Apple Health (Medicaid) rulemaking
This page includes all of the current rule making activity for Washington Apple Health (Medicaid)
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.
Wheelchairs - Powerdrive
Affected WAC: 182-543-4200
Description: The agency is clarifying the language and differences between adults and children using power-drive wheelchairs.
Affected WAC: 182-543-0500, 182-543-5700
Description: The agency is amending these sections to clarify the requirements for qualified health care providers.
DME - General reimbursement
Affected WAC: 182-543-9000, 182-543-9100, 182-543-9200, 182-543-9250, 182-543-9300, 182-543-9400
Description: The agency intends to amend Chapter 182-543 WAC 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 (the Act). These changes prohibit federal Medicaid reimbursement to states for certain durable medical equipment (DME) expenditures that are, in the aggregate, in excess of what Medicare would have paid for such items.
Affected WAC: 182-547-0100, 182-547-0200, 182-547-0700, 182-547-0750, 182-547-0800, 182-547-0850, 182-547-0900, 182-547-0950, 182-547-1000, 182-547-1050, 182-547-1100
Description: The agency is amending Chapter 182-547 WAC, Hearing aids, to implement E2SSB 5179 which restores coverage of hearing instruments for adults.
Preproposal (CR101) - WSR 18-09-021
Emergency Adoption (CR103E) - WSR 19-02-010
Effective: 1/1/19 - 4/18/19
Emergency Adoption (CR103E) - WSR 19-10-010
Proposal (CR102) - WSR 19-14-123
Hearing date: 8/6/19
*Comments due 8/6/19
Emergency Adoption (CR103E) - WSR 19-17-044
Durable medical equipment and related supplies, complex rehabilitation, prosthetics, orthotics, medical supplies and related services
Affected WAC: 182-543-0500, 182-543-1000, 182-543-1100, 182-543-2000, 182-543-2100, 182-543-2200, 182-543-2250, 182-543-3100, 182-543-4200, 182-543-4300, 182-543-4400, 182-543-5000, 182-543-5500, 182-543-5700, 182-543-6000, 182-543-7000, 182-543-7100, 182-543-7200, 182-543-7300, 182-543-8000, 182-543-8100, 182-543-8200
Description: The agency is reviewing and revising rules relating to durable medical equipment as a result of federal regulations published in February 2016 under 42 C.F.R., Part 440. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy. The agency previously filed a Preproposal Statement of Inquiry under WSR 16-13-009 to make changes resulting from the federal regulations and to add occupational therapists to the list of eligible prosthetic and orthotic providers. The agency completed the final rules to add occupational therapists to the list of eligible prosthetic and orthotic providers under WSR 17-15-073. This Preproposal Statement of Inquiry will address the remaining updates to Chapter 182-543 required as a result of the federal regulations.
Public Health Services (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 that all claims for Washington Apple Health clients in fee-for-service and managed care are subject to 340B rules.
Covered outpatient drugs and Noncovered outpatient drugs
Affected WAC: 182-530-2000, 182-530-2100
Description: The agency is removing language exceptions to prescription requirements for OTC products to promote smoking cessation. The agency is also updating language and adding products to comply with the Centers for Medicare & Medicaid Services (CMS) prescription requirements and the Apple Health Preferred Drug List (PDL).
Scope of coverage for Physician-related services; Tobacco cessation and Maternity care
Affected WAC: 182-531-0100, 182-531-1720, 182-533-0400
Description: The agency is amending these sections to update and clarify language, and to cross-reference details of coverage to the appropriate WAC sections.
Affected WAC: 182-531-1730
Description: The agency is revising WAC 182-531-1730, Telemedicine, to include renal dialysis centers to the list of originating sites for telemedicine, as allowed in SSB 5157.