HEALTH CARE AUTHORITY

[Filed May 31, 2023, 8:07 a.m.]

Title or Subject: Medicaid State Plan Amendment (SPA) 23-0020 Guarding Against Unnecessary Utilization of Care and Services.

Effective Date: July 1, 2023.

Description: The health care authority (HCA) intends to submit SPA 23-0020 to address information that was identified by state auditors during HCA's state fiscal year (SFY) 2021 single audit as missing from the medicaid state plan. During the SFY 22 single audit, the agency sought clarification from the Centers for Medicare and Medicaid Services (CMS) and was informed that Washington's medicaid state plan does not appear to include the necessary information to meet the requirements of 42 C.F.R. 456.1 (b)(1) regarding methods and procedures to safeguard against unnecessary utilization of care and services. Therefore, HCA will submit SPA 23-0020 to indicate that the state directly oversees a surveillance and utilization control program and that an entity that meets the requirements of the Social Security Act performs annual quality assurance reviews of managed care organizations.

SPA 23-0020 is expected to have no effect on the annual aggregate expenditures, reimbursement, or payment for any medicaid service; this SPA is for administrative purposes only.

SPA 23-0020 is under development. HCA would appreciate any input or concerns regarding this SPA. To request a copy of the SPA when it becomes available or submit comments, please contact the person named below (please note that all comments are subject to public review and disclosure, as are the names of those who comment).

CONTACT: Ming Wu, Program Integrity, 626 8th Avenue S.E., Olympia, WA 98501, phone 360-725-1946, TRS 711, email ming.wu@hca.wa.gov.