reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-531A - Applied behavior analysis › Section 182-531A-0700 - Applied behavior analysis (ABA)-Stage three: Delivery of ABA services

Current through Register Vol. 24-14, July 15, 2024
(1) A provider must
				obtain prior authorization before delivery of applied behavior analysis (ABA)
				services. To request prior authorization, a provider must submit the following
				documents to the medicaid agency or follow the managed care organization (MCO)
				process:
(a) The comprehensive diagnostic
				evaluation and multidisciplinary clinical treatment plan completed by the
				center of excellence (COE) described in this chapter;
(b) The ABA assessment and ABA therapy
				treatment plan described in this chapter; and
(c) Any documents required by the agency's
				ABA provider guide.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-531A - Applied behavior analysis › Section 182-531A-0800 - Applied behavior analysis (ABA)-Provider requirements

Current through Register Vol. 24-14, July 15, 2024
Center of excellence.
(1) For the purposes of this chapter, center
				of excellence (COE) refers to an individual provider, not a facility.
(2) A center of excellence (COE) must be an
				evaluating and prescribing provider.
(3) The COE provider must be:
(a) A person licensed under Title 18 RCW who
				is experienced in the diagnosis and treatment of autism spectrum disorders and
				is:
(i) A developmental
				pediatrician;
(ii) A
				neurologist;
(iii) A pediatric
				neurologist;
(iv) A pediatric
				psychiatrist;
(v) A psychiatrist;
				or
(vi) A psychologist;
				or
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-531A - Applied behavior analysis › Section 182-531A-0900 - Applied behavior analysis (ABA)-Covered services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency covers only the
				following applied behavior analysis (ABA) services, delivered in settings
				described in WAC
				182-531A-0600, for eligible
				clients:
(a) The ABA assessments that
				determine the relationship between environmental events and the client's
				behaviors;
(b) The direct provision
				of ABA services by the therapy assistant (TA) or lead behavior analysis
				therapist (LBAT);
(c) Initial ABA
				assessment and development of a written, initial ABA therapy treatment plan,
				limited to one per year;
(d) Up to
				four additional ABA assessments and revisions of the initial ABA therapy
				treatment plan per year, if necessary to meet client's needs;
(e) One lifetime authorization of day
				treatment services. If a provider's request for covered services exceeds
				limitations in this section, the agency evaluates the request under WAC
				182-501-0169.
(f) Supervision of the TA;
(g) Training and evaluation of family members
				or caregivers to carry out the approved ABA therapy treatment plans;
(h) Observation of the client's behavior to
				determine the effectiveness of the approved ABA therapy treatment plan;
				and
(i) On-site assistance in the
				event of a crisis.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-531A - Applied behavior analysis › Section 182-531A-1000 - Applied behavior analysis (ABA)-Noncovered services

