HEALTH CARE AUTHORITY

[Filed October 1, 2025, 9:12 a.m.]

Preproposal statement of inquiry was filed as WSR 23-24-065.

Title of Rule and Other Identifying Information: WAC 182-532-001 Reproductive health services—Definitions, 182-532-500 Family planning only programs—Purpose, 182-532-520 Family planning only programs—Provider requirements, 182-532-530 Family planning only programs—Covered services, 182-532-550 Family planning only programs—Payment limitations, 182-532-560 Family planning only programs—Documentation requirements, and 182-532-570 Family planning only programs—Good cause exemption from billing third-party insurance.

Hearing Location(s): On November 4, 2025, at 10:00 a.m. The health care authority (HCA) holds public hearings virtually without a physical meeting place. To attend the virtual public hearing, you must register in advance at https://us02web.zoom.us/webinar/register/WN_klyJXQreTC2C-q7UNWCPOg. If the link above opens with an error message, please try using a different browser. After registering, you will receive a confirmation email containing information about joining the public hearing.

Date of Intended Adoption: Not sooner than November 5, 2025.

Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, beginning October 1, 2025, 8:00 a.m., by November 4, 2025, 11:59 p.m.

Assistance for Persons with Disabilities: Contact Jessica Nguyen, phone 360-725-1174, fax 360-586-9727, telecommunication relay service 711, email Jessica.nguyen@hca.wa.gov, by October 17, 2025.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is amending these rules to expand coverage for family planning-related services and supplies when related to a family planning visit. HCA is also amending these rules to provide clarification and to align with the Washington family planning only demonstration waiver and other agency rules.

The proposed rules include coverage for HIV testing, viral hepatitis B and C testing, and vaccines for hepatitis B and hepatitis A/B combination vaccines. The rules also increase the maximum coverage age from 18 to 26 for people seeking services in confidence.

Reasons Supporting Proposal: See purpose.

Statutory Authority for Adoption: RCW 41.05.021 and 41.05.160.

Statute Being Implemented: RCW 41.05.021 and 41.05.160.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Governmental.

Name of Agency Personnel Responsible for Drafting: Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1408; Implementation and Enforcement: Andrea Estes, P.O. Box 45502, Olympia, WA 98504-5502, 360-725-1652.

A school district fiscal impact statement is not required under RCW 28A.305.135.

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.

Scope of exemption for rule proposal from Regulatory Fairness Act requirements:

The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The rules add coverage for services and supplies and require the provider to document visits that are family planning related. These changes do not impose more-than-minor costs on small businesses.

AMENDATORY SECTION(Amending WSR 25-06-057, filed 2/28/25, effective 3/31/25)

WAC 182-532-001Reproductive health services—Definitions.

The following definitions and those found in chapter 182-500 WAC apply to this chapter.

340B dispensing fee - The medicaid agency's established fee paid to a registered and medicaid-participating 340B drug program provider under the public health service (PHS) act for expenses involved in acquiring, storing and dispensing prescription drugs or drug-containing devices (see WAC 182-530-7900). A dispensing fee is not paid for nondrug items, devices, or supplies (see WAC 182-530-7050).

"Complication" - A condition occurring subsequent to and directly arising from the family planning services received under the rules of this chapter.

"Comprehensive preventive family planning visit" - For the purposes of this program, a comprehensive, preventive, contraceptive visit that includes evaluation and management of an individual, such as: Age appropriate history, examination, counseling/anticipatory guidance, risk factor reduction interventions, and laboratory and diagnostic procedures that are covered under the client's respective agency program.

"Contraception"- Prevention of pregnancy through the use of contraceptive methods.

"Contraceptive" - Food and Drug Administration (FDA)-approved prescription and nonprescription methods, including devices, drugs, products, methods, or surgical interventions used to prevent pregnancy, as described in WAC 182-530-2000.

