wa-26-18-090: Health Care Authority — WSR 26-18-090

WSR 26-18-090 (26-18)WSR 26-18-090PROPOSED RULESHEALTH CARE AUTHORITY[Filed September 2, 2026, 8:04 a.m.]Original Notice.Preproposal statement of inquiry was filed as WSR 26-14-092.Title of Rule and Other Identifying Information: WAC 182-534-0200 Enhanced payments for EPSDT well-child checkups for children in out-of-home placement.Hearing Location(s): On October 6, 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/9e03b114-69d9-465d-aacf-4bc10fba88d8@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 October 7, 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 September 3, 2026, 8:00 a.m., by October 6, 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 September 18, 2026.Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is removing outdated language from this rule to align with federal requirements, as well as department of children, youth, and family (DCYF) policies and procedures. The rules revise the description of out-of-home placement and provide that children may (instead of must) receive an initial health screen within five days of entering out-of-home placement.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: [HCA], governmental.Name of Agency Personnel Responsible for Drafting: Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1408; Implementation and Enforcement: Beth Tinker, P.O. Box 45502, Olympia, WA 98504-5502, 360-725-1047.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. HCA is revising these rules to align with federal requirements and DCYF policies. The rules change the description for out-of-home placement and relax the requirement for an initial health screening for children in out-of-home placement. HCA does not anticipate these rules will add any new costs to providers or impose more-than-minor costs on small businesses.September 2, 2026Wendy BarcusRules CoordinatorRDS-7324.1AMENDATORY SECTION(Amending WSR 25-13-048, filed 6/11/25, effective 7/12/25)WAC 182-534-0200Enhanced payments for EPSDT well-child checkups for children in out-of-home placement.The medicaid agency covers early periodic screening, diagnosis, and treatment (EPSDT) services, as described in WAC 182-534-0100, for children in out-of-home placement to ensure medically necessary needs are promptly addressed.(1) For the purposes of this section, out-of-home placement means temporary, 24 hour-per-day, substitute care for a child age 20 and younger((:(a) Placed away from the child's parents or guardians in licensed, paid, out-of-home care; and(b)))for whom the department of children, youth, and families or a tribe has placement and care authority.(2) The agency pays an enhanced fee only for well-child checkups provided to children in out-of-home placement when the placement meets the federal requirements under 42 C.F.R. Part 441, Subpart B.(3) For children in out-of-home placement, the agency exempts well-child checkups from coverage limitations, regardless of the periodicity schedule recommended by the American Academy of Pediatrics' Bright Futures guidelines or a comparable standard. The periodicity schedule is found in the agency's EPSDT well-child program billing guide.(4) The agency pays for initial health screenings for children transitioning to out-of-home placement to identify and address immediate health needs.(a) The agency pays for an initial health screening in addition to well-child checkups.(b) Children ((must))may have an initial health screen within five days of entering out-of-home placement and a required well-child checkup within 30 days of entering out-of-home placement.(c) The provider must document the initial health screening using the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Out-of-Home Placement Initial Health Screen Form (HCA 13-843).(5) The agency evaluates client files and payments made under this program. The agency may recover the enhanced payment amount when:(a) The child was not in out-of-home placement as defined in subsection (1) of this section when the EPSDT screen was provided; or(b) Documentation was not in the child's medical file.