reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › Section 182-538D-0258 - Behavioral health administrative service organizations-Administration of the Mental Health Involuntary Treatment Act and Substance Use Disorders Involuntary Treatment Act

Current through Register Vol. 24-14, July 15, 2024
Behavioral health administrative service organizations
				  (BH-ASOs) are responsible for administration of the Mental Health Involuntary
				  Treatment Act and Substance Use Disorders Involuntary Treatment Act, including
				  investigation, detention, transportation for people not eligible for medicaid,
				  due process and other court-related services, and other services required by
				  chapters 71.05, 71.24, and 71.34 RCW. This includes:
(1) BH-ASOs ensuring that designated crisis
				responders (DCRs) perform the duties of involuntary investigation and detention
				in accordance with the requirements of chapters 71.05, 71.24, and 71.34
				RCW.
(2) BH-ASOs and managed care
				organizations documenting the person's compliance with the conditions of mental
				health less restrictive alternative court orders by:
(a) Ensuring periodic evaluation of each
				committed person for release from or continuation of an involuntary treatment
				order. Evaluations must be recorded in the clinical record, and must occur at
				least monthly for ninety-day commitments and one hundred eighty-day
				commitments.
(b) Notifying the DCR
				if noncompliance with the less restrictive alternative order impairs the person
				sufficiently to warrant detention or evaluation for detention and petitioning
				for revocation of the less restrictive alternative court order.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › Section 182-538D-0264 - Behavioral health administrative service organizations and managed care organizations-Quality plan

Current through Register Vol. 24-14, July 15, 2024
A behavioral health administrative service organization
				  (BH-ASO) and managed care organization (MCO) must have a quality plan for
				  continuous quality improvement in the delivery of culturally competent
				  behavioral health services. See WAC
				  182-538-140 for
				  MCOs and WAC
				  182-538C-040
				  for BH-ASOs.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › Section 182-538D-0380 - Managed care organization-Choice of primary behavioral health provider

Current through Register Vol. 24-14, July 15, 2024
The managed care organization (MCO) must:
(1) Ensure that each person receiving
				nonemergency behavioral health rehabilitation services has a primary behavioral
				health provider who is responsible to carry out the individual service plan;
				and
(2) Allow people, parents of
				people age twelve and younger, and guardians of people of all ages to select a
				primary behavioral health provider from the available primary behavioral health
				provider staff within the MCO.
(3)
				Assign a primary behavioral health provider not later than fifteen working days
				after the person requests services if the person does not select a primary
				behavioral health provider.
(4)
				Allow a person to change primary behavioral health providers at any time for
				any reason. The person must notify the MCO or its designee of the request for a
				change, and inform the MCO or designee of the name of the new primary
				behavioral health provider.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › DEPARTMENT OF CORRECTIONS ACCESS TO CONFIDENTIAL MENTAL HEALTH INFORMATION › Section 182-538D-0600 - Purpose

Current through Register Vol. 24-14, July 15, 2024
In order to enhance and facilitate the department of
					 corrections' ability to carry out its responsibility of planning and ensuring
					 community protection, mental health records and information, as defined in this
					 section, that are otherwise confidential shall be released by any mental health
					 service provider to the department of corrections personnel for whom the
					 information is necessary to carry out the responsibilities of their office as
					 authorized in
					 RCW
					 71.05.445. Department of corrections
					 personnel must use records only for the stated purpose and must assure that
					 records remain confidential and subject to the limitations on disclosure
					 outlined in chapter 71.05 RCW, except as provided in
					 RCW
					 72.09.585.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › DEPARTMENT OF CORRECTIONS ACCESS TO CONFIDENTIAL MENTAL HEALTH INFORMATION › Section 182-538D-0620 - Scope