"Family planning only program" - The program that covers family planning only services for eligible clients for 12 months from the date the agency determines eligibility. This program was formerly referred to as TAKE CHARGE.

"Family planning-related services and supplies" - Services provided as part of, or as follow-up to, a family planning visit.

"Family planning services" - Medically safe and effective medical care, educational services, and contraceptives that enable individuals to plan and space the number of their children and avoid unintended pregnancies.

"Natural family planning" (also known as fertility awareness method)- Methods to identify the fertile days of the menstrual cycle and avoid unintended pregnancies, such as observing, recording, and interpreting the natural signs and symptoms associated with the menstrual cycle.

"Over-the-counter (OTC)" - Drugs, devices, and products that do not require a prescription to be sold or dispensed. (See WAC 182-530-1050)

"Reproductive health" - The prevention and treatment of illness, disease, and disability related to the function of reproductive systems during all stages of life and includes:

(a) Related, appropriate, and medically necessary care;

(b) Education of clients in medically safe and effective methods of family planning; and

"Reproductive health care services" - Any medical services or treatments, including pharmaceutical and preventive care service or treatments, directly involved in the reproductive system and its processes, functions, and organs involved in reproduction, in all stages of life. Reproductive health care services does not include infertility treatment.

"Reproductive system" - Includes, but is not limited to: Genitals, gonads, the uterus, ovaries, fallopian tubes, and breasts.

"Sexually transmitted infection (STI)" - A disease or infection acquired as a result of sexual contact.

AMENDATORY SECTION(Amending WSR 19-18-024, filed 8/28/19, effective 10/1/19)

WAC 182-532-500Family planning only programs—Purpose.

The purpose of family planning only programs is to provide family planning services to all clients capable of reproducing, regardless of gender, to:

(1) Improve access to family planning and family planning-related services; and

(2) Reduce unintended pregnancies((; and

(3) Promote healthy intervals between pregnancies and births)).

AMENDATORY SECTION(Amending WSR 19-18-024, filed 8/28/19, effective 10/1/19)

WAC 182-532-520Family planning only programs—Provider requirements.

To be paid by the medicaid agency for services provided to clients eligible for family planning only programs, providers must:

(1) ((Meet))Comply with the requirements under this chapter and chapters 182-501 and 182-502 WAC;

(2) Provide only those services that are within the scope of their licenses;

(3) Bill the agency according to the agency's published billing guides;

(4) Educate clients on Food and Drug Administration (FDA)-approved contraceptive methods and over-the-counter (OTC) contraceptive drugs, devices, and products, as well as related medical services;

(5) Provide medical services related to FDA-approved contraceptive methods and OTC contraceptive drugs, devices, and products as medically necessary;

(6) Supply or prescribe FDA-approved contraceptive methods and OTC contraceptive drugs, devices, and products as medically appropriate and in compliance with WAC 182-530-2000 (1)(b); and

(7) Refer the client to available and affordable nonfamily planning primary care services, as needed.

AMENDATORY SECTION(Amending WSR 22-02-025, filed 12/28/21, effective 2/1/22)

WAC 182-532-530Family planning only programs—Covered services.

The medicaid agency covers all of the following services:

(1) One comprehensive preventive family planning visit once every ((twelve))12 months, based on nationally recognized clinical guidelines. This visit must have a primary focus and diagnosis of family planning and include counseling, education, risk reduction, and initiation or management of contraceptive methods;

(2) Assessment and management of family planning or contraceptive problems, when ((medically necessary))clinically appropriate. For purposes of this section, "clinically appropriate" means the type, frequency, extent, site, and duration of medical services must reasonably correlate to the client's needs;

(3) Family planning-related services and supplies;

(4) Contraception, including:

(a) Food and Drug Administration (FDA)-approved contraceptive methods, as described under WAC 182-530-2000 (1)(b);

(b) Education and supplies for Federal Drug Administration (FDA)-approved contraceptive, natural family planning, and abstinence; and

