Washington Apple Health ABA facility rates 2026 are anchored by approved SPA 26-0002, effective January 1, 2026. The approval package updates fee-schedule effective dates and states that outpatient hospitals and clinics rendering intensive ABA as a day program do not receive a facility fee in addition to the per diem on the ABA fee schedule. The live schedule, billing guide, authorization, provider, setting, and remittance still control each claim.

Build one dated rate record

Capture provider entity, service location, facility class, client, service date, day-program status, code, unit, authorization, schedule file and effective date, submitted amount, allowed amount, denial or adjustment, and remittance. Keep January and July 2026 schedules as separate versions. A later rate should not overwrite the source used for an earlier date of service.

Apply the per-diem boundary

The state-plan page addresses intensive ABA rendered as a day program in an outpatient hospital or clinic. It says the per diem is not accompanied by an additional facility fee. Do not extend that statement to every clinic visit, professional service, non-day-program encounter, managed-care contract, or unrelated facility payment. Ask HCA to classify an ambiguous program in writing.

Use the live schedule and guide together

The ABA fee-schedule archive provides dated rate files, while the billing-guide page provides claim and program instructions. Store both. A number in a fee schedule does not establish authorization, client eligibility, covered unit, provider enrollment, or payment under a managed-care agreement.

Keep clinical and payment decisions separate

Current assessment rules and authorization rules remain distinct from rate methodology. A qualified clinician selects and updates treatment from individual need. The payer decides authorization under current rules. Finance then applies the correct rate and billing route; no payment edit should silently change treatment intensity.

A fictional Washington rate audit

Talia locks 31 facility days. Twenty-three have program classification, current authorization, day-program evidence, exact schedule row, no duplicate facility fee, submitted claim, and remittance. Completeness is 23 of 31, or 74.2%. Three use the July rate for January dates, two add a facility fee, one lacks day-program evidence, one has an expired authorization, and one omits the MCO contract route.

Handle adjustments without duplicating payment

Compare the original claim, replacement or void, remittance, payer notice, and net payment before resubmitting. Separate a schedule correction from a unit, provider, setting, or authorization correction. Preserve both gross and net movement. If a facility fee was paid with a per diem, route the exact cohort to compliance and HCA or the plan before refunding from an estimate.

Washington facility-rate checklist

Use the Washington Apple Health ABA facility rates 2026 register for final review. Verify SPA 26-0002, January 1 effective date, current schedule, provider and location, outpatient clinic or hospital class, day-program evidence, client eligibility, assessment and plan, authorization, code and unit, per diem, facility-fee exclusion, FFS or MCO route, claim, remittance, adjustment, continuity action, and source recheck.

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