Washington Administrative Code

(1) A certified peer support specialist or certified peer support specialist trainee credentialed by the department of health who provides medicaid-reimbursable peer support services must meet the requirements in WAC 182-116-0200.(2) Certified peer support specialists or certifie…

(1) People applying with the authority for peer support specialist training must:(a) Be age 18 or older; and(b) Attest on the authority's application that they self-identify as:(i) A person with one or more years of recovery from behavioral health experiences/challenges; or(ii) T…

The purpose of this chapter is to establish eligibility criteria for and effective date of enrollment in the public employees benefits board (PEBB) approved benefits.[Statutory Authority: RCW 41.05.160. WSR 07-20-129 (Order 07-01), § 182-12-108, filed 10/3/07, effective 11/3/07. …

The following definitions apply throughout this chapter unless the context clearly indicates another meaning:"Accidental death and dismemberment insurance" or "AD&D" means basic accidental death and dismemberment (AD&D) insurance paid for by the employing agency, as well as suppl…

The following entities and individuals shall be eligible for public employees benefits board (PEBB) benefits subject to the terms and conditions set forth below:(1) State agencies. State agencies, as defined in WAC 182-12-109, are required to participate in all PEBB benefits. Ins…

(1) All state agencies must carry out all actions, policies, and guidance issued by the public employees benefits board (PEBB) program necessary for the operation of benefit plans, education of employees, claims administration, and appeals process including those described in cha…

Eligibility for an employee whose work circumstances are described by more than one of the eligibility categories in subsections (1) through (5) of this section shall be determined solely by the criteria of the category that most closely describes the employee's work circumstance…

(1) Employees of state agencies are eligible to participate in the state's salary reduction plan provided they are eligible for public employees benefits board (PEBB) benefits as described in WAC 182-12-114 and they elect to participate within the time frames described in WAC 182…

Public employees benefits board (PEBB) medical, dental, and vision coverage is limited to a single enrollment per individual as described in subsections (1) through (5) of this section. Effective January 1, 2022, individuals are limited to a single enrollment in medical, dental, …

An employee may waive enrollment in public employees benefits board (PEBB) medical if they are enrolled in other employer-based group medical, a TRICARE plan, or medicare Part A and Part B as described in subsection (1)(a) through (c) of this section. They may not waive enrollmen…

This section applies to employees employed by state agencies (as defined in this chapter), including benefits-eligible seasonal employees, and is intended to address situations where an employee moves from one position or job to another due to a layoff, as described in WAC 182-12…

The employer contribution toward public employees benefits board (PEBB) benefits begins as described in WAC 182-12-114. This section describes under what circumstances employees maintain eligibility for the employer contribution toward PEBB benefits.(1) Maintaining the employer c…

Employees who have established eligibility for public employees benefits board (PEBB) benefits as described in WAC 182-12-114 may continue coverage for themselves and their dependents during certain types of leave or when their employment ends due to a layoff.(1) Employees who ar…

In order to avoid duplication of group health plan coverage, the following shall apply to employees during any period of approved educational leave. Employees eligible for continuation coverage provided in WAC 182-12-133 who obtain other employer-based group medical, dental, visi…

(1) An employee on approved leave under the federal Family and Medical Leave Act (FMLA) may continue to receive the employer contribution toward public employees benefits board (PEBB) benefits in accordance with the federal FMLA. The employee may also continue current supplementa…

(1) If an employee reverts for reasons other than a layoff and is not eligible for the employer contribution toward public employees benefits board (PEBB) benefits under this chapter, they may continue PEBB insurance coverage by self-paying the premium and applicable premium surc…

(1) Faculty may continue any combination of medical, dental, or vision, and may also continue life insurance and accidental death and dismemberment (AD&D) insurance by self-paying the premium and applicable premium surcharges set by the health care authority (HCA), with no contri…

(1) An employee or an employee's dependent who loses eligibility for the employer contribution toward public employees benefits board (PEBB) benefits and who qualifies for continuation coverage under the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) may continue …

(1) Employees awaiting the hearing outcome of a dismissal action before any of the following may continue their public employees benefits board (PEBB) insurance coverage by self-paying the premium and applicable premium surcharges set by the health care authority (HCA), with no c…

A retiring employee or a retiring school employee is eligible to continue enrollment or defer enrollment in public employees benefits board (PEBB) insurance coverage as a retiree if they meet procedural and substantive eligibility requirements as described in subsections (1), (2)…

(1) An elected and full-time appointed official of the legislative and executive branch of state government is eligible to continue enrollment or defer enrollment in public employees benefits board (PEBB) retiree insurance coverage under the same terms as an outgoing legislator, …

(1) A retiring employee or a retiring school employee may defer enrollment in public employees benefits board (PEBB) retiree insurance coverage at retirement if they meet substantive eligibility requirements as described in WAC 182-12-171(2) or as described in WAC 182-12-180(1). …

(1) The following individuals may defer enrollment in public employees benefits board (PEBB) retiree insurance coverage:(a) A retiring employee or a retiring school employee;(b) A dependent becoming eligible as a survivor; or(c) A retiree or a survivor enrolled in PEBB retiree in…

A retiree or an eligible dependent's public employees benefits board (PEBB) insurance coverage can be terminated by the health care authority (HCA) for the following reasons:(1) Failure to comply with the PEBB program's procedural requirements, including failure to provide inform…

Eligible employees who participate in public employees benefits board (PEBB) life insurance as an employee and eligible school employees who participate in school employees benefits board (SEBB) life insurance as an employee and meet qualifications for PEBB retiree insurance cove…

