Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-505 - Family, children, pregnancy and adult medical programs
Section 182-505-0300 - Hospital presumptive eligibility
Universal Citation: WA Admin Code 182-505-0300
Current through Register Vol. 24-18, September 15, 2024
(1) Purpose. The hospital presumptive eligibility (HPE) program provides temporary Washington apple health coverage to HPE-eligible persons who enroll through an HPE-qualified hospital.
(2) HPE-eligible persons. To be HPE-eligible:
(a) A
person must:
(i) Be younger than age 65;
and
(ii) Meet the eligibility
requirements for one or more of the following programs:
(A) Washington apple health for pregnant
women (chapter 182-505 WAC);
(B)
Washington apple health for kids (chapter 182-505 WAC);
(C) Washington apple health for foster care
(chapter 182-505 WAC);
(D)
Washington apple health for parents and caretaker relatives (chapter 182-505
WAC);
(E) Washington apple health
for adults (chapter 182-505 WAC); or
(F) Family planning only services (chapter
182-532 WAC).
(b) A person must not:
(i) Be an apple health beneficiary;
(ii) Be a supplemental security income
beneficiary; or
(iii) Have received
HPE coverage within the preceding 24 months.
(3) HPE-qualified hospitals. To be HPE-qualified, a hospital must:
(a) Operate
in Washington state;
(b) Submit a
signed core provider agreement (CPA) to the agency;
(c) Submit a signed HPE agreement to the
agency;
(d) Comply with the terms
of the CPA and HPE agreements;
(e)
Determine HPE eligibility using only those employees who have successfully
completed the agency's HPE training;
(f) Agree to provide HPE-application
assistance to anyone who requests it; and
(g) Agree to be listed on the agency's
website as an HPE-application assistance provider.
(4) Limitations.
(a) An HPE-qualified hospital must attempt to
help the person complete a regular apple health application before filing an
HPE application. If the person cannot indicate whether they expect to file a
federal tax return or be claimed as a tax dependent, the HPE-qualified hospital
may treat the person as a nonfiler under WAC
182-506-0010(5)(c)
for HPE purposes.
(b) HPE coverage
begins on the earlier of:
(i) The day the
HPE-qualified hospital determines the person is eligible; or
(ii) The day the HPE-qualified hospital
provides a covered medical service to the person, but only if the hospital
determines the person is eligible and submits the decision to the agency no
later than five calendar days after the date of service.
(c) HPE coverage ends on the earlier of:
(i) The last day of the month following the
month in which HPE coverage began; or
(ii) The day the agency determines the person
is eligible for other apple health coverage.
(d) HPE coverage does not qualify a person
for continuous eligibility under WAC
182-504-0015.
(e) If HPE coverage is based on pregnancy,
the pregnant person is eligible for HPE coverage only once for that
pregnancy.
(f) The HPE program
covers only those services included in the programs listed in subsection (2)(e)
of this section, except that pregnancy-related services are limited to
ambulatory prenatal care.
(g) A
child born to a person with HPE coverage is ineligible for apple health under
WAC 182-505-0210(2).
An HPE-qualified hospital must complete a separate HPE determination for the
newborn child.
Disclaimer: These regulations may not be the most recent version. Washington may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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