WAC 182-501-0055 Health care coverage—How the agency determines coverage of services for its health care programs using health technology assessments.
Effective August 9, 2015
- The medicaid agency uses health technology assessments to determine whether a new technology, new indication, or existing technology approved by the Food and Drug Administration (FDA) is a covered service under agency health care programs. The agency only uses health technology assessments when coverage is not mandated by federal or state law. A health technology assessment may be conducted by or on behalf of:
- The agency reviews available evidence relevant to a medical or dental service or health care-related equipment and uses a technology evaluation matrix to:
- Determine its efficacy, effectiveness, and safety;
- Determine its impact on health outcomes;
- Identify indications for use;
- Identify potential for misuse or abuse; and
- Compare to alternative technologies to assess benefit vs. harm and cost effectiveness.
- The agency may determine the technology, device, or technology-related supply is:
- Covered (see WAC 182-501-0060 for the scope of coverage under Washington apple health (WAH) programs);
- Covered with authorization (see WAC 182-501-0165 for the process on how authorization is determined);
- Covered with limitations (see WAC 182-501-0169 for how limitations can be extended); or
- Noncovered (see WAC 182-501-0070 for noncovered services).
- The agency may periodically review existing technologies, devices, or technology-related supplies and reassign authorization requirements as necessary using the provisions in this section for new technologies, devices, or technology-related supplies.
- The agency evaluates the evidence and criteria from HTACC to determine whether a service is covered under WAC 182-501-0050 (9) and (10) and this section.