Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Wheelchairs - Powerdrive
Affected WAC: 182-543-4200
Description: The agency is clarifying the language and differences between adults and children using power-drive wheelchairs.
Affected WAC: 182-543-0500, 182-543-5700
Description: The agency is amending these sections to clarify the requirements for qualified health care providers.
DME - General reimbursement
Affected WAC: 182-543-9000, 182-543-9100, 182-543-9200, 182-543-9250, 182-543-9300, 182-543-9400
Description: The agency intends to amend Chapter 182-543 WAC to align with section 503 of the Consolidated Appropriations Act, 2016 and section 5002 of the 21st Century Cures Act of 2016, which added section 1903(i)(27) to the Social Security Act (the Act). These changes prohibit federal Medicaid reimbursement to states for certain durable medical equipment (DME) expenditures that are, in the aggregate, in excess of what Medicare would have paid for such items.
Affected WAC: 182-547-0100, 182-547-0200, 182-547-1100, 182-547-0750, 182-547-0850, 182-547-0950, 182-547-1050
Description: The agency is amending Chapter 182-547 WAC, Hearing aids, to implement E2SSB 5179 which restores coverage of hearing instruments for adults.
Durable medical equipment and related supplies, complex rehabilitation, prosthetics, orthotics, medical supplies and related services
Affected WAC: 182-543-0500, 182-543-1000, 182-543-1100, 182-543-2000, 182-543-2100, 182-543-2200, 182-543-2250, 182-543-3100, 182-543-4200, 182-543-4300, 182-543-4400, 182-543-5000, 182-543-5500, 182-543-5700, 182-543-6000, 182-543-7000, 182-543-7100, 182-543-7200, 182-543-7300, 182-543-8000, 182-543-8100, 182-543-8200
Description: The agency is reviewing and revising rules relating to durable medical equipment as a result of federal regulations published in February 2016 under 42 C.F.R., Part 440. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy. The agency previously filed a Preproposal Statement of Inquiry under WSR 16-13-009 to make changes resulting from the federal regulations and to add occupational therapists to the list of eligible prosthetic and orthotic providers. The agency completed the final rules to add occupational therapists to the list of eligible prosthetic and orthotic providers under WSR 17-15-073. This Preproposal Statement of Inquiry will address the remaining updates to Chapter 182-543 required as a result of the federal regulations.
Covered outpatient drugs and Noncovered outpatient drugs
Affected WAC: 182-530-2000, 182-530-2001
Description: The agency is removing language exceptions to prescription requirements for OTC products to promote smoking cessation. The agency is also updating language and adding products to comply with the Centers for Medicare & Medicaid Services (CMS) prescription requirements and the Apple Health Preferred Drug List (PDL).
Scope of coverage for Physician-related services; Tobacco cessation and Maternity care
Affected WAC: 182-531-0100, 182-531-1720, 182-533-0400
Description: The agency is amending these sections to update and clarify language, and to cross-reference details of coverage to the appropriate WAC sections.
Affected WAC: 182-531-1730
Description: The agency is revising WAC 182-531-1730, Telemedicine, to include renal dialysis centers to the list of originating sites for telemedicine, as allowed in SSB 5157.
Affected WAC: 182-531-1600
Description: The agency is revising WAC 182-531-1600, Bariatric surgery, to reflect coverage changes made by the Health Technology Clinical Committee.
Palliative care case management/coordination services
Affected WAC: 182-531-0965, 182-531-0970, 182-531-0975, 182-531-0980, 182-531-0985
Description: The agency is amending this chapter to add rules regarding palliative care for adults.