Current through Register Vol. 24-14, July 15, 2024
Many records and reports are updated on a regular or as
					 needed basis. The scope of the records and reports to be released to the
					 department of corrections are dependent upon the reason for the request.
(1) For the purpose of a presentence
				  investigation release only the most recently completed or received records of
				  those completed or received within the twenty-four-month period before the date
				  of the request; or
(2) For all
				  other purposes including risk assessments release all versions of records and
				  reports that were completed or received within the ten year period prior to the
				  date of the request that are still available.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › DEPARTMENT OF CORRECTIONS ACCESS TO CONFIDENTIAL MENTAL HEALTH INFORMATION › Section 182-538D-0630 - Time frame

Current through Register Vol. 24-14, July 15, 2024
The mental health service provider will provide the
					 requested relevant records, reports and information to the authorized
					 department of corrections person in a timely manner, according to the purpose
					 of the request:
(1) Presentence
				  investigation - Within seven days of the receipt of the request. If some or all
				  of the requested relevant records, reports and information are not available
				  within that time period the mental health service provider shall notify the
				  authorized department of corrections person prior to the end of the
				  seven-day-period and provide the requested relevant records, reports or
				  information within a mutually agreed to time period; or
(2) All other purposes - Within thirty days
				  of the receipt of the request. If some or all of the requested relevant
				  records, reports and information are not available within that time period the
				  mental health service provider shall notify the authorized department of
				  corrections person prior to the end of the thirty-day period and provide the
				  requested relevant records, reports or information within a mutually agreed to
				  time period; or
(3) Emergent
				  situation requests - When an offender subject has failed to report for
				  department of corrections supervision or in an emergent situation that poses a
				  significant risk to the public, the mental health provider shall upon request,
				  release information related to mental health services delivered to the offender
				  and, if known, information regarding the whereabouts of the offender. Requests
				  if oral must be subsequently confirmed in writing the next working day, which
				  includes email or facsimile so long as the requesting person at the department
				  of corrections is clearly defined. The request must specify the information
				  being requested. Disclosure of the information requested does not require the
				  consent of consumer.
Information that can be released is limited to:
(a) A statement as to whether the offender is
				  or is not being treated by the mental health services provider; and
(b) Address or information about the location
				  or whereabouts of the offender.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-538D - Behavioral health services › DEPARTMENT OF CORRECTIONS ACCESS TO CONFIDENTIAL MENTAL HEALTH INFORMATION › Section 182-538D-0640 - Written requests

Current through Register Vol. 24-14, July 15, 2024
The written request for relevant records, reports and
					 information must include:
(1)
				  Verification that the person for whom records, reports and information are
				  being requested is under the authority of the department of corrections, per
				  chapter 9.94A RCW, and the expiration date of that authority;
(2) Sufficient information to identify the
				  person for whom records, reports and information are being requested including
				  name and other identifying data;
(3) Specification as to which records and
				  reports are being requested and the purpose for the request;
(4) Specification as to what relevant
				  information is requested and the purpose for the request;
(5) Identification of the department of
				  corrections person to whom the records, reports and information shall be sent,
				  including the person's name, title and address;
(6) Name, title and signature of the
				  requestor and date of the request.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-539 - HIV/AIDS related services › Section 182-539-0200 - AIDS-Health insurance premium payment program

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of the AIDS health insurance
				premium payment program is to help people who are not eligible for the medicaid
				agency's Washington apple health medical programs and who are diagnosed with
				AIDS pay their health insurance premiums.
(2) To be eligible for the AIDS health
				insurance premium payment program:
(a) A
				person must be:
(i) Diagnosed with AIDS as
				defined in WAC
				246-100-011;
(ii) A resident of the state of
				Washington;
(iii) Responsible for
				all or part of the health insurance premium payment (without the agency's
				help);
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-539 - HIV/AIDS related services › Section 182-539-0300 - Case management for persons living with HIV/AIDS

