wa-26-21-080: Health Care Authority — WSR 26-21-080

WSR 26-21-080 (26-21)WSR 26-21-080PROPOSED RULESHEALTH CARE AUTHORITY[Filed October 20, 2026, 3:42 p.m.]Original Notice.Preproposal statement of inquiry was filed as WSR 26-03-027.Title of Rule and Other Identifying Information: New chapter 182-567 WAC, Contingency management services; WAC 182-567-0100 Purpose, 182-567-0200 Definitions, 182-567-0300 Waivered and grant funded contingency management sites, 182-567-0400 Service description, 182-567-0500 Incentives, 182-567-0600 Client eligibility requirements, 182-567-0700 Provider eligibility requirements, 182-567-0800 Payment, billing, and reporting, and 182-567-0900 Administrative hearings.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 21, 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, 4:00 p.m.Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is planning to establish new rules under chapter 182-567 WAC for contingency management services. The contingency management treatment program is intended to complement other substance use disorder treatment services already offered by apple health by providing motivational incentives to eligible apple health clients. This rule making aligns with Washington's Medicaid Transformation Project 2.0, in accordance with Section 1115(a) demonstration waiver and special terms and conditions. Reasons Supporting Proposal: See purpose.Statutory Authority for Adoption: RCW 41.05.021 and 41.05.160.Statute Being Implemented: RCW 71.24.035 (5)(i), 71.24.145(3), 71.24.125(3), 71.24.546, 41.05.021, and 41.05.160.Rule is not necessitated by federal law, federal or state court decision.Name of Proponent: HCA, governmental.Name of Agency Personnel Responsible for Drafting: Valerie Freudenstein, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-5128; Implementation: Sonia Wagner, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1667; and Enforcement: Lora Weed, P.O. Box 42730, Olympia, WA 98504-2730, 360-725-1998.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:Is not exempt.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. This rule does not impose compliance costs on small businesses.October 20, 2026Wendy BarcusRules CoordinatorRDS-7366.4Chapter 182-567 WACCONTINGENCY MANAGEMENT SERVICESNEW SECTIONWAC 182-567-0100Purpose.(1) The contingency management treatment program is a structured minimum 12-week outpatient contingency management program during which incentives are available.(2) Incentives earned through the health care authority's (also referred to as the agency) contingency management program will not be included as gross countable income for determining apple health eligibility.(3) The agency's contingency management program may be provided to eligible apple health clients and is intended to complement other substance use disorder (SUD) treatment services already offered as part of behavioral health services covered by apple health.(4) The agency's contingency management program must be based on established clinical research demonstrating effective contingency management treatment.NEW SECTIONWAC 182-567-0200Definitions.The following definitions and those found in chapter 182-500 WAC apply to this chapter."Contingency management" - Behavioral intervention for substance use disorders where incentives (e.g., gift cards, prizes) are provided when an individual demonstrates substance nonuse (e.g., a negative urine drug test for stimulant drugs)."Incentives" - Items or services, such as gift cards or vouchers, that are used to reinforce objectively verified recovery behaviors using a clinically appropriate contingency management protocol consistent with evidence-based research."Licensed practitioner" - A licensed health care practitioner performing the services within the person's authorized scope of practice."Substance use disorder (SUD)" - See WAC 182-538D-0200 and 246-840-760.NEW SECTIONWAC 182-567-0300Waivered and grant funded contingency management sites.This chapter contains rules regarding contingency management services. For purposes of this chapter, contingency management services may be delivered through either contingency management waivered sites or grant funded contingency management sites. Both sites must meet agency fidelity, reporting, and oversight standards, but differ in funding authority and reimbursement mechanism.(1) Contingency management waiver-funded sites are provider organizations authorized by the agency to deliver contingency management services under an approved federal waiver authority and state plan framework.(a) Waiver-funded sites deliver contingency management as a covered service benefit when allowable and subject to all applicable medicaid program integrity, documentation, audit, and beneficiary protection requirements.(b) Waiver-funded sites must:(i) Demonstrate fidelity to the approved contingency management model;(ii) Maintain agency-required staff training and supervision standards; and(iii) Participate in agency-required technical assistance.(2) Agency-approved funded contingency management sites are provider organizations authorized by the agency to deliver contingency management services using time limited federal or state grant funds when contingency management is not otherwise billable as a covered medicaid service. These sites are subject to monitoring, audit, and fidelity review per the established contract or agreement between the agency or the agency's designee, contractor, or tribe.(a) Agency-approved funded contingency management sites operate under a state contract or grant agreement and must comply with all grant conditions, fiscal controls, participant eligibility requirements, and reporting obligations defined by the funding source.(b) These sites must:(i) Demonstrate fidelity to the approved contingency management model;(ii) Maintain agency-required staff training and supervision standards; and(iii) Participate in agency-required technical assistance.(3) Both waiver-funded and agency-approved funded sites must ensure participant protections, confidentiality compliance, conflict of interest safeguards, and fraud prevention controls. The agency may establish additional operational standards, training requirements, and data submission expectations through policy guidance, contract language, or program manuals.NEW SECTIONWAC 182-567-0400Service description.(1) The contingency management intervention uses an evidence-based approach that recognizes and reinforces individual positive behavior change consistent with substance nonuse.