Health Care Authority Rulemaking Notice

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Health Care Authority Rulemaking Notice

You are receiving this notice because you signed up to receive alerts for any rulemaking that occurs to one or more of the following rules.

Preproposal - Notice of Intent (CR101)

182-531-1500 Sleep Studies
Purpose: The agency is amending this rule to revise the requirements for a sleep center to become an agency-approved center of excellence (COE). The agency plans to reduce the number of documents that must be submitted for each sleep center. The agency will instead use the sleep center’s certification by the American Academy of Sleep Medicine (AASM), which requires the same documentation as listed in the current rule. (WSR 17-23-149)

Permanent Adoption (CR103P)

Managed Care Organizations Grievance and Appeals
182-538-040 Introduction
182-538-050 Definitions
182-538-110 The grievance and appeal system and agency administrative hearing for MCO enrollees.
182-538-140 Quality of care
182-538A-110 The grievance and appeal system, and agency administrative hearing for fully integrated managed care (FIMC) managed care organization(s) (MCOs)
182-538B-110 Grievance and appeal system and agency administrative hearing
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 system and are primarily related to the grievance and appeals process rules. (WSR 17-23-199)

Managed Care Organizations Grievance and Appeals

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 implement the crisis services provided by the ASOs to reflect changes in the use of managed care delivery systems; the changes are primarily related to the grievance and appeals process rules.

A public hearing was originally held on these rule amendments on May 9, 2017. However, the proposal erroneously added a provision for independent review in 182-538C-040(5)(b).The current amendment does not include that provision. The agency is also striking language that allows up to 45 days for an appeal determination. (WSR 17-23-200)

Administrative Hearings

182-526-0070 Filing documents
182-526-0155 Appellant's representation in the hearing
182-526-0200 Enrollee appeals of a managed care organization action
Purpose: The agency is revising these rules to: (1) to allow for support staff to confirm receipt of filed documents, rather than a judge in WAC 182-526-0070; (2) add language to WAC 182-526-0155 that was inadvertently omitted in a previous version; and (3) clarify where the hearing may take place in WAC 182-526-0200(3). (WSR 17-23-201)