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Affected providers: Providers serving Apple Health (Medicaid) fee-for-service (FFS) clients requiring replacement of medical supplies and equipment.
Purpose
The Health Care Authority (HCA) recognizes that some Apple Health fee-for-service (FFS) clients affected by the Spokane-area wildfires may have lost access to medically necessary medical supplies and equipment.
To support continuity of care and reduce administrative burden during this emergency HCA is authorizing Medicaid Fee-for-Service providers to furnish supplies, and equipment they currently supply to Medicaid clients as needed without pre-authorization, if such products have been lost, destroyed by fire, or have become inaccessible due to evacuation.
If the client receives Apple Health through a Managed care program, refer to HCA’s managed care website for contact information.
Effective dates
The waiver for prior authorization is effective for claims with date of service starting July 31, 2026 through the end of the state emergency.
Eligible supplies
The replacement is limited to medically necessary quantities.
Examples of eligible supplies include:
- Respiratory equipment and supplies such as nebulizers, CPAP/BiPAP, ventilators, oxygen equipment and supplies,
- Enteral nutrition
- Infusion therapy equipment and supplies
- Medical equipment and supplies such as wheelchairs, incontinence supplies, glucose monitors and testing supplies, continuous glucose monitors (CGM), and bath equipment
- Prosthetics and orthotics
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If authorization is required to obtain payment for a product that has been previously authorized or supplies which will now require authorization due to exceeding limits once replacement supplies are furnished, providers should submit their authorization request after the fact and note in their authorization request that the product was furnished as replacement for items destroyed or made inaccessible by fire. To receive retroactive prior authorization approval the documentation must include:
- The client has been directly affected by the Spokane area wildfire.
- The client no longer has access to previously dispensed covered medical supplies due to the wildfire.
- The replacement supplies are medically necessary to maintain the client’s health and safety.
Providers must submit documentation supporting the need for replacement supplies with prior authorization.
Post-Payment Review
HCA will conduct post-payment reviews of claims submitted under this emergency prior authorization waiver.
Claims submitted for clients who were not impacted by the Spokane-area wildfires, or that otherwise do not meet the requirements of this alert, may be subject to recoupment.
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