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency does not cover certain services under
				  the applied behavior analysis (ABA) program include, but are not limited
				  to:
(1)Autism camps;
(2)Dolphin therapy;
(3)Equine therapy or hippo therapy;
(4)Primarily educational services;
(5)Recreational therapy;
(6)Respite care;
(7)Safety monitoring services;
(8)School-based health care services or early
				intervention program-based services under WAC
				182-531A-0600(3)(b)(iii),
				unless prior authorized ;
(9)Vocational rehabilitation;
(10)Life coaching; and
(11) Treatment that is unproven or
				investigational for example, holding therapy, Higashi (day life therapy),
				auditory integration therapy).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-531A - Applied behavior analysis › Section 182-531A-1100 - Applied behavior analysis (ABA)-Prior authorization and recertification of ABA services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency requires prior authorization (PA) and recertification of the medical
				necessity of applied behavior analysis (ABA) services.
(2) Requirements for PA requests are
				described in WAC
				182-531A-0700.
(3) The agency may reduce or deny services
				requested based on medical necessity (refer to subsection (5) of this section)
				when completing PA or recertification responsibilities.
(4) The following are requirements for
				recertification of ABA services:
(a)
				Continued ABA services require the agency's authorization. Authorization is
				granted in three-month increments, or longer at the agency's
				discretion;
(b) The lead behavior
				analysis therapist (LBAT) must request authorization for continuing services 15
				calendar days prior to the expiration date of the current authorization. A
				reevalua-tion and revised ABA therapy treatment plan documenting the client's
				progress and showing measurable changes in the frequency, intensity, and
				duration of the targeted behavior/symptoms addressed in the previously
				authorized ABA therapy treatment plan must be submitted with this request.
				Documentation must include:
(i) Projection of
				eventual outcome;
(ii) Assessment
				instruments;
(iii) Developmental
				markers of readiness; and
(iv)
				Evidence of coordination with providers.
(c) When completing recertification
				responsibilities, the agency may request another evaluation from the COE to
				obtain that provider's review and recommendation. This COE provider must review
				the ABA therapy treatment plan, conduct a face-to-face visit with the client,
				facilitate a multidisciplinary record review of the client's progress, hold a
				family/caregiver conference, or request a second opinion before recommending
				continued ABA services. Services will continue pending
				recertification.
(d) When
				completing recertification responsibilities, the agency may retroactively
				authorize dates of service. Services will continue pending
				recertification.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-531A - Applied behavior analysis › Section 182-531A-1200 - Applied behavior analysis (ABA)-Services provided via telemedicine

Current through Register Vol. 24-14, July 15, 2024
Applied behavior analysis (ABA) services delivered using
				  telemedicine may be reimbursed by the agency when billed in accordance with the
				  rules regarding telemedicine and store-and-forward technology in WAC
				  182-501-0300 and the agency's
				  published billing instructions.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-050 - Reproductive health services-General

Current through Register Vol. 24-14, July 15, 2024
WAC 182-532-050 through
					 182-532-130
					 describe reproductive health services and related services covered by the
					 medicaid agency. For maternity-related services, see chapter 182-533 WAC. For
					 other related services, see chapter 182-531 WAC.
WSR 11-14-075, recodified as §
												182-532-050, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-050, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-050, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-050, filed 2/6/04, effective 3/8/04. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-050, filed 10/8/02, effective
						11/8/02. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800. WSR 00-14-066, §
						388-532-050, filed 7/5/00, effective
						8/5/00.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-100 - Reproductive health services-Eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency covers reproductive
				  health services, as described under WAC
				  182-532-120,
				  for clients covered by one of the Washington apple health programs as listed in
				  the table in WAC
				  182-501-0060.
(2) A client enrolled in an
				  agency-contracted managed care organization (MCO) may self-refer outside their
				  MCO for reproductive health care services including, but not limited to, family
				  planning, abortion, and sexually transmitted infection (STI) services from any
				  agency-approved provider.
(3) A
				  client who is age twenty-one or older may not self-refer outside their MCO for
				  sterilizations.
WSR 11-14-075, recodified as §
												182-532-100, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-100, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-100, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-100, filed 2/6/04, effective 3/8/04. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-100, filed 10/8/02, effective
						11/8/02. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800. WSR 00-14-066, §
						388-532-100, filed 7/5/00, effective
						8/5/00.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-110 - Reproductive health services-Provider requirements

Current through Register Vol. 24-14, July 15, 2024
To receive payment for reproductive health services, a
					 provider must:
(1) Meet the
				  requirements under this chapter and chapters 182-501 and 182-502 WAC;
(2) Provide only those services that are
				  within the scope of their licenses;
(3) Bill the agency according to the agency's
				  published billing guides;
(4)
				  Educate clients on Food and Drug Administration (FDA)-approved contraceptive
				  methods and over-the-counter (OTC) contraceptive drugs, devices, and products,
				  as well as related medical services;
(5) Provide medical services related to
				  FDA-approved contraceptive methods and OTC contraceptive drugs, devices, and
				  products upon request; and
(6)
				  Supply or prescribe FDA-approved contraceptive methods and OTC contraceptive
				  drugs, devices, and products upon request.
WSR 11-14-075, recodified as §
												182-532-110, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-110, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-110, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-110, filed 2/6/04, effective
						3/8/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-120 - Reproductive health services-Covered services