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency provides HIV/AIDS case management to
				  assist people infected with HIV to: Live as independently as possible; maintain
				  and improve health; reduce behaviors that put the person and others at risk;
				  and gain access to needed medical, social, and educational services.
(1) To be eligible for agency-reimbursed
				HIV/AIDS case management services, a person must:
(a) Have a current medical diagnosis of HIV
				or AIDS;
(b) Be eligible for Title
				XIX (medicaid) coverage under either the categorically needy program (CNP) or
				the medically needy program (MNP); and
(c) Require:
(i) Assistance to obtain and effectively use
				necessary medical, social, and educational services; or
(ii) Ninety days of continued monitoring
				under WAC
				182-539-0350(2).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-539 - HIV/AIDS related services › Section 182-539-0350 - HIV/AIDS case management reimbursement information

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency pays HIV/AIDS case
				management providers for the following three services:
(a) Comprehensive assessment. The assessment
				must cover the areas outlined in WAC
				182-539-0300(1) and
				(5).
(i)
				The agency pays for only one comprehensive assessment unless the client's
				situation changes as follows:
(A)There is a
				fifty percent change in need from the initial assessment; or
(B)The client transfers to a new case
				management provider.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-001 - Purpose

Current through Register Vol. 24-14, July 15, 2024
This chapter (WAC
					 182-540-001 through
					 182-540-065 ) contains rules for
					 the state-funded kidney disease program (KDP) administered by the health care
					 authority (the agency). The KDP is available for persons who have end-stage
					 renal disease requiring dialysis or kidney transplant, or persons who have
					 received a kidney transplant but who do not meet the eligibility standards for
					 any other Washington apple health program including medicaid or state-only
					 funded medical programs.
Statutory
					 Authority: 11-14-075, recodified as §
											182-540-001, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.510,
					 74.09.520,
					 74.09.522, and
					 42 C.F.R.
					 405.2101. WSR 03-21-039, § 388-540-001,
					 filed 10/8/03, effective 11/8/03. Statutory Authority:
					 RCW
					 74.04.050 and
					 74.08.090. WSR 00-01-088, §
					 388-540-001, filed 12/14/99, effective 1/14/00. Statutory Authority:
					 RCW
					 74.08.090. WSR 93-16-039 (Order 3600), §
					 388-540-001, filed 7/28/93, effective 8/28/93. WSR 13-23-007, §
											182-540-001, filed 11/7/2013,
					 effective 12/8/2013
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-021 - Kidney disease program (KDP) - Household size

Current through Register Vol. 24-14, July 15, 2024
(1) Household size is used to determine the
				  appropriate income standard for KDP eligibility and also whose income must be
				  counted or not counted.
(2) The
				  following members of a person's household must be included when determining the
				  household size:
(a) The applicant's spouse if
				  living in the same home;
(b)
				  Dependent children eighteen years of age and younger with no income who live in
				  the same household and for whom the person is legally responsible;
(c) Children nineteen through twenty-one
				  years of age who are attending full-time school or college; and
(d) Any other members of a person's household
				  that the person claimed as a dependent on their most recent federal income tax
				  return.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-022 - Kidney disease program (KDP)-Income eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) A household must have countable income at
				  or below two hundred twenty percent of the federal poverty level for a person
				  to be eligible for the kidney disease program (KDP). See WAC
				  182-540-021 to determine who must
				  be included in the household and whose income counts.
(2)The KDP contractor determines the
				  household's income based upon the information reported in the KDP application
				  and may request additional verification if the information in the application
				  is not clear. A KDP applicant must provide verification of all household income
				  (and expenses, if self-employed) to the KDP contractor for a KDP eligibility
				  determination.
(3)The agency does
				  not count the following income:
(a) The first
				  twenty dollars per month of unearned income for the entire household;
(b)Cost-of-living adjustments (COLAs) to
				  Social Security disability benefits and supplemental security income (SSI)
				  benefits that take effect in the calendar year of a KDP eligibility
				  determination and any subsequent COLAs to these benefits received by:
(i) The applicant;
(ii) The applicant's spouse; or
(iii) Other family members included in the
				  household size.
(c)Fifty
				  percent of the gross earned income of any person included in the household
				  size;
(d) Income received by a
				  dependent child age eighteen or younger who is not included in the household
				  size; or
(e) Any income source
				  which is specifically excluded by federal law.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-023 - Kidney disease program (KDP) - Change of circumstances

