Apple Health (Medicaid) rulemaking

The agency is amending these rules to allow for the payment of services under the Apple Health program by certified anesthesiologist assistants (CAA), as established in Chapter 18.71D RCW and adds other clarification about providers of anesthesia services.
The proposed rules:
• Add qualified dentists or oral surgeons and certified anesthesiologist assistants to the list of qualified anesthesiologist providers eligible for reimbursement
• Replace the “department” with “medicaid agency” or “agency”
• Relocate anesthesia reimbursement provisions from section 182-551-0300 to section 182-551-0350
• Update the source of the base anesthesia units (BAU) values
• Include the calculation of allowed anesthesia charges for more than one procedure and for add-on procedures
• Clarify that the agency does not reimburse attending surgeon for anesthesia services
• Describe reimbursement for multiple anesthesia providers present on a case and for anesthesia provided by a team

The agency is revising these rules to change the title of the rule section to Enhanced reimbursement – medication for opioid use disorder (MOUD). The agency is also revising the section to clarify the requirements for receiving the enhanced reimbursement for MOUD.

The agency is revising these sections to add behavioral support specialists as an eligible provider type and add behavioral health support specialist definition to align with the state plan definition.

The agency is revising these rules to remove the requirement that physician assistants work under the supervision of a physician. This change aligns with ESHB 2041 which authorizes physician assistants to enter into collaborative agreements with physicians to provide team-based care and enhance access to health care for people in Washington state.

HCA is reviewing these rules to evaluate their alignment with current billing practices.

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 WAC 182-552-0400 to update medical necessity criteria based on evidence reviews.

The agency is amending WAC 182-545-200 to expand payment criteria for occupational therapy.

In response to SB 5228, Section 2, Chapter 113, Laws of 2023, HCA is amending WAC 182-545-200 to state that HCA pays for outpatient rehabilitation services provided to eligible clients when provided by licensed or certified behavioral health agencies as part of a mental health or substance use disorder treatment program. HCA is also amending this rule to add separate limits for clients needing occupational therapy to treat behavioral health conditions.