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)

182-531-0050 Physician-related services definitions
(new) 182-531-2040 Enhanced reimbursement - Medication Assisted Treatment

Purpose: The Washington State legislature provided funding to increase the Medication Assisted Therapy (MAT) rate for opioid use disorder to match the Medicare rate in order to encourage more providers to treat patients with opioid use disorder. This represents an exception to current payment methodology and needs to be described in the administrative code. (WSR 18-14-112)

Permanent Adoption (CR103P)

182-512-0785 SSI-related medical—Effect of a sponsor's income.

Purpose: The agency is amending WAC 182-512-0785 to correct a typographical error in a WAC reference. WAC 182-512-0785(1)(d) references WAC 182-512-0190. This WAC does not exist. It should refer to WAC 182-512-0790. (WSR 18-15-005)

Private duty nursing for clients age 17 and younger
182-551-3000   General
182-551-3050 Definitions
182-551-3100  Client eligibility
182-551-3200  Provider requirements
182-551-3300  Application requirements
182-551-3400  Authorization

Purpose: The agency is amending WAC 182-551-3000, Private Duty nursing services for clients age seventeen and younger – General, as follows:

  • Title renamed to reflect that it contains general information about private duty nursing for clients age seventeen and younger; 
  • Definition of “private duty nursing” moved to a new section for definitions;
  •  Information added about receiving services through managed care organizations (MCOs);
  • Information added about coverage for services when the client has third-party liability (TPL) coverage; and
  • Information regarding client eligibility, provider requirements, application requirements, and authorization moved to new sections.

Changes to WAC 182-551-3000 explain that clients receive private duty nursing services through the Medically Intensive Children’s Program (MICP) and further clarify how services are provided through MCOs and when clients have TPL coverage.

The agency is creating a new WAC 182-551-3050, Private Duty nursing services for clients age seventeen and younger – Definitions, to define private duty nursing terms not previously found in WAC. The agency is creating new sections for client eligibility, provider requirements, application requirements, and authorization (new WACs 182-551-3100 through -3400). The rule changes reorganize the private duty nursing rules within Chapter 182-551 WAC, revise eligibility criteria, and clarify current agency policy. (WSR 18-15-010)

Foundational community supports program
182-559-100 General
182-559-150 Definitions
182-559-200 Eligible providers
182-559-300 Eligibility for community support services
182-559-350 Eligibility for supported employment service
182-559-400 Payment
182-559-600 Grievance and appeals system

Purpose: The agency is amending these rules to align with changes to the Foundational Community Supports program protocol that was approved by the Centers for Medicare & Medicaid Services (CMS). The amendments include:

  1. Revising the name of WAC 182-559-300 to reflect that this section contains eligibility for community support services (also known as supportive housing services) only; 
  2. Adding a new section, WAC 182-559-350, Eligibility for supported employment services, to provide detailed eligibility information, which is reflected in the protocol; and
  3. Adding new WAC 182-559-600, Grievance and appeals system, to clarify the grievance and appeals process for clients receiving services through the Foundational Community Supports program.  (WSR 18-15-007)