Current through Register Vol. 24-14, July 15, 2024
In addition to the services listed in WAC
					 182-531-0100,
					 the medicaid agency covers all of the following reproductive health
					 services:
(1) For a client capable of
				  reproducing, one comprehensive preventive family planning visit once every
				  twelve months, based on nationally recognized clinical guidelines, including:
(a) Sexually transmitted infection (STI) and
				  cancer screenings; and
(b)
				  Comprehensive and client-centered counseling, education, risk reduction, and
				  initiation or management of contraceptive methods.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-123

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						41.05.021,
						74.09.520,
						74.09.657,
						74.09.659, and
						74.09.800. WSR 13-16-008, §
												182-532-123, filed 7/25/13,
						effective 9/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-125

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						41.05.021,
						74.09.520,
						74.09.657,
						74.09.659, and
						74.09.800. WSR 13-16-008, §
												182-532-125, filed 7/25/13,
						effective 9/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-130 - Reproductive health services-Noncovered services

Current through Register Vol. 24-14, July 15, 2024
Noncovered reproductive health services are described in
					 WAC
					 182-501-0070
					 and
					 182-531-0150.
WSR 11-14-075, recodified as §
												182-532-130, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-130, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-130, filed 2/6/04, effective
						3/8/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › REPRODUCTIVE HEALTH SERVICES › Section 182-532-140 - Reproductive health services - Reimbursement and payment limitations

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				  reimburses providers for covered reproductive health services using the
				  department's published fee schedules.
(2) When a client enrolled in a
				  department-approved managed care plan self-refers outside the plan to either a
				  department-approved family planning provider or a department-contracted local
				  health department STD-I clinic for family planning or STD-I services, all
				  laboratory services must be billed through the family planning
				  provider.
(3) When a client
				  enrolled in a department managed care plan obtains family planning or STD-I
				  services from a department-approved family planning provider or a
				  department-contracted local health department/STD-I clinic which has a contract
				  with the managed care plan, those services must be billed directly to the
				  managed care plan.
WSR 11-14-075, recodified as §
												182-532-140, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-140, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-140, filed 2/6/04, effective
						3/8/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-500 - Family planning only programs-Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of family planning only programs is to provide
					 family planning services to:
(1)
				  Improve access to family planning and family planning-related
				  services;
(2) Reduce unintended
				  pregnancies; and
(3) Promote
				  healthy intervals between pregnancies and births.
WSR 11-14-075, recodified as §
												182-532-500, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-500, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-500, filed 2/6/04, effective
						3/8/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-510 - Family planning only programs-Eligibility

Current through Register Vol. 24-14, July 15, 2024
To be eligible for one of the family planning only programs
					 listed in this section, a client must meet the qualifications for that program.
					 For the purposes of this section, "full-scope coverage" means coverage under
					 either the categorically needy (CN) program, the broadest, most comprehensive
					 scope of health care services covered or the alternative benefits plan (ABP),
					 the same scope of care as CN, applicable to the apple health for adults
					 program.
(1)
Family planning
				  only - Pregnancy related program.
(a)
				  To be eligible for family planning only - Pregnancy related services, as
				  defined in WAC
				  182-532-001,
				  a client must be determined eligible for the Washington apple health for
				  pregnant women program during the pregnancy, or determined eligible for a
				  retroactive period covering the end of a pregnancy. See WAC
				  182-505-0115.
(b) A client is automatically eligible for
				  the family planning only - Pregnancy related program when the client's
				  pregnancy ends.
(c) A client may
				  apply for the family planning only program in subsection (2) of this section up
				  to sixty days before the expiration of the family planning only - Pregnancy
				  related program.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-520 - Family planning only programs-Provider requirements

