Apple Health (Medicaid) rulemaking

The agency is revising this rule in accordance with the Settlement Agreement in the case of National Association
of Chain Drug Stores, et al., v. Washington State Health Care Authority, et al. (Case No. 51489-3-II) and for the
purpose of ensuring the continuation of federal Medicaid funding.

HCA is amending these rules to add clarity and provide more detail on program requirements for how fee-for-service drugs must be billed to HCA for providers that are subject to the 340B program requirements.

The agency is amending this rule to clarify that signature for proof of delivery can be provided by either the client, the client’s designee, or the provider. Currently the rule does not include the “client’s designee.” This revision will bring the rule in alignment with HCA’s current practice.

The agency intends to amend this rule to reflect current standards of care.

HCA is expanding the age limit for the enhancement rate for pediatric care services and the administration of vaccines provided to clients from age 18 and younger to age 20 and younger.

The agency is amending these rules to align with Section 11405 of the Inflation Reduction Act (Pub. L. 117-169), which requires states to cover approved adult vaccines recommended by the Advisory Committee on Immunization Practices.

HCA is amending WAC 182-531-1400 (6) to update the requirements in subsection (6)(a) with a cross-reference to WAC 182-538D-0200 and to align requirements for professionals treating children with RCW 71.34.020 and WAC 182-538D-0200.

HCA is amending this rule to explain how HCA updates the state-only composite rate and to clarify language throughout.

The agency is removing the outdated clinical criteria for coverage of oxygen and is also revising other criteria. The clinical criteria in the current rules are more restrictive than Medicare’s current clinical criteria, which causes providers to request prior authorization more frequently than necessary. Under this rulemaking, the agency plans to align the rules with Medicare’s current requirements.