Apple Health (Medicaid) rulemaking

The agency is proposing to add speech language pathology assistants (SLPAs), physical therapy assistants (PTAs), occupational therapy assistants (OTAs), and rural emergency hospitals (REHs) to the list of eligible providers in WAC 182-502-0002. OTA’s and PTA’s are already listed in WAC 182-545-200, but for consistency, the agency is also adding these providers to the general eligible provider list in WAC 182-502-0002. The agency will also be adding SLPAs to the list of providers who may enroll with the agency under WAC 182-545-200.

The agency is amending these rules to comply with CMS-0057-F: Advancing Interoperability and Improving Prior Authorization. CMS-0057-F updates the turnaround times for standard requests from no later than 15 days to no later than 7 days, and no later than 72 hours for expedited/urgent requests.

The agency is amending this rule to make necessary corrections to the table of service categories.

HCA is revising WAC 182-502-0030 to clarify its authority to terminate a provider’s enrollment with HCA and to clarify the impacts of terminations for cause to include any associated providers according to 42 CFR Part 455. HCA is revising WAC 182-502-0040 to clarify that termination for convenience is the final agency action.

The agency is amending WAC 182-501-0100 to reflect the 2011 change in authority for overseeing the Medicaid program from the Washington State Department of Social and Health Services (DSHS) to the Health Care Authority (HCA). Currently, the rule references only the DSHS lien statutes. This amendment will add reference to the HCA lien statutes. Both HCA and DSHS use liens for subrogation purposes.

The agency is revising these rules to provide more clarity on the business license requirement to become a medicaid enrolled provider.

This rule clarifies the pathway for clients to address concerns about provider care through the licensing, certification, or survey organization (e.g., Department of Health, Department of Social and Health Services’ Residential Care Services).

The agency is amending the rule to add to the factors an administrative law judge is to consider when determining whether to grant a hearing continuance and to add expectations regarding the timing of the administrative law judge’s initial decision.

This rule will clarify that the agency offers an administrative hearing only when authorized by statute or rule. This rule is needed to clarify the agency’s subject matter jurisdiction of a resident’s appeals related to transfer or discharge from an adult family home, assisted living facility, or enhanced services facilities. Under RCW 34.05.413, the agency is required to offer administrative hearing only when required by law. Because no law requires a hearing right for other facility types, the agency is issuing this rule to clarify when there is a right to an administrative hearing.

The agency is amending its administrative hearing rules to clarify the role of HCA presiding officers and to clarify contact information for, and the role of, the office of administrative hearings.