Current through Register Vol. 24-14, July 15, 2024
To be paid by the medicaid agency for services provided to
					 clients eligible for family planning only programs, providers must:
(1) Meet the requirements under this chapter
				  and chapters 182-501 and 182-502 WAC;
(2) Provide only those services that are
				  within the scope of their licenses;
(3) Bill the agency according to the agency's
				  published billing guides;
(4)
				  Educate clients on Food and Drug Administration (FDA)-approved contraceptive
				  methods and over-the-counter (OTC) contraceptive drugs, devices, and products,
				  as well as related medical services;
(5) Provide medical services related to
				  FDA-approved contraceptive methods and OTC contraceptive drugs, devices, and
				  products as medically necessary;
(6) Supply or prescribe FDA-approved
				  contraceptive methods and OTC contraceptive drugs, devices, and products as
				  medically appropriate; and
(7)
				  Refer the client to available and affordable nonfamily planning primary care
				  services, as needed.
WSR 11-14-075, recodified as §
												182-532-520, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-520, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-520, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-520, filed 2/6/04, effective
						3/8/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-530 - Family planning only programs-Covered services

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency covers all of the following
					 services:
(1) One comprehensive
				  preventive family planning visit once every twelve months, based on nationally
				  recognized clinical guidelines. This visit must have a primary focus and
				  diagnosis of family planning and include counseling, education, risk reduction,
				  and initiation or management of contraceptive methods;
(2) Assessment and management of family
				  planning or contraceptive problems, when medically necessary;
(3) Contraception, including:
(a) Food and Drug Administration
				  (FDA)-approved contraceptive methods, as described under WAC
				  182-530-2000;
(b) Education and supplies for Federal Drug
				  Administration (FDA)-approved contraceptive, natural family planning, and
				  abstinence; and
(c) Sterilization
				  procedures, as described under WAC
				  182-531-1550.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-533

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						41.05.021,
						74.09.520,
						74.09.657,
						74.09.659, and
						74.09.800. WSR 13-16-008, §
												182-532-533, filed 7/25/13,
						effective 9/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-540

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-540, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-540, filed 11/30/05, effective 12/31/05; WSR 04-05-011, §
						388-532-540, filed 2/6/04, effective
						3/8/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-550 - Family planning only programs - Payment limitations

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency limits payment under
				  the family planning only programs to services that:
(a) Have a primary focus and diagnosis of
				  family planning as determined by a qualified licensed medical practitioner;
				  and
(b) Are medically necessary for
				  the client to safely and effectively use, or continue to use, the client's
				  chosen contraceptive method.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-560 - Family planning only programs-Documentation requirements

Current through Register Vol. 24-14, July 15, 2024
In addition to the requirements in WAC
					 182-502-0020,
					 providers must document the following in the client's medical record:
(1) Primary focus and diagnosis of the visit
				  is family planning related;
(2)
				  Contraceptive methods discussed;
(3) Plan for use of a contraceptive method,
				  or the reason and plan for no contraceptive method;
(4) Education, counseling, and risk reduction
				  with sufficient detail that allows for follow-up;
(5) Referrals to, or from, other providers;
				  and
(6) If applicable, a copy of
				  the completed consent form for sterilization. (See WAC
				  182-531-1550
				  )
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › FAMILY PLANNING ONLY PROGRAMS › Section 182-532-570 - Family planning only programs-Good cause exemption from billing third-party insurance

Current through Register Vol. 24-14, July 15, 2024
(1) For the
				  purposes of this section, "good cause" means that the use of the third-party
				  coverage would violate a client's confidentiality because the third party:
(a) Routinely sends written, verbal, or
				  electronic communications, as defined in
				  RCW
				  48.43.505, to the third-party subscriber and
				  that subscriber is someone other than the client; or
(b) Requires the client to use a primary care
				  provider who is likely to report the client's request for family planning
				  services to the subscriber.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-700

Current through Register Vol. 24-14, July 15, 2024
11-14-075, recodified as §
												182-532-700, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-700, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-700, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). 02-21-021, § 388-532-700, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-720

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-720, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-720, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-720, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.04.050,
						74.04.055,
						74.04.057,
						74.08.090. WSR 04-15-057, §
						388-532-720, filed 7/13/04, effective 8/13/04. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-720, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-730

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-730, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090. WSR 10-19-057, § 388-532-730,
						filed 9/14/10, effective 10/15/10. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-730, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-730, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-730, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-740

