Apple Health (Medicaid) rulemaking

HCA is amending these rules to add the following provider types: Certified Peer Specialist, Certified Peer Specialist Trainee, and Psychological Associate.

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.

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.