(1) An employee or a school employee who is determined to be retroactively eligible for a disability retirement is eligible to enroll or defer enrollment (as described in WAC 182-12-200 or 182-12-205) in public employees benefits board (PEBB) retiree insurance coverage if:(a) The…

(1) A retired employee, a retired school employee, or an eligible survivor of an employee, school employee, or retiree of an employer group as defined in WAC 182-12-109 who loses eligibility for public employees benefits board (PEBB) retiree insurance coverage due to the employer…

Surviving spouses, state registered domestic partners, and dependent children of emergency service personnel who are killed in the line of duty are eligible to enroll or defer enrollment in public employees benefits board (PEBB) retiree insurance coverage.(1) This section applies…

To be enrolled in PEBB health plan coverage, a dependent must be eligible under this section and the subscriber must comply with enrollment procedures outlined in WAC 182-12-262.The public employees benefits board (PEBB) program verifies the eligibility of all dependents and will…

(1) Enrolling dependents in public employees benefits board (PEBB) health plan coverage, supplemental dependent life insurance, and accidental death and dismemberment (AD&D) insurance. A dependent must be enrolled in the same health plan coverage as the subscriber unless otherwis…

(1) When a National Medical Support Notice (NMSN) requires a subscriber to provide health plan coverage for a dependent child the following provisions apply:(a) The subscriber may enroll their dependent child and request changes to their health plan coverage as described under su…

The survivor of an eligible employee, an eligible school employee, or a retiree who meets the eligibility criteria and submits the required forms as described in subsection (1), (2), or (3) of this section is eligible to enroll or defer enrollment as a survivor under public emplo…

If eligible, dependents may continue health plan enrollment under one of the continuation coverage options in subsection (1) or (2) of this section by self-paying the premiums and applicable premium surcharges set by the health care authority (HCA), with no contribution from the …

The board annually determines the design of the PEBB wellness incentive program.(1) All subscribers, except PEBB subscribers who are enrolled in both medicare Parts A and B, and in the medicare risk pool as described in RCW 41.05.080(3), are eligible to participate in the PEBB we…

(1) The Washington state health care authority (the authority) appoints a tribal-designated crisis responder upon request and after consultation with one or more federally recognized Indian tribes or after meeting and conferring with one or more Indian health care providers. This…

The purpose of this chapter is to establish criteria for state residents for participation in medicare supplemental coverage available through the HCA.[Statutory Authority: RCW 41.05.197, 41.05.160. WSR 19-01-054 (Admin #2018-02), § 182-13-010, filed 12/14/18, effective 1/14/19. …

Unless otherwise specifically provided, the definitions contained in this section apply throughout this chapter.(1) "HCA" means the Washington state health care authority.(2) "Health plan," or "plan" means any individual or group: Policy, agreement, or other contract providing co…

A resident is eligible to apply for medicare supplemental coverage available through the HCA provided the resident is:(1) Enrolled in Parts A and B of medicare; and(2) Not eligible to purchase coverage as a retired or disabled employee under RCW 41.05.195.[Statutory Authority: RC…

Residents meeting eligibility requirements may apply for medicare supplemental coverage available through the HCA:(1) No earlier than thirty days before they are enrolled in both Parts A and B of medicare;(2) Within sixty-three days after becoming a resident of Washington state;(…

(1) An appropriately trained professional person means a psychiatrist, psychologist, psychiatric nurse, social worker, licensed marriage and family therapist, licensed mental health counselor, psychiatric advanced registered nurse practitioner, and other mental health professiona…

(1) The health care authority operates programs to support people who are in recovery from substance use disorder. Recovery residences provide housing for people in recovery from substance use disorder. These residences are safe, established homes that meet the standards set by t…

The following definitions apply to this chapter:"Accredited" for the purposes of this chapter, means an organization approved by the National Alliance of Recovery Residences (NAAR)."Appropriate client" means a person in recovery from substance use disorder who meets the requireme…

A licensed or certified service provider may refer an appropriate client only to a recovery residence that is included in the registry, except as provided in WAC 182-135-0130.[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 23-20-044, § 182-135-0120, filed 9/27/23, effectiv…

If an approved recovery residence is not located in an appropriate client's desired county, a licensed or certified service provider may refer the client to another suitable placement or service.[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 23-20-044, § 182-135-0130, fil…

(1) Purpose. The health care authority has established the recovery residence operating revolving loan to maintain an ongoing revolving fund, as authorized by 42 U.S.C. Sec. 300x-25(a) and as described in RCW 41.05.762.(2) Fund. The fund identified in subsection (1) of this secti…

(1) This chapter establishes standards for issuing endorsements to mobile rapid response crisis teams (MRRCTs) and community-based crisis teams (CBCTs) according to RCW 71.24.903 and the authority's best practice guide. MRRCTs and CBCTs provide on-site interventions for people ex…

The following definitions apply to this chapter:"Authority" means the Washington state health care authority."Behavioral health administrative services organization (BH-ASO)" means the same as in WAC 182-538-050."Behavioral health emergency" means a person is experiencing a signi…

(1) Application. To apply for an endorsement, an eligible organization must submit an application for endorsement to the authority and all documentation required in subsection (3) of this section. Eligible organizations may apply:(a) Online through the authority's website; or(b) …

A community-based crisis team (CBCT) exempt from minimum personnel standards must submit the application described in WAC 182-140-0030(1) and:(1) Policies and procedures that outline how the exempt CBCT will comply with the training requirements in WAC 182-140-0090;(2) A memorand…

An endorsed team seeking renewal must:(1) Renew its endorsement every three years.(2) Submit its renewal application by the deadline established on the authority's endorsement web page. (See https://www.hca.wa.gov/billers-providers-partners/program-information-providers/mobile-cr…