Washington Administrative Code
2023 Archive

Chapter 182-538 WAC
Last Update: 11/29/23

MANAGED CARE
PDF of Chapter Digest
WAC Sections
182-538-040Introduction.
182-538-050Definitions.
182-538-060Managed care choice and assignment.
182-538-067Qualifications to become a managed care organization (MCO) in integrated managed care.
182-538-068Qualifications to become a primary care case management (PCCM) provider in integrated managed care regional service areas.
182-538-070Payments, corrective action, and sanctions for managed care organizations (MCOs).
182-538-071Payments for primary care case management (PCCM) providers in the integrated managed care for regional service areas.
182-538-095Scope of care for integrated managed care enrollees and managed care organization benefit administration requirements.
182-538-096Scope of service for PCCM enrollees.
182-538-100Managed care emergency services.
182-538-110The grievance and appeal system and agency administrative hearing for managed care organization (MCO) enrollees.
182-538-111The administrative hearing process for primary care case management (PCCM).
182-538-120Enrollee request for a second medical opinion.
182-538-130Exemptions and ending enrollment in managed care.
182-538-140Quality of care.
182-538-150Apple health foster care program.
182-538-170Notice requirements.
182-538-180Rights and protections.
182-538-190Behavioral health services only (BHSO).
182-538-195Telemedicine and store and forward technology.
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
182-538-061Voluntary enrollment into managed care—Washington medicaid integration partnership (WMIP). [Statutory Authority: RCW 41.05.021, 42 C.F.R. 438. WSR 13-02-010, § 182-538-061, filed 12/19/12, effective 2/1/13. WSR 11-14-075, recodified as § 182-538-061, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.522. WSR 08-15-110, § 388-538-061, filed 7/18/08, effective 8/18/08; WSR 06-03-081, § 388-538-061, filed 1/12/06, effective 2/12/06. Statutory Authority: RCW 74.08.090, 74.09.522, 2003 E1 c 25 § 201(4), 2004 c 276 § 201(4), 42 U.S.C. 1396N (section 1915 (b) and (c) of the Social Security Act of 1924). WSR 05-01-066, § 388-538-061, filed 12/8/04, effective 1/8/05.] Repealed by WSR 15-24-098, filed 12/1/15, effective 1/1/16. Statutory Authority: RCW 41.05.021 and 41.05.160.
182-538-063Managed care for medical care services clients. [Statutory Authority: RCW 41.05.021, 42 C.F.R. 438. WSR 13-02-010, § 182-538-063, filed 12/19/12, effective 2/1/13. Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. WSR 12-19-051, § 182-538-063, filed 9/13/12, effective 10/14/12. WSR 11-14-075, recodified as § 182-538-063, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 2007 c 522 § 209 (13)-(14). WSR 08-10-048, § 388-538-063, filed 5/1/08, effective 6/1/08. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 06-24-036, § 388-538-063, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.08.090 and 74.09.522. WSR 06-03-081, § 388-538-063, filed 1/12/06, effective 2/12/06. Statutory Authority: RCW 74.08.090, 74.09.035, 74.09.522, and 2003 1st sp.s. c 25 § 209(15). WSR 04-15-003, § 388-538-063, filed 7/7/04, effective 8/7/04.] Repealed by WSR 15-24-098, filed 12/1/15, effective 1/1/16. Statutory Authority: RCW 41.05.021 and 41.05.160.
182-538-065Medicaid-eligible basic health (BH) enrollees. [Statutory Authority: RCW 41.05.021, 42 C.F.R. 438. WSR 13-02-010, § 182-538-065, filed 12/19/12, effective 2/1/13. WSR 11-14-075, recodified as § 182-538-065, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.522. WSR 06-03-081, § 388-538-065, filed 1/12/06, effective 2/12/06. Statutory Authority: RCW 74.08.090, 74.09.522, 2003 E1 c 25 § 201(4), 2004 c 276 § 201(4), 42 U.S.C. 1396N (section 1915 (b) and (c) of the Social Security Act of 1924). WSR 05-01-066, § 388-538-065, filed 12/8/04, effective 1/8/05. Statutory Authority: RCW 74.09.080, 74.08.510, [74.08.]522, 74.09.450, 1115 Waiver, 42 U.S.C. 1396. WSR 02-01-075, § 388-538-065, filed 12/14/01, effective 1/14/02. Statutory Authority: RCW 74.08.090, 74.09.510 and [74.09.]522 and 1115 Federal Waiver, 42 U.S.C. 1396 (a), (e), (p), 42 U.S.C. 1396r-6(b), 42 U.S.C. 1396u-2. WSR 00-04-080, § 388-538-065, filed 2/1/00, effective 3/3/00.] Repealed by WSR 15-24-098, filed 12/1/15, effective 1/1/16. Statutory Authority: RCW 41.05.021 and 41.05.160.
182-538-112The department of social and health services' (DSHS) hearing process for enrollee appeals of managed care organization (MCO) actions. [WSR 11-14-075, recodified as § 182-538-112, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.522. WSR 08-15-110, § 388-538-112, filed 7/18/08, effective 8/18/08; WSR 06-03-081, § 388-538-112, filed 1/12/06, effective 2/12/06. Statutory Authority: RCW 74.08.090, 74.09.522, 2003 E1 c 25 § 201(4), 2004 c 276 § 201(4), 42 U.S.C. 1396N (section 1915 (b) and (c) of the Social Security Act of 1924). WSR 05-01-066, § 388-538-112, filed 12/8/04, effective 1/8/05. Statutory Authority: RCW 74.08.090, 74.09.522, and 74.09.450. WSR 04-13-002, § 388-538-112, filed 6/2/04, effective 7/3/04. Statutory Authority: RCW 74.08.090, 74.09.522. WSR 03-18-110, § 388-538-112, filed 9/2/03, effective 10/3/03.] Repealed by WSR 13-02-010, filed 12/19/12, effective 2/1/13. Statutory Authority: RCW 41.05.021, 42 C.F.R. 438.