Apple Health Rule Making Notice

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Apple Health (Medicaid): Provider Alert

Preproposal - Notice of Intent (CR101)

182-551-3000, Private Duty Nursing, (WSR 17-08-008)
Purpose: The agency is amending WAC 182-551-3000 to update the definition of “private duty nursing.” The agency is moving the subsections in WAC 182-551-3000 regarding client eligibility, provider requirements, application requirements, and authorization to new WAC sections in order to clarify the information and make it easier to find. WAC 182-531-3000 is being renamed to reflect that it contains general information about private duty nursing for clients age seventeen and younger. The language in the new WAC sections contains additional changes to clarify information regarding client eligibility, provider requirements, application requirements, and authorization.

Permanent Adoption (CR103P)

182-538A-130, -190, FIMC Enrollment Correction, (WSR 17-07-087)
Purpose: The agency is amending these rules because it is delegating third-party activities to managed care organizations.

182-554-100, -200, -300, -7400, -500, -525, -550, -600,-700, -800, -900, Enteral Nutrition, (WSR 17-08-009)
Purpose: All of the sections in this chapter have been amended to update outdated references to Title 388 WAC, MAA, etc., and have been simplified for easier reading. The amendment to WAC 182-554-400 adds valid prescription and proof of delivery requirements. The amendment to WAC 182-554-500 includes requirements regarding registered dietitian evaluations and recordkeeping for WIC clients and amended authorization requirements and clinical criteria. The amendment to WAC 182-554-600 adds requirements for recordkeeping for WIC clients. The amendment to WAC 182-554-700 adds prior authorization instructions. The requirements for clients with specific medical conditions who need oral enteral nutrition were relocated from WAC 182-554-500 to new sections WAC182-554-525 and 182-554-550. Authorization requirements were added to WAC 182-554-525 to protect clients under one year of age who receive thickeners. The FDA issued a warning not to give babies thickeners, particularly those born prematurely, because there is substantial evidence that it puts them at risk of necrotizing enterocolitis. The recommendation is supported by the American Academy of Pediatrics.

Emergency Adoption (CR103E)

182-554-500, Enteral Nutrition, (WSR 17-08-010)
Purpose: To add prior authorization requirements for providers prescribing thickeners to clients younger than one year of age.