wa-26-21-029: Health Care Authority — WSR 26-21-029

WSR 26-21-029 (26-21)WSR 26-21-029PROPOSED RULESHEALTH CARE AUTHORITY[Filed October 13, 2026, 11:58 a.m.]Original Notice.Preproposal statement of inquiry was filed as WSR 26-17-001.Title of Rule and Other Identifying Information: WAC 182-550-1100 Hospital care—General.Hearing Location(s): On November 24, 2026, at 10:00 a.m. The health care authority (HCA) holds public hearings virtually without a physical meeting place. Virtual public hearings are held via Microsoft Teams webinar. To attend, you must register in advance at https://events.gcc.teams.microsoft.com/event/1de14fd1-9801-4ad7-9b49-74f51c93ed5a@11d0e217-264e-400a-8ba0-57dcc127d72d. After registering, you will receive a confirmation email containing information about joining the public hearing. You will be able to join the public hearing through most standard internet browsers; you do not need to install Microsoft Teams.Date of Intended Adoption: Not sooner than November 25, 2026.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 22, 2026, 8:00 a.m., by November 24, 2026, 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 arc@hca.wa.gov, by November 6, 2026.Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is updating this section to establish rules for a postdelivery and transitional care program, as directed under RCW 74.09.835 (chapter 213, Laws of 2024, SSB [2E2SSB] 5580).Reasons Supporting Proposal: See purpose.Statutory Authority for Adoption: RCW 74.09.835 (chapter 213, Laws of 2024, SSB [2E2SSB] 5580).Statute Being Implemented: RCW 74.09.835 (chapter 213, Laws of 2024, SSB [2E2SSB] 5580).Rule is not necessitated by federal law, federal or state court decision.Name of Proponent: HCA, governmental.Name of Agency Personnel Responsible for Drafting: Blake O'Connor, 626 7th Avenue S.E., Olympia, WA 98501, 360-725-1344; Implementation and Enforcement: Abby Cole, 626 7th Avenue S.E., Olympia, WA 98501, 360-725-1835.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.This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal: Is exempt under RCW 19.85.025(4).Explanation of exemptions: These rules do not apply to small businesses. Scope of exemption for rule proposal:Is fully exempt.October 13, 2026Wendy BarcusRules CoordinatorRDS-7460.1AMENDATORY SECTION(Amending WSR 26-07-031, filed 3/11/26, effective 4/11/26)WAC 182-550-1100Hospital care—General.(1) The medicaid agency:(a) Pays for an eligible Washington apple health client's admission to a hospital only when the client's attending physician orders admission and when the admission and treatment provided:(i) Are covered under WAC 182-501-0050, 182-501-0060 and 182-501-0065;(ii) Are medically necessary as defined in WAC 182-500-0070;(iii) Are determined according to WAC 182-501-0165 when prior authorization is required;(iv) Are authorized when required under this chapter; and(v) Meet applicable state and federal requirements. (b) For hospital admissions, defines "attending physician" as the client's primary care provider, or the primary provider of care to the client at the time of admission.(2) Medical record documentation of hospital services must meet the requirements in WAC 182-502-0020.(3) The agency pays for a hospital covered service provided to an eligible apple health client enrolled in an agency-contracted managed care organization (MCO) plan, under the fee-for-service program if the service is excluded from the MCO's capitation contract with the agency and meets prior authorization requirements. (See WAC 182-550-2600 for inpatient psychiatric services.)(4) The agency pays up to 26 days of inpatient hospital care for hospital-based withdrawal management, medical stabilization, and drug treatment for chemical dependent pregnant clients eligible under the substance-using pregnant people (SUPP) program.See WAC 182-533-0701 through 182-533-0730.(5) The agency pays for inpatient hospital withdrawal management of acute alcohol or other drug intoxication when the services are provided to an eligible client:(a) In a withdrawal management unit in a hospital that has a withdrawal management provider agreement with the agency to perform these services, and the services are approved by the division of behavioral health and recovery (DBHR) within the health care authority (HCA); or(b) In an acute hospital and all the following criteria are met:(i) The hospital does not have a withdrawal management specific provider agreement with DBHR;(ii) The hospital provides the care in a medical unit;(iii) Nonhospital-based withdrawal management is not medically appropriate for the client;(iv) The client does not require medically necessary inpatient psychiatric care, and it is determined that an approval from the agency or the agency's designee as an inpatient stay is not indicated;(v) The client's stay qualifies as an inpatient stay;(vi) The client is not participating in the agency's substance-using pregnant people (SUPP) program; and(vii) The client's principal diagnosis meets the agency's medical inpatient withdrawal management criteria listed in the agency's published billing instructions.(6) The agency pays for up to five days of enhanced inpatient hospital withdrawal management of acute alcohol or other drug intoxication when the services are provided to an eligible postpartum client:(a) Who meets the criteria in subsection (5)(b)(i) through (vi) of this section; and(b) Whose principal diagnosis meets the agency's medical inpatient postpartum substance use disorder criteria listed in the agency's published billing instructions.(7) The agency covers medically necessary dental-related services provided to an eligible client in a hospital-based dental clinic when the services:(a) Are provided under chapter 182-535 WAC; and(b) Are billed on the American Dental Association (ADA) or health care financing administration (HCFA) claim form.(((7)))(8) The agency pays a hospital for covered dental-related services, including oral and maxillofacial surgeries, that are provided in the hospital's operating room, when:(a) The covered dental-related services are medically necessary and provided under chapter 182-535 WAC;(b) The covered dental-related services are billed on a UB claim form; and(c) At least one of the following is true:(i) The dental-related service(s) is provided to an eligible apple health client on an emergency basis;(ii) The client is eligible under the division of developmental disability program;(iii) The client is age eight or younger; or(iv) The dental service is prior authorized by the agency.(((8)))(9) For inpatient voluntary or involuntary psychiatric admissions, see WAC 182-550-2600.(((9)))(10) For clients age 20 and younger, see the early periodic screening, diagnosis, and treatment (EPSDT) program described in chapter 182-534 WAC.