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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
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.
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.
Telemedicine - Audio Only
Affected WAC: 182-531-0100, 182-531-1730
Pending formal proposal
Filed date: 07/16/2021
Affected WAC: 182-531-0375
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.
Palliative care case management/coordination services
Affected WAC: 182-531-0965, 182-531-0970, 182-531-0975, 182-531-0980, 182-531-0985
Washington apple health – Gender affirming interventions for gender dysphoria
Affected WAC: 182-531-1675
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
Collaborative care and Alcohol and substance misuse counseling
Affected WAC: 182-531-0425, 182-531-1710
Ambulance Transport Fund - QA Fee
Affected WAC: 182-546-0125, 182-546-4700, 182-546-4725
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.
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
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.
WA Apple Health - Citizenship and immigration status (COFA)
Affected WAC: 182-503-0535
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.
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