Description: The health care authority (HCA) intends to submit SPA 24-0005 to add one encounter-eligible visit per Indian health service (IHS)-eligible medicaid beneficiary per day to the currently allowed five encounters per day. This visit applies to pharmaceuticals/drugs purchased through the IHS and dispensed by a pharmacy facility operated by a tribe or tribal organization and funded by Title I or III of the Indian Self Determination and Education Assistance Act at the outpatient per visit encounter rate published in the Federal Register. SPA 24-0005 also clarifies reimbursement for 340B discounted drugs and that actual drug cost is paid rather than the encounter rate if the drug cost exceeds the encounter rate.

The annual aggregate expenditure/reimbursement/payment for tribal pharmacy claims at the encounter rate for up to one encounter per person per day is anticipated to be $7,515,232 for state fiscal year 2024.

A copy of SPA 24-0005 is available for review. HCA would appreciate any input or concerns regarding this SPA. To request a copy of the SPA or submit comments, please contact the person named below by April 15, 2024 (please note that all comments are subject to public review and disclosure, as are the names of those who comment).

CONTACT: Lena Nachand, Office of Tribal Affairs, 626 8th Avenue S.E., Olympia, WA 98504, phone 360-725-1386, TRS 711, email lena.nachand@hca.wa.gov.