Current through Register Vol. 24-14, July 15, 2024
(1) A person who is
				  approved for KDP is required to report changes in their circumstances to the
				  KDP contractor within thirty days of the date of the change. The person is
				  required to report the following changes:
(a)
				  When total income for household members included in the KDP household size goes
				  above two hundred twenty percent FPL and the change is expected to last for
				  thirty calendar days or longer;
(b)
				  When countable resources exceed the standards described in WAC
				  182-540-030;
(c) When there is a change in household
				  members or household size;
(d) When
				  the person is determined eligible for medicare; or
(e) When the person is no longer a resident
				  in the state of Washington.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-025 - Kidney disease program (KDP) - Application and recertification requirements - KDP contractor

Current through Register Vol. 24-14, July 15, 2024
When a person applies for the kidney disease program
					 (KDP), the KDP contractor must :
(1)
Inform the applicant of the requirements for KDP
					 eligibility as defined in this chapter , provide the applicant with the
					 necessary forms and instructions
to complete the KDP application, and provide the applicant
					 with a copy of the person's rights and responsibilities.
(2) If required, help the applicant submit an
				  application for medical benefits with the department of social and health
				  services (DSHS) community services office or the health benefits exchange.
(a) The KDP contractor must obtain the
				  person's application documentation from DSHS or the health benefits exchange
				  and keep a copy in the person's record.
(b) The KDP contractor may authorize KDP
				  payment pending the outcome of the medical application; however, if the person
				  is subsequently approved for medical coverage for any month in which KDP funds
				  were authorized, those expenses must not be billed to KDP. If KDP has already
				  reimbursed those funds, the contractor must refund the KDP, subject to
				  exceptions for transportation expenses, health insurance premiums, and expenses
				  paid by the KDP which were used to meet a spenddown liability as described in
				  WAC 182-540-015(6)(a), (b), and
				  (c).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-026 - Kidney disease program (KDP) - Application and recertification requirements - Client

Current through Register Vol. 24-14, July 15, 2024
(1) An applicant
				  for KDP must:
(a) Complete the KDP
				  application form and submit any necessary documentation to the KDP contractor
				  in order to make an eligibility determination;
(b) Do one of the following:
(i) Provide application documentation from
				  the department of social and health services (DSHS) or the Washington
				  Healthplanfinder verifying that the applicant applied for Washington apple
				  health (WAH) within the six-month period prior to the month of application for
				  KDP, and that the application for WAH was denied due to an eligibility
				  requirement and not because the person failed to complete the application
				  process; or
(ii) Submit an
				  application for WAH to DSHS and/or via the Washington Healthplanfinder, as
				  applicable, and provide the KDP contractor with a copy of the application
				  documentation when an eligibility determination has been made; and
(c) Apply for medicare within
				  thirty calendar days of applying for KDP and provide written proof from the
				  Social Security Administration that the application was approved or denied. A
				  copy of the proof must be kept in the person's record.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-030 - Kidney disease program (KDP)-Resource eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) The person's household must have
				  countable resources at or below the limits established in the federal
				  low-income subsidy (LIS) program for the person to be eligible for the kidney
				  disease program. LIS resource standards are listed at
https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources
.
(2) See WAC
				  182-540-021 to determine who must
				  be included in the household when making a determination of whose resources
				  count.
(3) The following resources
				  are not counted:
(a) A home, defined as real
				  property owned by a client as their principal place of residence together with
				  surrounding and contiguous property;
(b) Household furnishings;
(c) One burial plot per household member or
				  irrevocable burial plans with a mortuary;
(d) Up to $1,500 for a person or $3,000 for a
				  couple set aside in a revocable burial account;
(e) Any resource which is specifically
				  excluded by federal law.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-045 - Kidney disease program (KDP) contractor requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The kidney disease program (KDP)
				  contractor must:
(a) Be a medicare-certified
				  end-stage renal disease (ESRD) facility; and
(b) Have a valid KDP client services contract
				  with the agency.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-055 - Kidney disease program (KDP) covered services

