WSR 20-05-090
[Filed February 19, 2020, 9:12 a.m.]
Subject of Possible Rule Making: WAC 182-501-0165 Medical and dental coverageFee-for-service (FFS) prior authorizationDetermination process for payment; other related rules as appropriate.
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 health care authority (HCA) is updating WAC 182-501-0165 to further implement full integration of behavioral health in HCA's medicaid program by removing the term "mental health" and replacing it with the term "behavioral health." This change will ensure clarity that clients receiving behavioral health services under HCA's medicaid fee-for-service program receive appropriate notices and opportunities for hearings based on adverse benefit decisions resulting from prior authorization.
Many legislative changes have occurred this decade, including integrating substance use disorder services with delivery of mental health disorder treatments known as "behavioral health," the transition of behavioral health from the department of social and health services (DSHS) to HCA through 2ESHB 1388, chapter 201, Laws of 2018, then the full integration of physical and behavioral health purchasing and administration in E2SSB 5432, chapter 325, Laws of 2019.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: Not applicable.
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 (Rulemaking Questions), P.O. Box 42716, Olympia, WA 98504-2716, phone 360-725-1408, fax 360-586-9727, telecommunication relay services (TRS) 711, email, website; or Josh Morse (Program Questions), P.O. Box 42712, Olympia, WA 98504-2712, phone 360-725-0839, fax 360-586-9727, TRS 711, email, website
February 19, 2020
Wendy Barcus
Rules Coordinator