Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-500 - Medical definitions › Section 182-500-0010 - Medical assistance definitions-A

Current through Register Vol. 24-14, July 15, 2024
"Administrative renewal"
means the agency uses
				  electronically available income and resources data sources to verify and
				  recertify a person's Washington apple health benefits for a subsequent
				  certification period. A case is administratively renewed when the person's
				  self-attested income and resources are reasonably compatible (as defined in WAC
				  182-500-0095) with the
				  information available to the agency from the electronic data sources and the
				  person meets citizenship, immigration, Social Security number, and age
				  requirements.
"After-pregnancy coverage (APC)"
means
				  full-scope Washington apple health (medicaid) health care coverage for people
				  up to 12 months after the month their pregnancy ends under WAC
				  182-505-0115.
"Agency"
or
"medicaid agency"
means
				  the Washington state health care authority (HCA).
"Agency's designee"
means any entity expressly
				  designated by the agency to act on its behalf.
"Allowable costs"
are the documented costs as
				  reported after any cost adjustment, cost disallowances, reclassifications, or
				  reclassifications to nonallowable costs which are necessary, ordinary and
				  related to the outpatient care of medical care clients or not expressly
				  declared nonallowable by applicable statutes or regulations. Costs are ordinary
				  if they are of the nature and magnitude which prudent and cost-conscious
				  management would pay.
"Alternative benefits plan"
means the range of
				  health care services included within the scope of service categories described
				  in WAC 182-501-0060 available to persons
				  eligible to receive health care coverage under the Washington apple health
				  modified adjusted gross income (MAGI)-based adult coverage described in WAC
				  182-505-0250.
"Ancillary services"
means additional services
				  ordered by the provider to support the core treatment provided to the patient.
				  These services may include, but are not limited to, laboratory services,
				  radiology services, drugs, physical therapy, occupational therapy, and speech
				  therapy.
"Apple health for kids"
is the umbrella term for
				  health care coverage for certain groups of children that is funded by the state
				  and federal governments under Title XIX medicaid programs, Title XXI Children's
				  Health Insurance Program, or solely through state funds (including the program
				  formerly known as the children's health program). Funding for any given child
				  depends on the program for which the child is determined to be eligible. Apple
				  health for kids programs are included in the array of health care programs
				  available through Washington apple health (WAH).
"Attested income"
or
"attested
				  resources"
means a self-declared statement of a person's income or
				  resources made under penalty of perjury to be true. (See also "
				  self-attestation.")
"Authorization"
means the agency's or the
				  agency's designee's determination that criteria are met, as one of the
				  preconditions to the agency's or the agency's designee's decision to provide
				  payment for a specific service or device. (See also "expedited prior
				  authorization" and "prior authorization.")
"Authorized representative"
is defined under WAC
				  182-503-0130.
11-14-075, recodifived as §
											182-500-0010, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090 and 2011 1st sp.s. c 15. 11-14-053,
					 § 388-500-0010, filed 6/29/11, effective
					 7/30/11.