Current through Register Vol. 24-14, July 15, 2024
(1) The kidney disease program (KDP) covers
				  the cost of health care services essential to the treatment of end-stage renal
				  disease (ESRD) and its complications. Within available funding and at the
				  discretion of the KDP contractor covered services include:
(a) Dialysis:
(i) Center dialysis((
-
)) Covers
				  the cost of dialysis, necessary supplies, and related services provided in a
				  kidney center;
(ii) Home
				  dialysis((
-
)) Covers the cost of providing dialysis and related
				  services in the home; and
(iii)
				  Dialysis while hospitalized((
-
)) Covers the cost of dialysis and
				  related services while the KDP client is confined to an acute care facility and
				  is unable to dialyze at his/ her regular site.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-060 - Kidney disease program (KDP) client appeal rights

Current through Register Vol. 24-14, July 15, 2024
(1) Clients have the right to appeal:
(a) KDP eligibility decisions made by the
				  person's KDP contractor;
(b)
				  Coverage decisions made by the contractor or the first decision submitted by
				  the agency for medical services or devices that are not considered to be for
				  the treatment of the person's ESRD diagnosis; or
(c) The denial, made by the KDP contractor,
				  of services found in WAC
				  182-540-055(1) 
				  which have been denied by a KDP contractor.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY DISEASE PROGRAM (STATE-FUNDED) › Section 182-540-065 - Kidney disease program (KDP) - Reimbursement

Current through Register Vol. 24-14, July 15, 2024
(1) The agency reimburses KDP contractors:
(a) Within the limits of legislative funding
				  for the program;
(b) According to
				  the terms of each kidney center's contract with the agency; and
(c) According to the provisions of the KDP
				  manual.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-101 - Purpose and scope

Current through Register Vol. 24-14, July 15, 2024
This section describes the medicaid agency reimbursement
					 rules for free-standing kidney centers providing dialysis and end-stage renal
					 disease services to agency clients.
11-14-075, recodified as §
												182-540-101, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.510,
						74.09.520,
						74.09.522, and
						42 C.F.R.
						405.2101. 03-21-039, § 388-540-101,
						filed 10/8/03, effective 11/8/03.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-110 - Eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) To be eligible
				  for the kidney center services described in this section, a person must be
				  diagnosed with end-stage renal disease (ESRD) or acute renal failure and be
				  covered under:
(a) One of the Washington
				  apple health programs listed in the table in WAC
				  182-501-0060;
(b) Alien emergency medical; or
(c) Qualified medicare beneficiary (QMB) -
				  (The agency pays only for medicare premium, coinsurance and
				  deductible).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-120 - Provider requirements

Current through Register Vol. 24-14, July 15, 2024
To receive reimbursement from the medicaid agency for
					 providing care to agency clients, a kidney center must:
(1) Be a medicare-certified end-stage renal
				  disease (ESRD) facility and have a signed core provider agreement with the
				  agency (see chapter 182-502 WAC);
(2) Meet requirements found in chapter
				  182-502 WAC;
(3) Provide only those
				  services within the scope of their provider's license; and
(4) Provide, either directly or through an
				  affiliate, all physical facilities, professional consultation, personal
				  instructions, medical treatment, care, and all supplies necessary for carrying
				  out an medically sound ESRD treatment program, including :
(a) Dialysis for ESRD clients;
(b) Kidney transplant treatment, either
				  directly or by referral, for ESRD clients when medically indicated;
(c) Treatment for conditions directly related
				  to ESRD;
(d) Training and
				  supervision of supporting personnel and clients for home dialysis, medical
				  care, and treatment; and
(e)
				  Supplies and equipment for home dialysis.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-130 - Covered services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				  agency covers the following services and supplies subject to the restrictions
				  and limitations in this section and other applicable published WAC:
(a) In-facility dialysis;
(b) Home dialysis;
(c) Training for self-dialysis;
(d) Home dialysis helpers;
(e) Dialysis supplies;
(f) Diagnostic lab work;
(g) Treatment for anemia; and
(h) Intravenous drugs.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-140 - Noncovered services

