Washington Administrative Code Title 182 - Health Care Authority
Washington Administrative Code (WAC) Title 182 – Health Care Authority
Overview:
Title 182 of the Washington Administrative Code governs the Health Care Authority (HCA), which is responsible for the administration and oversight of various health-related programs in Washington State, including Medicaid (Apple Health), public employee and retiree benefits, and health care purchasing for other public programs.
Key Areas Covered in Title 182:
Medicaid (Apple Health) Programs:
Eligibility rules
Enrollment processes
Benefits and coverage
Managed care regulations
Provider Requirements:
Provider enrollment and credentialing
Billing and reimbursement
Provider responsibilities and audits
Behavioral Health Services:
Integration of mental health and substance use disorder services
Certification and licensing of behavioral health organizations
Prescription Drug Coverage:
Preferred drug lists
Prior authorization requirements
Pharmacy provider standards
Medical Equipment and Supplies:
Coverage guidelines
Provider responsibilities for durable medical equipment (DME)
Appeals and Hearings:
Client and provider appeal rights
Administrative hearing processes
Public Employee Benefits:
Eligibility and enrollment in PEBB (Public Employees Benefits Board) and SEBB (School Employees Benefits Board)
Rules for employer contributions and benefits
Health Technology Assessments:
Criteria for determining coverage for new medical technologies and treatments
Example WAC Chapters Under Title 182:
WAC 182-503 – Client eligibility for Apple Health
WAC 182-530 – Prescription drug program
WAC 182-550 – Hospital services
WAC 182-548 – Managed care
WAC 182-531 – Physician-related services
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