to enact rate increases for behavioral health services, primary care services, and family planning services. HCA is amending WAC 182-531-1850, Payment methodology for physician-related services—General and billing modifiers, to allow for adjustment of rates as directed by the Legislature.
Agency contact:
Jason Crabbe, rule writer
360-725-9563
Preproposal (CR101) - WSR 21-15-102
Filed date: 07/20/2021
Telemedicine - Audio Only
Affected WAC: 182-531-0100, 182-531-1730
Pending formal proposal
Filed date: 07/16/2021
Description: The agency is developing and revising rules to provide for audio-only telemedicine, in alignment with ESSB 1196.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 21-15-065
Filed date: 07/16/2021
Audiology services
Affected WAC: 182-531-0375
Withdrawn
Effective: 11/12/2020
Description: Under E2SSB 5179, the agency restored coverage of hearing instruments for adults effective January 1, 2019. The agency is amending WAC 182-531-0375 to reflect the addition of adult coverage.
Agency contact:
Jason Crabbe, rule writer
360-725-9563
Preproposal (CR101) - WSR 19-16-143
Filed: 8/6/19
Withdrawal (CR101) - WSR 20-23-049
Effective: 11/12/2020
Palliative care case management/coordination services
Affected WAC: 182-531-0965, 182-531-0970, 182-531-0975, 182-531-0980, 182-531-0985
Withdrawn
Effective: 10/21/2020
Description: The agency is amending this chapter to add rules regarding palliative care for adults.
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 18-21-073
Filed: 10/11/18
Withdrawal (CR101) - WSR 20-21-103
Effective: 10/21/2020
Washington apple health – Gender affirming interventions for gender dysphoria
Affected WAC: 182-531-1675
Formally proposed
Effective: 5/6/2021
Description: The agency is revising this rule to: • Remove the list of noncovered services currently in subsection (6)(e) of this rule and clarify that requests will be evaluated for medical necessity • Remove barriers and unnecessary administrative processes for the client and provider • Streamline the authorization process
Agency contact:
Melinda Froud, rule writer
360-725-1408
Preproposal (CR101) - WSR 19-24-054
Filed: 11/26/19
Proposal (CR102) - WSR 21-01-012
Hearing Date: 1/26/2021
*Comments due by 2/9/2021
Permanent Adoption (CR103P) - WSR 21-08-058
Effective: 5/6/2021
Collaborative care and Alcohol and substance misuse counseling
Affected WAC: 182-531-0425, 182-531-1710
Expedited adoption
Filed: 7/22/2021
Description: HCA is amending these WAC sections to change "chemical dependency" to "substance use disorder".
Agency contact:
Michael Williams, rule writer
360-725-1346
Expedited Adoption (CR105) - WSR 21-16-003
Filed: 7/22/2021
Ambulance Transport Fund - QA Fee
Affected WAC: 182-546-0125, 182-546-4700, 182-546-4725
Formally proposed
Effective: 8/8/2021
Description: Rules are necessary to provide for a quality assurance fee for specified providers of emergency ambulance to be added to the base funding from all other sources supporting additional Medicaid payments to nonpublic and nonfederal providers. Additionally, a section is being added for a dedicated fund established by the treasury as the ambulance transport fund.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 20-19-013
Filed date: 9/3/2020
Proposal (CR102) - WSR 21-12-055
Hearing date: 07/06/2021
*Comments due 07/06/2021
Permanent Adoption (CR103P) - WSR 21-15-010
Effective: 8/8/2021
Ambulance Transportation
Affected WAC: 182-546-0001, 182-546-0100, 182-546-0125, 182-546-0150, 182-546-0200, 182-546-0250, 182-546-0300, 182-546-0425, 182-546-0450, 182-546-0500, 182-546-0505, 182-546-0510, 182-546-0520, 182-546-0525, 182-546-0545, 182-546-0600, 182-546-0700, 182-546-0800, 182-546-0900, 182-546-1000, 182-546-1500, 182-546-2500, 182-546-3000, 182-546-4000, 182-546-0050, 182-546-0400, 182-546-0515, 182-546-4100, 182-546-4200, 182-546-4300
Formally proposed
Effective date: 09-06-2020
Description: The agency is revising these sections to update ambulance program policies, clarify existing policies and coverage, remove outdated information, update erroneous rule citations, and perform other housekeeping fixes. The agency began this process under WSR 14-03-080, but the project was placed on hold several times to allow for other related ambulance transportation rulemakings to occur within this chapter, such as GEMT program, Ricky Garcia Act, Treat and Refer. The agency is now restarting this project and wants to make sure that our interested stakeholder list is current.
Agency contact:
Valerie Freudenstein, rule writer
360-725-1344
Preproposal (CR101) - WSR 19-16-020
Filed: 7/26/19
Proposal (CR102) - WSR 20-10-007
Hearing date: Rescheduled
Proposal (CR102) - WSR 20-11-004
Hearing date: 6/23/2020
*Comments due 6/23/2020
Permanent Adoption (CR103P) - WSR 20-17-010
Effective date: 09-06-2020
WA Apple Health - Citizenship and immigration status (COFA)
Affected WAC: 182-503-0535
Formally proposed
Effective: 10/10/2021
Description: The agency is amending this section to align with the Consolidated Appropriations Act, 2021 (Sec. 208) which restored eligibility for Medicaid benefits for individuals from the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia.
Agency contact:
Michael Williams, rule writer
360-725-1346
Preproposal (CR101) - WSR 21-07-066
Filed date: 3/26/2021
Emergency Adoption (CR103E) - WSR 21-12-078
Effective date: 06/01/2021 - 07/21/2021
Emergency Adoption (CR103E) - WSR 21-16-004
Effective: 07/22/2021 - 09/18/2021
Proposal (CR102) - WSR 21-16-065
Hearing date: 09/072021
*Comments due 09/07/2021
Permanent Adoption (CR103P) - WSR 21-19-029
Effective: 10/10/2021