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-740, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-740, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-740, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-740, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-743

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
						RCW
						41.05.021,
						74.09.520,
						74.09.657,
						74.09.659, and
						74.09.800. WSR 13-16-008, §
												182-532-743, filed 7/25/13,
						effective 9/1/13.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-745

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-745, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-745, filed 5/13/08, effective
						6/13/08.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-750

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-750, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-750, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-750, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-750, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-760

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-760, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090. WSR 10-19-057, § 388-532-760,
						filed 9/14/10, effective 10/15/10. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-760, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-760, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-760, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-780

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-780, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-780, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-780, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-780, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-532 - Reproductive health/family planning only programs › TAKE CHARGE PROGRAM › Section 182-532-790

Current through Register Vol. 24-14, July 15, 2024
WSR 11-14-075, recodified as §
												182-532-790, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090 and
						74.09.800. WSR 08-11-031, §
						388-532-790, filed 5/13/08, effective 6/13/08. Statutory Authority:
						RCW
						74.08.090,
						74.09.520, and
						74.09.800. WSR 05-24-032, §
						388-532-790, filed 11/30/05, effective 12/31/05. Statutory Authority:
						RCW
						74.08.090,
						74.09.520,
						74.09.800, and SSB 5968, 1999 c
						392 § 2(12). WSR 02-21-021, § 388-532-790, filed 10/8/02, effective
						11/8/02.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0300 - Services under First Steps

Current through Register Vol. 24-14, July 15, 2024
(1) Under
				  the 1989 Maternity Care Access Act, and
				  RCW
				  74.09.760 through
				  74.09.910, the agency established
				  First Steps to provide access to services for eligible women and their
				  infants.
(2) The rules for the:
(a) Maternity support services (MSS)
				  component of First Steps are found in WAC
				  182-533-0310 through
				  182-533-0345.
(b) Infant case management (ICM) component of
				  First Steps are found in WAC
				  182-533-0360 through
				  182-533-0386.
(c) Childbirth education (CBE) component of
				  First Steps are found in WAC
				  182-533-0390.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0310 - Maternity support services - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of maternity support services (MSS) is
					 to:
(1) Improve and promote healthy
				  birth outcomes. Services are delivered by an MSS interdisciplinary team to
				  eligible pregnant and post-pregnant women and their infants.
(2) Help eligible clients to access:
(a) Prenatal care as early in the pregnancy
				  as possible; and
(b) Health care
				  for their infants.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0320 - Maternity support services Client eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) To receive maternity support services
				  (MSS), a client must:
(a) Be covered under
				  the alternative benefit plan, categorically needy, medically needy, or
				  state-funded medical programs under Washington apple health; and
(b) Be within the eligibility period of a
				  maternity cycle as defined in WAC
				  182-533-0315.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0325 - Maternity support services Provider requirements

Current through Register Vol. 24-14, July 15, 2024
Maternity support service providers may include community
					 clinics, federally qualified health centers, local health departments,
					 hospitals, nonprofit organizations, and private clinics.
(1) To be paid for providing maternity
				  support services (MSS) and infant case management (ICM) services to eligible
				  clients, a provider must:
(a) Be enrolled as
				  an eligible provider with the medicaid agency (see WAC
				  182-502-0010 ).
(b) Be currently approved as an MSS/ICM
				  provider by the medicaid agency.
(c) Meet the requirements in this chapter,
				  chapter 182-502 WAC and the medicaid agency's current billing
				  instructions.
(d) Ensure that
				  professional staff providing services:
(i)
				  Meet the minimum regulatory and educational qualifications for the scope of
				  services provided under WAC
				  182-533-0327; and
(ii) Follow the requirements in this chapter
				  and the medicaid agency's current billing instructions.
(e) Screen each client for risk factors using
				  the agency's designated MSS screening tool, located on the agency's web site
				  under forms. Agency approval is required for a provider to use an alternate MSS
				  screening tool.
(f) Screen clients
				  for ICM eligibility.
(g) Conduct
				  case conferences under WAC
				  182-533-0327(2).
(h) Develop and implement an individualized
				  care plan for each client.
(i)
				  Initiate and participate in care coordination activities throughout the
				  maternity cycle with at least MSS interdisciplinary team members, the client's
				  prenatal care provider, and the Women, Infants, and Children (WIC) Nutrition
				  Program.
(j) Comply with Section
				  1902(a)(23) of the Social Security Act regarding the client's freedom to choose
				  a provider.
(k) Comply with Section
				  1915(g)(1) of the Social Security Act regarding the client's voluntary receipt
				  of services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0327 - Maternity support services-Professional staff qualifications and interdisciplinary team

