Description
The agency intends to amend existing rules and develop new rules to implement the remaining requirements in RCW 71.24.920 related to certified peer specialists.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 25-05-099
  • Hearing Date: 3/25/2025
  • Registration is required to attend the public hearing.
    View the rulemaking's CR102 for the registration link.
  • Comments due by 3/25/2025

Permanent Adoption (CR103P)

2025 State Plan Amendments

The State Plan is the officially recognized statement describing the nature and scope of Washington State's Medicaid program.

Title SPA packet number Date approved
Certified Peer Specialists 25-0001 04/30/2025
Pre-release Reentry Services for Juveniles 25-0003-A 06/03/2025
Reentry Services for Juveniles 25-0003-B 06/25/2025
Reentry Services 25-0003 06/24/2025
Physician Services Updates 25-0005 09/05/2025
Dental Therapists 25-0006 05/28/2025
January 2025 Fee Schedule Updates 25-0007 04/23/2025
Alternative Benefits Package 25-0008 07/02/2025
Add Psychological Associates and Rename Certified Peer Specialists and Trainees 25-0010 11/3/2025
HCBS Rates 25-0011 04/20/2025
Update Inpatient DRG LARC Payment 25-0012 06/26/2025
Managed Care Reentry Services 25-0013 07/21/2025
April 2025 Fee Schedule Updates 25-0014 08/18/2025
Clinic Benefits Update 25-0015 06/13/2025
Remove Ancillary Services From Admin Day Rate 25-0017 10/30/2025
MAT-MOUD Updates 25-0018 01/08/2026
July 2025 Fee Schedule Updates 25-0020 11/25/2025
Recovery Audit Contractors 25-0021 11/21/2025
Nursing Facility Rates 25-0022 12/15/2025
HCBS-Personal Care Services Rates 25-0023 12/1/2025
State Psychiatric Facilities-Hospitals For Youth 25-0024 03/20/2026
Outpatient Actual Acquisition Cost Pharmaceuticals 25-0027 03/12/2026
Hospital Outlier Threshold Amount 25-0030 03/10/2026
Transplant Payments 25-0031 03/13/2026
Certified Public Expenditures Protocol Updates 25-0032 03/12/2026
Disaster Relief (Flooding) 25-0033 03/24/2026

Provider Alerts 2025

Emails relevant to rules, Medicaid provider guides, and policies.

Date Provider Alert
01/09/2025 MES and CRT – removal of prior authorization for certain HCPCS codes
01/21/2025 Applied Behavior Analysis (ABA) billing guide updates – Effective February 1, 2025
01/28/2025 Enhanced payments for trauma care
01/29/2025 Home Health providers – Electronic Visit Verification (EVV) update
02/19/2025 Kidney Center Services Billing Guide, Effective 02/19/2025
02/28/2025 Birth doula billing guide updates eff. February 28, 2025
02/28/2025 Physicians billing guide updates
03/10/2025 New taxonomies for licensed mental health associates
03/20/2025 Quarterly Billing Guide Updates, Effective 4/1/2025
03/20/2025 Medical Equipment and Supplies – Compression garments and bathroom equipment
03/28/2025 Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List update for April 1, 2025
04/04/2025 Home Health Providers – Electronic Visit Verification (EVV) Update
04/10/2025 PM&R and LTAC prior authorization (PA) requests
04/10/2025 New Community Health Worker (CHW) Services Billing Guide
04/23/2025 Reminder EPSDT Well-Child Program billing requirements take effect July 1, 2025
04/24/2025 New Reentry Targeted Case Management (rTCM) Billing Guide, eff. July 1, 2025
04/25/2025 Home Health Providers – Electronic Visit Verification (EVV) Webinar Update
05/15/2025

Apple Health (Medicaid) Physical Health Audio-Only Procedure Code List update for May 1, 2025

05/20/2025

Medical Equipment and Supplies – Discontinued DME email inbox, effective June 1, 2025

05/22/2025

Discontinued EPA Number 870 for Evidence-Based Practice; effective July 1, 2025

06/03/2025

Reminder - PM&R and LTAC prior authorization (PA) requests

06/16/2025

Community Health Worker (CHW) Services Billing Guide updates, Eff 7/1/2025

06/16/2025

Quarterly Billing Guide Updates, Effective 7/1/2025

06/17/2025 EPSDT billing guide reminder
06/25/2025 Final reminder EPSDT Well-child program billing requirements take effect 7/1/25
06/26/2025 Changes to Apple Health (Medicaid) Audio-Only Procedure Code Lists, eff. 7/1/25
07/01/2025 Apple Health recognizes certified anesthesiologist assistants as servicing providers, effective July 1, 2025
07/23/2025 Hospital ancillary services
08/19/2025 Interpreter Services Billing Guide update eff August 15, 2025
08/27/2025 Hospice Services Billing Guide Update, Effective September 1, 2025
09/03/2025 Private Duty Nursing - Overtime clarification
09/22/2025 Quarterly Billing Guide Updates, Effective 10/1/2025
09/26/2025 New Health-Related Social Needs (HRSN) Services Billing Guide effective 10/1/2025
10/1/2025 New Reentry Services Billing Guide, eff. October 1, 2025
10/2/2025

