DSHS and HCA forms, WACs, rule-making, and useful LTC links
Revised date
Forms
WACs and rulemaking
- Title 388 of Washington Administrative Code (WAC): Department of Social and Health Services (DSHS) Code reviser
- Title 182 of Washington Administrative Code (WAC): Health Care Authority (HCA) Code reviser
- Health Care Authority (HCA) WAC rules index
- DSHS Rules and Policies Assistance Unit (Title 388)
- Health Care Authority (HCA) recent Medicaid rule filings. (Title 182)
Aging and long-term supports
- Aging and Long-Term Supports Administration
- Home and Community Services (HCS) APS, Area Agencies on Aging (AAA) caregiver and provider resources, locate by county
- Residential Care Services (RCS) nursing home or assisted living complaints. 800-562-6078 or cru@dshs.wa.gov
- Residential Care Services (RCS): information on adult family home, assisted living, and nursing home providers
- Intake phone numbers for Home and Community Services (request for HCS services, in-home care, care in a residential setting, or nursing facility coverage) are found in Applications for long term services and supports (LTSS).
For more information on who does what LTSS program, see Overview - Long-term Services and Supports chart.
CSD/ESA contact numbers
- Community Service Division
- CSD Statewide Call Center 877-501-2233
- CSD specialty Provider Line (spend down) 800-394-4571
- CSD Fax line for clients and stakeholders 888-338-7410
Resources for LTSS staff
- Health Care Authority (HCA): main Medicaid agency
- Washington Health Benefit Exchange: oversees and manages the health care application website:
- Washington Healthplanfinder: used to apply for health care coverage
- Eligibility overview: HCA descriptions of medical programs (including medical standards)
Medical assistance coverage
- Scope of care
- Eligibility Overview (medical assistance booklet)
- Medication coverage lists including over the counter items
- Pharmacy information
- Wheelchairs, DME, and supplies
- Transportation services
- Prosthetic and orthotic devices
- Home infusion services
Medical assistance administrative hearing rules
Managed care, TPL, and long-term care insurance information
Nursing facility (NF) billing guides
- Nursing Facility Provider Billing Guide
- ProviderOne Billing and Resource Guide (includes provider notices)
Help desk and online services
- Washington State Medicaid Customer Service (toll-free number and email link for customers and providers, use this link to order a replacement medical service card)
- Washington State Medicaid P1 find a provider
Smarter track mailbox for internal ProviderOne manual updates
When to use MMIS Help
Situation: Client is discharged from a NF and cannot get a prescription filled because of the coding. We need to email MMIS Help when needing a manual fix in the system. This includes when we correct an incorrect date of death in ACES. Once the case is closed in ACES, any fix must be manually sent over to HCA to match ACES data.
Medicare buy-in issues
- Field staff use Barcode tickler 102@MBU
- For clients, contact the Medicaid Customer Service Center 800-562-3022
Federal Medicaid, Medicare, Social Security, and Railroad Retirement
- Centers for Medicare & Medicaid Services (CMS): Health and Human Services (HHS) portal to Medicare and Medicaid information
- Medicaid.gov
- Spousal Impoverishment including standards and post eligibility from Medicaid.gov
- Third Party Liability and Coordination of Benefits from Medicaid.gov
- SSA's Program Operations Manual System (POMS) (Federal site for policy on SSI related programs
- Railroad Retirement 877-772-5772
- Social Security Act
- Social Security Online
- Code of Federal Regulations (CFR)
- Medicare - Official U.S. Government Site for Medicare
Washington LawHelp, Ombudsman, RCS complaint line, SHIBA
- Long-term care assistance (Estate Recovery, COPES, in-home care, Nursing Facility Medicaid overview from Washington LawHelp
- Effect of marital separation on Medicaid eligibility from Washington LawHelp
- LTC Ombudsman Program 800-562-6028
- Statewide Health Insurance Benefits Advisors (SHIBA) Helpline (assistance with Medical insurance including Medicare D plans)