Current through Register Vol. 24-14, July 15, 2024
(1) MSS providers
				  must use qualified professionals, as specified in this section.
(a) Behavioral health specialists who are
				  currently credentialed, certified, or licensed in Washington by the department
				  of health under chapters 246-809, 246-810, 246-811, and 246-924 WAC as one of
				  the following:
(i) Licensed mental health
				  counselor.
(ii) Licensed
				  independent clinical social worker.
(iii) Licensed social worker.
(iv) Licensed marriage and family
				  therapist.
(v) Licensed
				  psychologist.
(vi) Associate mental
				  health counselor.
(vii) Associate
				  independent clinical social worker.
(viii) Associate social worker.
(ix)  Associate marriage and family
				  therapist.
(x) Certified
				  counselor.
(xi) Certified substance
				  use disorder professional.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0328 - Maternity support services-Documentation requirements

Current through Register Vol. 24-14, July 15, 2024
Providers must fulfill the documentation requirements
					 under WAC
					 182-502-0020 and the medicaid
					 agency's current billing instructions including:
(1) Required supervision records for
				  community health workers;
(2)
				  Continued education verification and renewal of credentials for professional
				  staff;
(3) Subcontracting
				  documents, as specified under WAC
				  182-533-0325(3);
				  and
(4) Client records, which
				  include consent forms and documentation for screening, assessments, care plans,
				  case conferences, case management, and care coordination for each
				  client.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0330 - Maternity support services - Covered services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency must cover these
				  maternity support services (MSS) provided by an MSS interdisciplinary team:
(a) In-person screening(s) for risk factors
				  related to pregnancy and birth outcomes;
(b) Brief assessment when
				  indicated;
(c) Brief
				  counseling;
(d) Education that
				  relates to improving pregnancy and parenting outcomes;
(e) Interventions for risk factors identified
				  on the care plan;
(f) Basic health
				  messages;
(g) Case management
				  services;
(h) Care coordination;
(i) Infant case management (ICM)
				  screening.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0340 - Maternity support services - Noncovered services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency must cover only those
				  services listed in WAC
				  182-533-0330.
(2) The medicaid agency must evaluate a
				  request for any noncovered service under the provisions of WAC
				  182-501-0160.
11-14-075, recodified as §
												182-533-0340, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.760 through
						74.09.910, and 2009 c 564 §
						1109. 10-12-011, § 388-533-0340, filed 5/21/10, effective 6/21/10.
						Statutory Authority:
						RCW
						74.04.050,
						74.08.090,
						74.09.530, and
						74.09.700. 06-24-036, §
						388-533-0340, filed 11/30/06, effective 1/1/07. Statutory Authority:
						RCW
						74.08.090,
						74.09.760 through
						74.09.910. 04-13-049, §
						388-533-0340, filed 6/10/04, effective
						7/11/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0345 - Maternity support services-Payment

