WSR 15-02-057
(Washington Apple Health)
[Filed January 5, 2015, 3:10 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 14-23-007.
Title of Rule and Other Identifying Information: WAC 182-505-0300 Hospital presumptive eligibility.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106B, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at or directions can be obtained by calling (360) 725-1000), on February 10, 2015, at 10:00 a.m.
Date of Intended Adoption: Not sooner than February 11, 2015.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail, fax (360) 586-9727, by 5:00 p.m. on February 10, 2015.
Assistance for Persons with Disabilities: Contact Kelly Richters by February 2, 2015, TTY (800) 848-5429 or (360) 725-1307 or e-mail
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These rules are necessary to provide temporary Washington apple health coverage to individuals who are determined eligible for hospital presumptive eligibility coverage by a qualified hospital.
Reasons Supporting Proposal: See Purpose statement above.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Statute Being Implemented: Patient Protection and Affordable Care Act established under Public Law 111-148.
Rule is necessary because of federal law, Patient Protection and Affordable Care Act established under Public Law 111-148.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Chantelle Diaz, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1842; Implementation and Enforcement: Mick Pettersen, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-0913.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The joint administrative [rules] review committee has not requested the filing of a small business economic impact statement, and these rules do not impose a disproportionate cost impact on small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
January 5, 2015
Jason R. P. Crabbe
Rules Coordinator
WAC 182-505-0300 Washington apple healthHospital presumptive eligibility.
(1) Generally. The hospital presumptive eligibility (HPE) program provides temporary Washington apple health (WAH) coverage to HPE-eligible persons who enroll through an HPE-qualified hospital.
(2) HPE-eligible persons. To be HPE-eligible, a person must:
(a) Be younger than age sixty-five;
(b) Not be a WAH beneficiary;
(c) Not be a supplemental security income beneficiary;
(d) Not have received HPE coverage within the preceding twenty-four months; and
(e) Meet the eligibility requirements for one or more of the following programs:
(i) WAH for pregnant women (chapter 182-505 WAC);
(ii) WAH for kids (chapter 182-505 WAC);
(iii) WAH for foster care (chapter 182-505 WAC);
(iv) WAH for parents and caretaker relatives (chapter 182-505 WAC);
(v) WAH for adults (chapter 182-505 WAC);
(vi) TAKE CHARGE for family planning services (chapter 182-532 WAC).
(3) HPE-qualified hospitals. To be HPE-qualified, a hospital must:
(a) Operate in Washington state;
(b) Submit a signed core provider agreement (CPA);
(c) Submit a signed HPE agreement;
(d) Comply with the terms of the CPA and HPE agreement;
(e) Determine HPE eligibility using only those employees who have successfully completed the agency's HPE training;
(f) Agree to provide HPE-application assistance to anyone who requests it; and
(g) Agree to be listed on the agency's web site as an HPE-application assistance provider.
(4) Limitations.
(a) An HPE-qualified hospital must attempt to help the person complete a regular WAH application before filing an HPE application. If the person cannot indicate whether he or she expects to file a federal tax return or be claimed as a tax dependent, the HPE-qualified hospital may treat the person as a nonfiler under WAC 182-506-0010 (5)(c) for HPE purposes.
(b) HPE coverage begins on the earlier of:
(i) The day the HPE-qualified hospital determines the person is eligible; or
(ii) The day the HPE-qualified hospital provides a covered medical service to the person, but only if the hospital determines the person is eligible and submits the decision to the agency no later than five calendar days after the date of service.
(c) HPE coverage ends on the earlier of:
(i) The last day of the month following the month in which HPE coverage began; or
(ii) The day the agency determines the person is eligible for other WAH coverage.
(d) HPE coverage does not qualify a person for continuous eligibility under WAC 182-504-0015.
(e) If HPE coverage is based on pregnancy, the pregnant woman is eligible for HPE coverage only once for that pregnancy.
(f) The HPE program covers only those services included in the programs listed in subsection (2)(e) of this section except that pregnancy-related services are limited to ambulatory prenatal care.
(g) A child born to a woman with HPE coverage is ineligible for WAH under WAC 182-505-0210(2). An HPE-qualified hospital must complete a separate HPE determination for the newborn child.