Apple Health (Medicaid) rulemaking

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.

The agency amended WAC 182-543-5700 to correct the number for a form titled Medical Necessity for Wheelchair
Purchase for Nursing Facility Clients. The correct form number is HCA 19-0006.

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 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 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.

The Health Care Authority (HCA) is updating the types of professionals and organizations that may provide health care services to eligible clients. HCA is making the following amendments in connection with several separate rulemaking actions:
1) Adding independent diagnostic testing facilities to subsection (2)(v) (WSR 25-05-044)
2) Adding anesthesiologist assistants to subsection (1)(d) (WSR 24-24-108)
3) Adding and expanding certified peer counselors to subsection (1)(i) (WSR 25-02-110); this replaces the reference to peer counselors currently in subsection (1)(yy)(ii)
4) Removing early and periodic screening, diagnosis, and treatment (EPSDT) clinics from subsection (2)(m) (WSR 25-02-069)
5) Adding dental therapists to subsection (1)(q) (WSR 25-06-041)
This rule also adds community health workers to subsection (1)(m). The public hearing on that amendment was held on February 25, 2025 (25-03-102 WSR).

HCA is amending these rules to align them with current policies and practices.

The agency is revising this section to update language in subsection (3)(d) allowing the agency to adjust fees using market research as necessary to align with other reimbursement WACs and the state plan amendment.