Apple Health (Medicaid) rulemaking

The agency is amending WAC 182-543-2000 to amend the medical equipment and supplies provider requirements.

HCA is amending this rule to clarify requirements for proof of delivery of all medical equipment and supplies.

The agency is amending WAC 182-543-3300. Rule updates will include updated medical necessity criteria based on evidence review(s).

The agency is amending this rule to update medical equipment, supplies, & appliances definitions to align with industry standard.

HCA is amending these rules to change the medical necessity criteria for hospital beds and to clarify the process for submitting prior authorization requests to HCA.

HCA is removing all instances of “automated maximum allowable cost” and “AMAC” from WAC 182-530-7150 and repealing WAC 182-530-8150. HCA is no longer using AMAC as a reimbursement method.

HCA is repealing WAC 182-531-1250, physician standby services, and is amending WAC 182-533-0400, maternity care and newborn delivery, to remove references to physician standby services. HCA is amending WAC 182-531-0150, noncovered physician-related and health care professional services—general and administrative, to add physician standby services.

HCA is amending these rules to add the following provider types: Certified Peer Specialist, Certified Peer Specialist Trainee, and Psychological Associate.

The agency is amending WAC 182-531-1850 to allow for exceptions to the general rule that the agency does not make separate reimbursement for Centers for Medicare and Medicaid Services bundled services.

The agency is revising this section to add behavior health support specialists as a provider part of the collaborative care team.