(((4)))(5) The following services, when ((appropriate, during a visit focused on family planning))clinically appropriate or according to nationally recognized guidelines:

(a) Pregnancy testing;

(b) Cervical cancer screening((, according to nationally recognized clinical guidelines));

(c) Gonorrhea and chlamydia screening and treatment ((for clients age thirteen through twenty-five, according to nationally recognized clinical guidelines));

(d) Syphilis screening and treatment ((for clients who have an increased risk for syphilis, according to nationally recognized guidelines)); ((and))

(e) Sexually transmitted infection (STI) screening, testing, and treatment, when medically indicated by symptoms or report of exposure, and medically necessary for the client's safe and effective use of their chosen contraceptive method((.

(5)));

(f) HIV testing, including rapid tests; and

(g) Viral hepatitis B and C testing;

(6) Hepatitis B and hepatitis A/B combination vaccines; and

(7) Human papillomavirus (HPV) vaccines.

AMENDATORY SECTION(Amending WSR 19-18-024, filed 8/28/19, effective 10/1/19)

WAC 182-532-550Family planning only programs—Payment limitations.

(1) The medicaid agency limits payment under the family planning only programs to services that:

(a) Have a primary focus and diagnosis of family planning as determined by a qualified licensed medical practitioner; ((and))

(b) Are medically necessary for the client to safely and effectively use, or continue to use, the client's chosen contraceptive method; and

(2) The agency pays:

(a) Providers for covered family planning services using the agency's published fee schedules;

(b) For family planning pharmacy services, family planning laboratory services, and sterilization services using the agency's published fee schedules; and

(c) A dispensing fee only for contraceptive drugs purchased through the 340B program of the Public Health Service Act. (See chapter 182-530 WAC)

(3) The agency does not pay for inpatient services under the family planning only programs, except for complications arising from covered family planning services.

(4) The agency requires providers to:

(a) Meet the timely billing requirements of WAC 182-502-0150; and

(b) Seek timely reimbursement from a third party when a client has available third-party resources, as described under WAC 182-501-0200. Exceptions to this requirement are described under WAC 182-501-0200 (((2) and (3))) and 182-532-570.

(((5) Services provided to family planning clients by federally qualified health centers (FQHCs), rural health centers (RHCs), and Indian health care providers (IHCP) do not qualify for encounter or enhanced rates.))

AMENDATORY SECTION(Amending WSR 19-18-024, filed 8/28/19, effective 10/1/19)

WAC 182-532-560Family planning only programs—Documentation requirements.

In addition to the requirements in WAC 182-502-0020, providers must document the following in the client's medical record:

(1) Primary focus and diagnosis of the visit is family planning or family planning-related;

(2) Contraceptive methods discussed;

(3) Plan for use of a contraceptive method, or the reason and plan for no contraceptive method;

(4) Education, counseling, and risk reduction with sufficient detail that allows for follow-up;

(5) Referrals to, or from, other providers; and

(6) If applicable, a copy of the completed consent form for sterilization. (See WAC 182-531-1550)

AMENDATORY SECTION(Amending WSR 19-18-024, filed 8/28/19, effective 10/1/19)

WAC 182-532-570Family planning only programs—Good cause exemption from billing third-party insurance.

(1) For the purposes of this section, "good cause" means that the use of the third-party coverage would violate a client's confidentiality because the third party:

(a) Routinely sends written, verbal, or electronic communications, as defined in RCW 48.43.505, to the third-party subscriber and that subscriber is someone other than the client; or

(b) Requires the client to use a primary care provider who is likely to report the client's request for family planning services to the subscriber.

(2) Clients eligible for family planning only programs may request an exemption from the requirement to bill third-party insurance due to "good cause" if they are:

(a) ((Eighteen))Twenty-six years of age or younger and seeking services in confidence; or

(b) Domestic violence victims and seeking services in confidence.