Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-552 - Respiratory care › Section 182-552-0005 - Respiratory care-Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions and those in chapter 182-500 WAC
				  apply to this chapter.
"Adult family home"
- A residential home
				  licensed to care for up to six residents that provides rooms, meals, laundry,
				  supervision, assistance with activities of daily living, and personal care. In
				  addition to these services, some homes provide nursing or other special care
				  and services.
"Apnea"
- The cessation of airflow for at least
				  10 seconds.
"Apnea-hypopnea index (AHI)"
- The average
				  number of episodes of apnea and hypopnea per hour of sleep without the use of a
				  positive airway pressure device. For purposes of this chapter, respiratory
				  effort related arousals (RERAs) are not included in the calculation.
"Arterial PaO2"
-
				  Measurement of partial pressure of arterial oxygen.
"Authorized prescriber"
- A health care
				  practitioner authorized by law or rule in the state of Washington to prescribe
				  oxygen and respiratory care equipment, supplies, and services.
"Base year"
- As used in this chapter, means the
				  year in which the respiratory care current fee schedule is adopted.
"Bi-level respiratory assist device with backup
				  rate"
- A device that allows independent setting of inspiratory and
				  expiratory pressures to deliver positive airway pressure (within a single
				  respiratory cycle) by way of tubing and a noninvasive interface (such as a
				  nasal or oral facial mask) to assist spontaneous respiratory efforts and
				  supplement the volume of inspired air into the lungs. In addition, these
				  devices have a timed backup feature to deliver this air pressure whenever
				  sufficient spontaneous inspiratory efforts fail to occur.
"Bi-level respiratory assist device without backup
				  rate"
- A device that allows independent setting of inspiratory and
				  expiratory pressures to deliver positive airway pressure (within a single
				  respiratory cycle) by way of tubing and a noninvasive interface (such as a
				  nasal, oral, or facial mask) to assist spontaneous respiratory efforts and
				  supplement the volume of inspired air into the lungs.
"Blood gas study"
- For the purposes of this
				  chapter, is either an oximetry test or an arterial blood gas test.
"Boarding home"
- Adult residential care (ARC)
				  facility, enhanced adult residential care (EARC) facility, or assisted living
				  (AL) facility.
"Central sleep apnea (CSA)"
- Is defined
				  as:
(1) An apnea-hypopnea index (AHI)
				greater than or equal to five; and
(2) Central apneas/hypopneas greater than 50
				percent of the total apneas/hypopneas; and
(3) Central apneas or hypopneas greater than
				or equal to five times per hour; and
(4) Symptoms of either excessive sleepiness
				or disrupted sleep.
"Chronic obstructive pulmonary disease (COPD)"
-
				  Any disorder that persistently obstructs bronchial airflow. COPD mainly
				  involves two related diseases: Chronic bronchitis and emphysema. Both cause
				  chronic obstruction of air flowing through the airways and in and out of the
				  lungs. The obstruction is generally permanent and worsens over time.
"Complex sleep apnea (CompSA)"
- A form of
				  central apnea specifically identified by the persistence or emergence of
				  central apneas or hypopneas, upon exposure to CPAP or a bi-level respiratory
				  assist device without a back-up rate feature, when obstructive events have
				  disappeared. These clients have predominantly obstructive or mixed apneas
				  during the diagnostic sleep study occurring at greater than or equal to five
				  times per hour. With use of a CPAP or bi-level respiratory assist device
				  without a back-up rate feature, the client shows a pattern of apneas and
				  hypopneas that meets the definition of central sleep apnea (CSA).
"Continuous positive airway pressure (CPAP)"
- A
				  single-level device which delivers a constant level of positive air pressure
				  (within a single respiratory cycle) by way of tubing and an interface to assist
				  spontaneous respiratory efforts and supplement the volume of inspired air into
				  the lungs.
"Dependent edema"
- Fluid in the tissues,
				  usually ankles, wrists, and the arms.
"Emergency oxygen"
- The immediate, short-term
				  administration of oxygen to a client who normally does not receive oxygen but
				  is experiencing an acute episode which requires oxygen.
"Erythrocythemia"
- More hematocrit (red blood
				  cells) than normal.
"FIO2"
- The fractional
				  concentration of oxygen delivered to the client for inspiration. For the
				  purpose of this policy, the client's prescribed FIO2
				  refers to the oxygen concentration the client normally breathes when not
				  undergoing testing to qualify for coverage of a respiratory assist device
				  (RAD). That is, if the client does not normally use supplemental oxygen, their
				  prescribed FIO2 is that found in room air.
"FEV1"
- The forced expired volume in one
				  second.
"FVC"
- The forced vital capacity.
