Health Care Authority Rule Making Notice

Washington State Health Care Authority sent this bulletin at 07/14/2017 04:11 PM PDT

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Health Care Authority Rule Making Notice

Preproposal - Notice of Intent (CR101)

182-549-1450 Rural health clinics- General payment information
Purpose: The agency is amending WAC 182-549-1450, Rural health clinics – General payment information, to implement a new payment method that allows rural health clinics to choose to receive encounter payments directly from a client’s managed care organization. (WSR 17-15-036)

Proposal - Public Hearings (CR102)

182-526-0100 Expedited administrative hearings for urgent health care needs.
182-526-0280 Continuing a hearing when an appellant is an applicant or recipient.
182-526-0290 Reinstating a hearing after an order of default or an order of dismissal. Purpose: To comply with new federal rules in 42 CFR Part 431, the agency is creating a new section WAC 182-526-0100 to allow for expedited administrative hearings for urgent health care needs. The agency is revising WAC 182-526-0290(4) and (6) to correct an error in the recently filed permanent rules for Chapter 182-526 WAC. In subsection (4), if an appellant fails to appear at the scheduled prehearing conference to address the petition to vacate, the order becomes a final order. The ALJ or review judge does not dismiss the matter with prejudice. In subsection (6), if the petition to vacate is not filed timely or the appellant fails to establish good cause to excuse any default or to reinstate the matter for hearing, the ALJ must issue an initial order, not a final order, dismissing the appeal. In WAC 182-526-0280, the agency is proposing to strike the introductory statement "This section applies to continuance requests made by applicants or recipients." (WSR 17-15-044)

182-538C-040 Behavioral health services
182-538C-110 Grievance and appeal system and agency administrative hearing for behavioral health administrative services organizations (BH-ASOs)
Purpose: The agency is amending these rules to comply with the federal rule changes adopted by the Centers for Medicare and Medicaid Services (CMS), which revised 42 C.F.R. Parts 431, 433, 438, 440, 457, and 495. These changes modernize the Medicaid managed care regulations to reflect changes in the use of managed care delivery systems and are primarily related to the grievance and appeals process rules. (WSR 17-15-060)

182-504-0125 Washington Apple Health - Effect of reported changes
182-523-0100 Washington Apple Health – Medical extension
Purpose: The agency is revising this rule to clarify that a “parent or caretaker relative” who received coverage must also be eligible for that coverage and removing outdated information in subsection (9) of WAC 182-504-0125. (WSR 17-15-066)

About the Health Care Authority (HCA)

The Washington State Health Care Authority purchases health care for more than 2 million Washington residents through Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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