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency pays for the covered maternity support
					 services (MSS) described in WAC
					 182-533-0330, subject to the
					 requirements in this section:
(1) MSS
				  are:
(a) Provided to a client who meets the
				  eligibility requirements in WAC
				  182-533-0320.
(b) Provided to a client during a
				  face-to-face encounter on an individual basis or in a group setting. If
				  provided in a group setting, the group must consist of at least three but no
				  more than twelve clients.
(c)
				  Provided by a provider that meets the criteria in WAC
				  182-533-0325. When provided in a
				  group setting, services may not be provided by a community health
				  worker.
(d) Provided according to
				  the agency's maternity support services (MSS)/infant case management (ICM)
				  provider guide.
(e) Documented in
				  the client's record or chart.
(f)Billed using:
(i) The eligible client's agency-assigned
				  client identification number;
(ii)
				  The appropriate procedure codes, modifiers, and allowed number of units
				  identified in the agency's MSS/ICM provider guide; and
(iii) The provider's national provider
				  identifier and MSS/ICM taxonomy.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0360 - Infant case management - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of infant case management (ICM) is to improve
					 the welfare of infants by providing their parent(s) with information and
					 assistance to access needed medical, social, educational, and other
					 services.
11-14-075, recodified as §
												182-533-0360, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.760 through
						74.09.910, and 2009 c 564 §
						1109. 10-12-010, § 388-533-0360, filed 5/21/10, effective 6/21/10.
						Statutory Authority:
						RCW
						74.08.090,
						74.09.760 through
						74.09.910. 04-13-049, §
						388-533-0360, filed 6/10/04, effective
						7/11/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0365 - Infant case management - Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions in WAC
					 182-533-0315 also apply to infant
					 case management (ICM).
11-14-075, recodified as §
												182-533-0365, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.760 through
						74.09.910, and 2009 c 564 §
						1109. 10-12-010, § 388-533-0365, filed 5/21/10, effective 6/21/10.
						Statutory Authority:
						RCW
						74.08.090,
						74.09.760 through
						74.09.910. 04-13-049, §
						388-533-0365, filed 6/10/04, effective
						7/11/04.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0370 - Infant case management-Client eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) To be eligible to receive infant case
				  management (ICM), an infant must meet all the following criteria:
(a) Be covered under categorically needy,
				  medically needy, or state-funded medical programs under Washington apple
				  health.
(b) Meet the age
				  requirement for ICM, which is the day after the maternity cycle (defined in WAC
				  182-533-0315
				  ) ends, through the last day of the month of the infant's first
				  birthday.
(c) Reside with at least
				  one parent who provides the infant's day-to-day care and is:
(i) The infant's natural or adoptive
				  parent(s);
(ii) A person other than
				  a foster parent who has been granted legal custody of the infant; or
(iii) A person who is legally obligated to
				  support the infant.
(d)
				  Have a parent(s) who needs assistance in accessing medical, social, educational
				  and/or other services to meet the infant's basic health and safety
				  needs.
(e) Not be receiving any
				  case management services funded through Title XIX medicaid that duplicate ICM
				  services.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-533 - Maternity-related services › FIRST STEPS SERVICES FOR WOMEN AND INFANTS › Section 182-533-0375 - Infant case management Provider requirements

Current through Register Vol. 24-14, July 15, 2024
(1) Infant case management (ICM) services may
				  be provided only by a qualified infant case manager who is employed by a
				  provider meeting the requirements in WAC
				  182-533-0325.
(2) The infant case manager must meet at
				  least one of the following qualifications under (a), (b), or (c) of this
				  subsection:
(a) Be a current member of the
				  maternity support services (MSS) interdisciplinary team under WAC
				  182-533-0327(1)(a), (b), or
				  (c).
(b) Have a bachelor of arts, bachelor of
				  science, or higher degree in a social service-related field, such as social
				  work, behavioral sciences, psychology, child development, or mental health,
				  plus at least one year of full-time experience working in one or more of the
				  following areas:
(i) Community
				  services;
(ii) Social
				  services;
(iii) Public health
				  services;
(iv) Crisis
				  intervention;
(v) Outreach and
				  referral programs; or
(vi) Other
				  related fields.
(c) Have
				  an associate of arts degree, or an associate's degree in a social
				  service-related field, such as social work, behavioral sciences, psychology,
				  child development, or mental health, plus at least two years of full-time
				  experience working in one or more of the following areas:
(i) Community services;
(ii) Social services;
(iii) Public health services;
(iv) Crisis intervention;
(v) Outreach and referral programs;
(vi) Other related fields.