Skip to content
RuleResource Intelligence

← All developments

Washington HCA Apple Health (Medicaid) rulemaking · July 12, 2026 · Primary source

WSR 26-13-049: Termination of provider enrollment - For cause/For convenience

Score 71PRIMARYregulatoryState MedicaidWA

Summary

Washington State Health Care Authority adopted permanent rules amending WAC 182-502-0030 and WAC 182-502-0040, effective 31 days after the June 11, 2026 adoption date, to clarify the agency's authority to terminate Medicaid provider enrollment for cause and to specify that terminations for cause extend to associated providers under 42 CFR Part 455. The amended WAC 182-502-0030 reorganizes and expands the enumerated grounds for for-cause termination, including exclusion from Medicare or Medicaid, criminal convictions, fraudulent billing findings, drug mismanagement, and failure to cooperate with agency investigations. The amended WAC 182-502-0040 clarifies that termination for convenience constitutes final agency action.

What this may mean

When a billing provider, including a group practice, is terminated for cause, all servicing providers enrolled under that agreement who lack a separate enrollment agreement face immediate inactivation or their own for-cause termination. When a partial or full owner of an enrolled group practice is terminated for cause, the entire group practice enrollment is terminated and all servicing providers without a separate agreement are inactivated. The rule codifies retroactive termination and recoupment authority for providers who misrepresented information at enrollment.

Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.

Related items