Apple Health Rule Making Notice

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Apple Health (Medicaid): Provider Alert

Preproposal - Notice of Intent (CR101)

182-517-0100, Medicare Savings Program, (WSR 17-06-055)
Purpose:  The agency is amending this rule to add an alternative method of counting income to determine eligibility for the Medicare Savings Programs (MSP). For households with other non-applying dependents who are not eligible using the SSI-related budgeting methodology, the agency will use the alternative method based on household size and compare the household to the Federal Poverty Level that corresponds with the MSP.

Withdrawal of CR101

182-530-7700, 182-531-0250, 182-502-0006, Medicare/Medicaid Crossover (WSR 17-06-064 Withdrawal)
Purpose: The agency is amending rules to comply with Section 1902(a)(10)(E) of the Social Security Act that requires changes to payment of Medicare cost sharing for qualified Medicare beneficiaries.

Proposal - Public Hearings (CR102)

182-518-0030, Notice Requirements, (WSR 17-06-047)
Purpose: The agency is amending this rule to update its notification practices.

Permanent Adoption (CR103P)

182-502-0110, Conditions of Payment, (WSR 17-06-063)
Purpose: The agency is amending WAC 182-502-0110 to clarify prior authorization requirements for dual-eligible clients when their Medicare benefits exhaust. The amendments also add language to clarify that timely billing requirements must be met and that the agency may do post payment review on claims. The revisions to do not change current policy. The WAC section title is being changed to better reflect the information in the section.

182-530-1050, -3000, -3100, -3200, -4100, -4125, -4150, -6000, -7000, -7050, -7150, -7250, -7300, -7700, -7900, -8000, -8100, -8150, Prescription Drug Reimbursement, (WSR 17-07-001)
Purpose: The agency is revising this chapter to align with the Centers for Medicare and Medicaid Services (CMS) new covered outpatient drug rule, CMS-2345-FC. The agency is also amending these rules to increase the number of drug classes eligible for supplemental rebates. Changes include but are not limited to definition updates; new language about drugs, devices, and drug-related supplies; authorization updates; new language about point-of-sale and actual acquisition costs; updates to therapeutic interchange program; clarified processes for mail order and specialty pharmacy services; added information on 340B providers; added information on Medicare Part A, B, and C; and revised section on drugs purchased under the Public Health Services act.