(2) The contingency management intervention provides incentives for refraining from substance use as evidenced by testing negative in point of care drug tests.(3) Contingency management is offered along with other therapeutic interventions, as appropriate, such as cognitive behavioral therapy, that meet the definition of rehabilitative services as defined by section 1905(a) of the Social Security Act and 42 C.F.R. 440.130(d).(4) A client is not required to participate in other psychosocial services in order to receive contingency management intervention.NEW SECTIONWAC 182-567-0500Incentives.The contingency management intervention consists of series of incentives for meeting treatment goals.(1) The incentives may consist of cash equivalents (e.g., gift cards of low retail value) with restrictions placed on the incentives so they are not used to purchase:(a) Weapons;(b) Cannabis;(c) Tobacco;(d) Alcohol;(e) Over-the-counter preparations containing possible intoxicants such as dextromethorphan;(f) Pornographic material; and(g) Any item associated with participation in gambling (e.g., through the purchase of lottery tickets).(2) Clients will receive incentives during the course of a contingency management treatment episode.(3) To qualify for a contingency management incentive, a client must demonstrate nonuse of substances.(4) The size, nature, and distribution of all contingency management incentives will be determined by the agency.NEW SECTIONWAC 182-567-0600Client eligibility requirements.(1) To qualify for contingency management intervention, clients must meet the following conditions:(a) Be assessed and determined to have a substance use disorder for which contingency management is appropriate based on the fidelity of treatment to the evidence-based intervention;(b) Not be enrolled in another contingency management program for substance use disorder;(c) Consent to participate in the program;(d) Receive services from an eligible provider that offers the contingency management intervention; and(e) Not be a part of the tailored supports for older adults (TSOA) program.(2) The presence of additional substance use disorders and/or diagnoses does not disqualify a client from receiving contingency management intervention.(3) Contingency management can be used in combination with medication for the treatment of opioid use disorder.(4) Participation in contingency management will have no impact on client eligibility for, or obligation or right to use, other Washington apple health services.NEW SECTIONWAC 182-567-0700Provider eligibility requirements.The contingency management intervention is delivered by eligible providers that meet the requirements in this section and agree to deliver the intervention in a contingency management site.(1) The following practitioners can deliver the contingency management intervention:(a) Substance use disorder professionals (SUDP) certified by the department of health;(b) Certified peer support specialists; or(c) Other trained staff under supervision of a qualified professional licensed or certified by the department of health.(2) Providers must meet the following requirements:(a) Be an enrolled provider with the agency and have a current approved core provider agreement (CPA) to provide apple health services including:(i) Primary care;(ii) Behavioral health; and/or(iii) Substance use disorder services.(b) Participate in contingency management-specific training developed and offered by the agency or the agency-designated contractor;(c) Undergo a readiness review and be approved by the agency to ensure the provider is capable of offering contingency management intervention in accordance with agency standards; and(d) Participate in ongoing training and technical assistance as requested or identified by the agency or the agency's designated contractor through ongoing monitoring to meet agency standards.NEW SECTIONWAC 182-567-0800Payment, billing, and reporting.(1) The agency pays for the contingency management services described in this chapter when the services are provided and billed according to the agency's rules specific to contingency management.(2) Contingency management services are not state plan services.(3) Payment for contingency management waivered services includes incentives and point of care tests only.(4) Contingency management services do not have a specific medicaid billable procedure code. Providers are not reimbursed through standard claims submission through the agency's claim payment system. Payment is based on verified service delivery, protocol adherence, and approved incentive distribution rather than fee-for-service billing codes.(5) Approved contingency management sites must submit documentation and payment requests to the agency directly through an agency-defined reimbursement or invoicing process.(6) Direct reimbursement requires participating sites to maintain auditable records of participant eligibility, service encounters, incentive amounts, and fidelity to the approved contingency management model.(7) Sites must submit required program and financial documentation in a format specified by the agency.(8) Contingency management sites must comply with any data reporting requirements established by the agency to support research, evaluation, and performance monitoring efforts including, but not limited to:(a) Documentation in the client's record;(b) Data and quality reporting; and(c) Survey participation.(9) Supplemental data reporting may be required. Providers may be required to submit limited participant and service data elements through designated reporting platforms or evaluation partners to support oversight, federal reporting, and program evaluation.(10) All data submission must comply with applicable confidentiality, minimum necessary disclosure, and federal and state privacy requirements. Data sharing pathways are defined through contract or agreement, data use agreement, or interagency agreement to ensure lawful transmission and use of information.NEW SECTIONWAC 182-567-0900Administrative hearings.(1) When the health care authority issues a notice denying, suspending, or terminating a client's request for contingency management services, the agency gives clients written notice of an action under chapter 182-518 WAC.(2) Clients have the right to appeal the agency's adverse action under chapter 182-526 WAC.(3) Any appeals related to a request to authorize or pay for a service will terminate when the available funding for contingency management is exhausted. The agency does not authorize or pay for services without funding.