WSR 16-02-122 PERMANENT RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed January 6, 2016, 10:55 a.m., effective February 6, 2016] Effective Date of Rule: Thirty-one days after filing.
Purpose: The agency is amending the Washington apple health definition for "agency designee" to include any state agency selected to act on behalf of the health care authority. The agency is also amending the definition of "agency" to include the term "medicaid agency."
Citation of Existing Rules Affected by this Order: Amending WAC 182-500-0015 [182-500-0010].
Adopted under notice filed as WSR 15-24-112 on December 1, 2015.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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: January 6, 2016.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 15-15-143, filed 7/17/15, effective 8/17/15)
WAC 182-500-0010 Medical assistance definitions—A.
"Administrative renewal" means the agency uses ((verification from)) electronically available income data sources to verify and recertify a person's Washington apple health benefits for a subsequent certification period. A case is administratively renewed when the person's self-attested income is reasonably compatible (as defined in WAC 182-500-0095) with the information available to the agency from the electronic data sources and the person meets citizenship, immigration, Social Security number, and age requirements.
"Agency" or "medicaid agency" means the Washington state health care authority (HCA)((, created under chapter 41.05 RCW)).
"Agency's designee" means ((the Washington state department of social and health services (DSHS), created under chapter 43.20A RCW)) any entity expressly designated by the agency to act on its behalf.
"Allowable costs" are the documented costs as reported after any cost adjustment, cost disallowances, reclassifications, or reclassifications to nonallowable costs which are necessary, ordinary and related to the outpatient care of medical care clients or not expressly declared nonallowable by applicable statutes or regulations. Costs are ordinary if they are of the nature and magnitude which prudent and cost-conscious management would pay.
"Alternative benefits plan" means the range of health care services included within the scope of service categories described in WAC 182-501-0060 available to persons eligible to receive health care coverage under the Washington apple health modified adjusted gross income (MAGI)-based adult coverage described in WAC 182-505-0250.
"Ancillary services" means additional services ordered by the provider to support the core treatment provided to the patient. These services may include, but are not limited to, laboratory services, radiology services, drugs, physical therapy, occupational therapy, and speech therapy.
"Apple health for kids" is the umbrella term for health care coverage for certain groups of children that is funded by the state and federal governments under Title XIX medicaid programs ((or)), Title XXI Children's Health Insurance Program, or solely through state funds (including the program formerly known as the children's health program). Funding for any given child depends on the program for which the child is determined to be eligible. Apple health for kids programs are included in the array of health care programs available through Washington apple health (WAH).
"Attested income" means a self-declared statement of a person's income made under penalty of perjury to be true. (See also "self-attested income.")
"Authorization" means the agency's or the agency's designee's determination that criteria are met, as one of the preconditions to the agency's or the agency's designee's decision to provide payment for a specific service or device. (See also "expedited prior authorization" and "prior authorization.")
"Authorized representative" is defined under WAC 182-503-0130.
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