EPSDT Well-Child Program Name Change, Effective 10-1-25

10/13/2025 Physician standby services discontinued 10/1/2025
10/17/2025

Updated Medicare telehealth guidance

10/31/2025 Substance-Using Pregnant People (SUPP), adding CPT code 99239, eff. 10/1/25
12/9/2025

Prescription Drug Expedited Authorization (EA) List eff. January 1, 2026

12/12/2025

New billing requirements for associate-level providers, effective 1-1-2026

12/17/2025

Updates to Family Planning Billing Guide, Eff January 1, 2026

12/17/2025

Quarterly Billing Guide Updates, Effective 01/01/2026

12/29/2025

Collaborative Care Management HCPCS code G0512 ending on 12/31/2025

12/30/2025

Dental anesthesia codes and prior authorization updates, effective January 1, 2026

Description
The agency is updating the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) chapter to align with guidance from the Centers for Medicare & Medicaid Services.

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 25-10-064
  • Hearing Date: 6/10/2025
  • Registration is required to attend the public hearing.
    View the rulemaking's CR102 for the registration link.
  • Comments due by 6/10/2025

Permanent Adoption (CR103P)

Children and youth services

Learn about children and youth services for Apple Health (Medicaid) clients.

What are children and youth services?

Children and youth services are also known as Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and are available for Apple Health clients from birth through 20 years of age.

EPSDT is a free benefit that includes a broad set of health care services, including preventive, dental, mental health, developmental, and specialty care. EPSDT services help ensure children get the health care they need when they need it.

Learn more about EPSDT.

Who can access EPSDT?

EPSDT services are for children and youth birth through 20 years of age who are enrolled in Apple Health coverage.

Parents and caregivers who are under 21 years of age and who are on CN or MN coverage can also access EPSDT services. "Under 21" means through the day before their 21st birthday.

What services are covered?

EPSDT covers services that are medically necessary (WAC 182-500-0070). The broad set of services ensures that your child/youth has access to health care that meets their individual needs. Some covered EPSDT services include:

Other necessary health care services

EPSDT includes diagnostic and treatment services when a health issue is identified. Diagnostic services help you and your health care provider identify what services will address the health issue. This may take place during a well-child checkup or performed outside your regular checkups by a qualified health care provider.

When an issue is identified as a part of a well-child checkup, your health care provider may provide care to address the need or connect you to another provider for additional services.

How to access additional services?

When a child or youth needs a service that is not listed as a covered service or goes beyond the assigned amount of sessions, your health care provider can submit a request for additional services. Requests are reviewed on a case-by-case basis using information specific to your child or youth to determine if the services are medically necessary (WAC 182-501- 0165).

How to find a provider?

Learn how to find a provider and make your first appointment.

Additional services and supports

Description
HCA is amending WAC 182-501-0213, Case management services, and writing new rules under new Chapter 182-563 WAC to provide limited coverage for certain services for incarcerated individuals up to 90 days before their expected release date. This rulemaking aligns with Washington’s Medicaid Transformation Project 2.0, in accordance with Section 1115(a) of the Social Security Act and the Consolidated Appropriations Act (CAA).

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 25-08-063
  • Hearing Date: 5/6/2025
  • Registration is required to attend the public hearing.
    View the rulemaking's CR102 for the registration link.
  • Comments due by 5/6/2025

Permanent Adoption (CR103P)

Description
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

Agency contacts

Rulemaking contact
Program contact
Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 25-07-047
  • Hearing Date: 4/22/2025
  • Registration is required to attend the public hearing.
    View the rulemaking's CR102 for the registration link.
  • Comments due by 4/22/2025

Withdrawal (CR102)

Proposal (CR102)

  • WSR 25-09-089
  • Hearing Date: 5/27/2025
  • Registration is required to attend the public hearing.
    View the rulemaking's CR102 for the registration link.
  • Comments due by 5/27/2025

Permanent Adoption (CR103P)

Supported employment

Supported employment is one branch of the Foundational Community Supports (FCS) program. It is an effective approach centered on assisting individuals in securing competitive employment within the community, while also providing the necessary support to ensure their success in the workplace. Meaningful employment contributes to a more fulfilling life for many adults and youth in transition, aiding them in achieving their career and educational objectives, and promoting recovery for those facing behavioral health challenges.

Overview

Supported employment extends beyond mere job placement; it mitigates the risks of homelessness and incarceration while empowering individuals to escape cycles of poverty. By emphasizing personal choice and support, it enables participants to flourish in their roles, enhance their lives, and become contributing members of their communities. This model is utilized in various environments, including community mental health centers and rehabilitation programs, and is adaptable to different geographic contexts and job markets.

Central to our initiative is the Individual Placement and Support (IPS) model, an evidence-based strategy designed to assist individuals in obtaining meaningful employment. This model prioritizes individual preferences, boosts self-esteem, and ultimately improves quality of life, financial stability, and mental health in Washington State.

Unemployment has a significant impact on overall well-being, often leading to reduced life expectancy, particularly among those with behavioral health issues or prior involvement in the justice system. Moreover, systemic barriers frequently hinder individuals from returning to work by diminishing public benefits, and there is a notable shortage of resources for benefit planning to facilitate transitions from public assistance to earned income. IPS programs demonstrate a high rate of successful implementation and sustainability over time.

Resources