WSR 16-23-149
(Washington Apple Health)
[Filed November 22, 2016, 10:33 a.m.]
Subject of Possible Rule Making: WAC 182-526-0200 Enrollee appeals of a managed care organization action; multiple sections of chapter 182-538 WAC, Managed care; WAC 182-538A-050 Definitions, 182-538A-110 The grievance system for fully integrated managed care (FIMC) managed care organizations (MCOs), 182-538B-050 Definitions, 182-500-0015 Medical assistance definitionsB, 182-501-0180 Health care services provided outside the state of WashingtonGeneral provisions, 182-501-0182 Health care provided in another state or U.S. territoryNonemergency, 182-501-0184 Health care services provided outside of the United States and U.S. territories or in a foreign country; multiple sections of chapter 182-502A WAC, Program integrity; WAC 182-502-0005 Core provider agreement, 182-502-0006 Enrollment for nonbilling individual providers, 182-502-0010 When the medicaid agency enrolls, 182-502-0012 When the medicaid agency does not enroll, 182-502-0210 Statistical data-provider reports; and other related rules as necessary.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 41.05.021, 41.05.160.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The agency is amending these rules to comply with the federal rule changes adopted by the Centers for Medicare and Medicaid Services (CMS), which revised 42 C.F.R. Parts 431, 433, 438, 440, 457 and 495. These changes modernize the medicaid managed care regulations to reflect changes in the use of managed care delivery systems and are primarily related to the grievance and appeals process rules. During the course of this review, the agency may identify additional changes that are required in order to improve clarity or update policy.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The department of social and health services.
Process for Developing New Rule: The agency welcomes the public to take part in developing this rule. If interested, contact the person identified below to receive an early rule draft to review. After the early review, the agency will send a notice of proposed rule making (CR-102) to everyone receiving this notice and anyone who requests a copy.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, fax (360) 586-9727, TTY 1-800-848-5429, e-mail
November 22, 2016
Wendy Barcus
Rules Coordinator