Apple Health (Medicaid) rulemaking

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.

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.

The agency is amending chapter 182-526 WAC to update its regulations related to the service of a petition for judicial review.

The agency is revising this section to (1) add psychiatric mental health nurse practitioners as a diagnosing and prescribing provider for ABA; (2) clarify that the providers listed in subsection (4)(a) may require additional COE training for diagnosing and prescribing ABA for adults age 21 and over; and (3) clarify that providers in subsection (3)(a)(ii), (v), and (vi) do not require COE training for diagnosing/ prescribing ABA for children age 20 and younger or adults age 21 and over.

Engrossed Substitute Senate Bill 5291 (Chapter 380, Laws of 2025) was signed into law on May 20, 2025. The bill created a new chapter 212 under Title 48 RCW concerning supplemental long-term care insurance. Supplemental long-term care insurance is a new product designed to provide coverage once WA Cares benefits under chapter 50B.04 RCW have been exhausted. The Office of the Insurance Commissioner (OIC) added a new chapter 212 to Title 284 WAC (WSR 26-05-001) to implement the new law and to ensure all affected parties understand their rights and obligations. The Health Care Authority is amending its long-term care partnership rules to add a cross-reference to the new OIC rules.

The agency is amending its rules so that home equity limits do not apply to applicants receiving services through a nursing facility level of care determination unless the client is applying for institutional or home and community based waiver programs. The agency is also amending WAC 182-513-1250 to update the circumstances under which a client is not eligible for community first choice services.

The agency is amending the spousal impoverishment rule (WAC 182-513-1660) to update the tailored supports for older adults (TSOA) resource standard. The agency changed the TSOA resource standard effective October 9, 2023, by amending WAC 182-513-1640 under WSR 23-19-014, but neglected to update WAC 182-513-1660 at that time.