Description
Effective January 1, 2027, federal law (P.L. 119-21, Section 71112) shortens the retroactive coverage period for federally-funded medical assistance. The agency is amending its rules to comply with this change in federal law.

Agency contacts

Rulemaking contact

Brian Jensen

Program contact

Riva Garza

Rulemaking status history

Preproposal (CR101)

00465: Mismatch between Claim header amount and Line sum (multiple t1015 lines)
Discovery log number
00465
Discovery description

For claims containing multiple T1015 lines, the system does not currently aggregate the line amounts correctly, leading to a mismatch between the header amount and the sum of the associated claim lines. A fix has been identified to ensure correct process.

Date reported
ETA
Provider impact
Phase 1
Workaround
N/A
Description
The agency is amending these rules to remove short-term post-hospitalization housing from the medical respite program definition as this housing is separate from medical respite. Medical respite is short-term recovery/rehabilitation for a client’s acute medical condition. The housing applies to other health-related social needs (HRSN) services that only provide room and board such as rent/temporary housing that is included per demonstration period. Additionally, the cap of 6 months of utilization will be per rolling 12-month period for the medical respite program as this aligns with CMS guidance.

Agency contacts

Rulemaking contact

Valerie Freudenstein

Program contact

Rob McDonough

Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 26-09-019
  • Hearing Date: 5/26/2026
  • Registration is required to attend the public hearing.
    View the rulemaking's CR102 for the registration link.
  • Comments Due: 5/26/2026

Simon Borumand

Description
To implement the Prescription Drug Affordability Board methodology for setting upper payment limits for prescription drugs the board has determined have led or will lead to excess costs based on its affordability review as required in RCW 70.405.050.

Agency contacts

Rulemaking contact

Valerie Freudenstein

Program contact

Simon Borumand

Rulemaking status history

Preproposal (CR101)

Katherine Ruiz

00464: ProviderOne Deducting Incorrect Client Responsibility Amount
Discovery log number
00464
Discovery description

ProviderOne received reports from Social Service providers that the amount of client responsibility deducted from their recent claims did not match the amount applied to the Social Service Authorization line. The issue has been resolved starting with RAs issued 2/27/2026. Impacted claims issued between 1/30/2026 and 2/20/2026 will be adjusted by the Health Care Authority the week of 3/9/2026.

  • If too much client responsibility was deducted from your claim, you will receive a refund.
  • If not enough client responsibility was deducted, an overpayment will be sent to the Office of Financial Recovery.

Impact to clients, provider or staff: No action is necessary by the impacted providers. The Health Care Authority will be adjusting impacted claims to correct the issue. Corrected claims will be viewable on your March 13, 2026 remittance advice (RA).

Date reported
ETA
Provider impact
Phase 2
Workaround
None
Description
The agency is planning to move urological and incontinence supplies from WAC 182-543-5500 into a new section under WAC 182-543-6100. This change aligns with the agency’s move to contracted provider reimbursement for these supplies.

Agency contacts

Rulemaking contact

Valerie Freudenstein

Rulemaking status history

Preproposal (CR101)

Subscribe to