"Group I"
- Clinical criteria, set by medicare,
				  to identify clients requiring oxygen. The agency follows the Group I clinical
				  criteria listed in the Centers for Medicare and Medicaid Services National
				  Coverage Determination for Home Use of Oxygen, which is found in the Medicare
				  Coverage Database.
"Group II"
- Clinical criteria, set by medicare,
				  to identify clients who require oxygen. Their blood oxygen levels may be within
				  normal range, however, they have complicating conditions that require
				  supplemental oxygen use. The agency follows the Group II clinical criteria
				  listed in the Centers for Medicare and Medicaid Services National Coverage
				  Determination for Home Use of Oxygen, which is found in the Medicare Coverage
				  Database.
"Group III"
- Clients for whom intermittent home
				  oxygen therapy is considered medically necessary to treat cluster headaches.
				  These clients also have a documented clinical history that includes all of the
				  following:
* At least five attacks of severe, strictly unilateral pain
				  that is orbital, supraorbital, temporal, or in any combination of these sites,
				  lasting 15 to 180 minutes, and occurring at least once every other day up to
				  eight times a day;
* At least one of the following symptoms or signs,
				  ipsilateral to the headache:
-Conjunctival injection and/or lacrimation;
-Nasal congestion and/or rhinorrhea;
-Eyelid edema;
-Forehead and facial sweating; or
-Miosis and/or ptosis;
* Occurring with a frequency at least once every other day up
				  to eight times per day;
* Not better accounted for by another ICHD-3
				  diagnosis;
* Prevents ability to function in all activities; and
* Other treatment has failed.
"Home and community residential settings"
-
				  In-home, adult family home, or boarding home.
"Hypopnea"
- A temporary reduction of airflow
				  lasting at least ten seconds and accompanied with a 30 percent reduction in
				  thoracoabdominal movement or airflow as compared to baseline, and with at least
				  a four percent decrease in oxygen saturation. The AHI is the average number of
				  episodes of apnea and hypopnea per hour of sleep without the use of a positive
				  airway pressure device.
"Hypoxemia"
- Less than normal level of oxygen
				  in the blood.
"Maximum allowable"
- The maximum dollar amount
				  the medicaid agency reimburses a provider for a specific service, supply, or
				  piece of equipment.
"Month"
- For the purposes of this chapter,
				  means 30 days.
"Nebulizer"
- A medical device which administers
				  drugs for inhalation therapy for clients with respiratory conditions such as
				  asthma or emphysema.
"Obstructive sleep apnea (OSA)"
- This syndrome
				  refers to the interruption of breathing during sleep, due to obstructive tissue
				  in the upper airway that collapses into the air passage with
				  respiration.
"Oxygen"
- Medical grade liquid or gaseous
				  oxygen.
"Oxygen concentrator"
- A medical device that
				  removes nitrogen from room air and retains almost pure oxygen 87 percent to 95
				  percent) for delivery to a client.
"Oxygen system"
- All equipment necessary to
				  provide oxygen to a client.
"Portable oxygen system"
- A system which allows
				  the client to be independent of the stationary system for several hours,
				  thereby providing mobility for the client.
"Pulmonary hypertension"
- High blood pressure
				  in the vessels that feed through the lungs, causing the right side of the heart
				  to work harder to oxygenate blood.
"Respiratory care"
- The care of a client with
				  respiratory needs and all related equipment, oxygen, services, and
				  supplies.
"Respiratory care practitioner"
- A person
				  licensed by the department of health according to chapter 18.89 RCW and chapter
				  246-928 WAC as a respiratory therapist (RT) or respiratory care practitioner
				  (RCP).
"Respiratory effort related arousals (RERA)"
-
				  These occur when there is a sequence of breaths that lasts at least 10 seconds,
				  characterized by increasing respiratory effort or flattening of the nasal
				  pressure waveform, which lead to an arousal from sleep. However, they do not
				  meet the criteria of an apnea or hypopnea.
"Restrictive thoracic disorders"
- This refers
				  to a variety of neuromuscular and anatomical anomalies of the chest/rib cage
				  area that may result in hypoventilation, particularly while the client sleeps
				  at night.
"Reasonable useful lifetime (RUL)"
- For 36
				  month capped oxygen equipment, the RUL is five years. The RUL is not based on
				  the chronological age of the equipment. It starts on the initial date of the
				  rental and runs for five years from that date.
"Stationary oxygen system"
- Equipment designed
				  to be used in one location, generally for the purpose of continuous use or
				  frequent intermittent use.
Statutory Authority:
					 RCW
					 41.05.021. 12-14-022, §
											182-552-0005, filed 6/25/12,
					 effective 8/1/12.