Wash. Admin. Code § 182-501-0055 - Health care coverage - How the agency determines coverage of services for its health care programs using health technology assessments

(1) The medicaid agency uses health technology assessments to determine whether a new technology, new indication, or existing technology approved by the Food and Drug Administration (FDA) is a covered service under agency health care programs. The agency only uses health technology assessments when coverage is not mandated by federal or state law. A health technology assessment may be conducted by or on behalf of:

(a)The agency; or

(b)The health technology assessment clinical committee (HTACC) under RCW 70.14.080 through 70.14.140.

(2) The agency reviews available evidence relevant to a medical or dental service or health care-related equipment and uses a technology evaluation matrix to:

(a)Determine its efficacy, effectiveness, and safety;

(b)Determine its impact on health outcomes;

(c)Identify indications for use;

(d)Identify potential for misuse or abuse; and

(e)Compare to alternative technologies to assess benefit vs. harm and cost effectiveness.

(3)The agency may determine the technology, device, or technology-related supply is:

(a) Covered (see WAC 182-501-0060 for the scope of coverage under Washington apple health (WAH) pro-grams;

(b) Covered with authorization (see WAC 182-501-0165 for the process on how authorization is determined;

(c) Covered with limitations (see WAC 182-501-0169 for how limitations can be extended; or

(d) Noncovered (see WAC 182-501-0070 for noncovered services .

(4)The agency may periodically review existing technologies, devices, or technology-related supplies and reassign authorization requirements as necessary using the provisions in this section for new technologies, devices, or technology-related supplies.

(5) The agency evaluates the evidence and criteria from HTACC to determine whether a service is covered under WAC 182-501-0050(9) and (10) and this section.

Notes

Wash. Admin. Code § 182-501-0055

Amended by WSR 15-15-053, Filed 7/9/2015, effective 8/9/2015

11-14-075, recodified as §182-501-0055, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. 10-07-116, § 388-501-0055, filed 3/22/10, effective 4/22/10. Statutory Authority: RCW 74.08.090 and 70.14.090. 09-17-004, § 388-501-0055, filed 8/6/09, effective 9/6/09.