Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
Physician's Definitions & Enhanced Reimbursement - Medication assisted treatment (MAT)
Affected WAC: 182-531-0050, 182-531-2040
Description: The Washington State legislature provided funding to increase the Medication Assisted Treatment (MAT) rate for opioid use disorder to match the Medicare rate in order to encourage more providers to treat patients with opioid use disorder. This represents an exception to current payment methodology and needs to be described in the administrative code.
Preproposal (CR101) - WSR 18-14-112
Emergency Adoption (CR103E) - WSR 18-20-041
Effective: 10/1/2018 - 1/20/19
Emergency Adoption (CR103E) - WSR 19-03-136
Effective: 1/21/19 - 5/21/19
Proposal (CR102) - WSR 19-06-079
Hearing date: 4/9/19
*Comments due by 4/9/19
Permanent Adoption (CR103P) - WSR 19-09-052
Physician-related services requiring prior authorization
Affected WAC: 182-531-0200
Description: The agency is amending this WAC to remove the reference to consent forms and replace with “written acknowledgement.” This amendment will align WAC 182-531-0200 with 42 CFR 441.255(c), WAC 182-531-0050, RCW 7.70.060, and RCW 7.70.065.
Gender dysphoria treatment program
Affected WAC: 182-531-1675
Description: In 2017, the agency began rulemaking on WAC 182-531-1675 filed under WSR 17-05-084 and held a public hearing on the proposed rules on June 27, 2017 (filed under WSR 17-11-140). After the reviewing the comments received at the public hearing, the agency reevaluated the project and has decided to make substantial changes and restart the rulemaking from the beginning.
Primary Care Rate Increase
Affected WAC: 182-531-2030
Description: To comply with ESSB 6032, rulemaking is necessary to allow for an increase in rates for pediatric care services and vaccines.
Scope of services physician & noncovered services (Vaccines)
Affected WAC: 182-531-0100
Description: The agency is revising these sections to clarify which vaccines the agency covers. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy
Affected WAC: 182-531-0425
Description: As authorized in Substitute Senate Bill 5883, the agency is creating rules for a new model of care called Collaborative Care Model which is part of the integration of mental health and physical health.
Preproposal (CR101) - WSR 18-02-089
Emergency Adoption (CR103E) - WSR 18-08-017
Emergency Adoption (CR103E) - WSR 18-16-007
Emergency Adoption (CR103E) - WSR 18-23-069
Effective: 11/16/18 - 3/14/19
Proposal (CR102) - WSR 19-06-083
Hearing date: 4/9/19
Comments due by 4/9/19
Emergency Adoption (CR103E) - WSR 19-07-049
Effective: 3/15/19 - 7/13/19
Permanent Adoption (CR103P) - WSR 19-13-022
Affected WAC: 182-531-1500
Description: The agency is amending this rule to revise the requirements for a sleep center to become an agency-approved center of excellence (COE). The agency plans to reduce the number of documents that must be submitted for each sleep center. The agency will instead use the sleep center’s certification by the American Academy of Sleep Medicine (AASM), which requires the same documentation as listed in the current rule.
Respiratory care - reimbursement
Affected WAC: 182-552-0001, 182-552-1400, 182-552-1600
Description: The agency is amending these rules 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.
Mandibular advancement device
Affected WAC: 182-552-0450
Description: The agency is adding coverage limits for mandibular advancement devices.
Affected WAC: 182-552-1000
Description: The agency is revising this section to (1) clarify the clinical criteria for the rental of a backup ventilator; (2) revise the authorization requirements for ventilators; and (3) remove the outdated clinical criteria for ventilators for clients 17 years of age and younger.