WSR 23-16-058
PERMANENT RULES
HEALTH CARE AUTHORITY
[Filed July 26, 2023, 1:05 p.m., effective August 26, 2023]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The health care authority is removing any mention of the DATA 2000 waiver in WAC 182-531-2040.
Citation of Rules Affected by this Order: Amending WAC 182-531-2040.
Adopted under notice filed as WSR 23-13-103 on June 20, 2023.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: July 26, 2023.
Wendy Barcus
Rules Coordinator
OTS-4618.1
AMENDATORY SECTION(Amending WSR 19-09-052, filed 4/12/19, effective 5/13/19)
WAC 182-531-2040Enhanced reimbursement—Medication assisted treatment for opioid use disorder.
(1) The medicaid agency pays an enhanced reimbursement using the medicare rate when medication assisted treatment (MAT) is part of the visit for selected evaluation and management (E/M) codes and the provider meets the criteria in this section.
(2) The purpose of this enhanced reimbursement is ((to encourage providers to obtain and use a Drug Addiction Treatment Act of 2000 waiver (DATA 2000 waiver))) to increase client access to evidence-based treatment using medications for opioid use disorder.
(3) To receive the enhanced reimbursement for MAT, a provider must:
(a) Bill using the agency's expedited prior authorization process;
(b) ((Currently use a DATA 2000 waiver to prescribe MAT to clients with opioid use disorder;
(c))) Bill for treating a client with a qualifying diagnosis for opioid use disorder; and
(((d)))(c) Provide opioid-related counseling during the visit.
(4) The agency payment for MAT under this section is limited to one enhanced reimbursement, per client, per day.
(5) The agency does not pay an enhanced reimbursement for services a client receives for opioid use disorder through an opioid treatment program facility licensed by the department of health.