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				  agency does not reimburse kidney centers for the following:
(a) Blood and blood products (refer to WAC
				  182-540-190 );
(b) Personal care items such as slippers and
				  tooth-brushes; or
(c) Additional
				  staff time or personnel costs. Staff time is paid through the composite rate.
				  Home dialysis helpers are the only personnel cost paid outside the composite
				  rate (refer to WAC
				  182-540-160 ).
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-150 - Reimbursement-General

Current through Register Vol. 24-14, July 15, 2024
(1) Kidney center
				  services described in this section are paid by one of two methods:
(a)
Composite rate payments
-
				  This is a payment method in which all standard equipment, supplies, and
				  services are calculated into a blended rate.
(i) A single dialysis session and related
				  services are reimbursed through a single composite rate payment (refer to WAC
				  182-540-160 ).
(ii) Composite rate payments for continuous
				  ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis
				  (CCPD) are limited to thirty-one per month for an individual client.
(iii) Composite rate payments for all other
				  types of dialysis sessions are limited to fourteen per month for an individual
				  client.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-160 - Items and services included in the composite rate

Current through Register Vol. 24-14, July 15, 2024
(1) The following equipment, supplies, and
				  services for in-facility and home dialysis are included in the composite rate:
(a) Medically necessary dialysis
				  equipment;
(b) All dialysis
				  services furnished by the facility's staff;
(c) Standard end-stage renal disease
				  laboratory tests (refer to WAC
				  182-540-180 );
(d) Home dialysis support services including
				  delivery, installation, and maintenance of equipment;
(e) Purchase and delivery of all necessary
				  dialysis supplies;
(f) Declotting
				  of shunts and any supplies used to declot shunts;
(g) Oxygen and the administration of
				  oxygen;
(h) Staff time used to
				  administer blood and nonroutine parenteral items;
(i) Noninvasive vascular studies; and
(j) Training for self-dialysis and home
				  dialysis helpers.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-170 - Items and services not included in the composite rate

Current through Register Vol. 24-14, July 15, 2024
The following items and services are not included in the
					 composite rate and must be billed separately, subject to the restrictions or
					 limitations in this section and other applicable published WAC:
(1) Drugs related to treatment, including but
				  not limited to epoetin alpha (EPO) and diazepam. The drug must:
(a) Be prescribed by a physician;
(b) Meet the rebate requirements described in
				  WAC 182-530-7500; and
(c) Meet the requirements of WAC
				  246-905-020 when provided for
				  home use.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-180 - Laboratory services

Current through Register Vol. 24-14, July 15, 2024
(1) Laboratory
				  services included in the composite rate, performed by either the facility or an
				  independent laboratory, must not be billed separately except as provided for in
				  (b) of this subsection:
(a) Standard
				  end-stage renal disease (ESRD) lab tests are included in the composite rate
				  when performed at recommended intervals (see billing instructions for current
				  list).
(b) The standard ESRD lab
				  tests referred to in (a) of this subsection can be reimbursed separately from
				  the composite rate only when it is medically necessary to test more frequently:
(i) Proof of medical necessity must be
				  documented in the client's medical record when billing for more frequent
				  testing. A diagnosis of end-stage renal disease is not sufficient;
(ii) The claim must include information on
				  the nature of the illness or injury (diagnosis, complaint or symptom) requiring
				  the performance of the test(s); or
(iii) An ICD-9CM diagnosis code may be shown
				  in lieu of a narrative description.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-190 - Blood products and services

Current through Register Vol. 24-14, July 15, 2024
(1)
				  The medicaid agency reimburses free-standing kidney centers for:
(a) Blood processing and other fees assessed
				  by nonprofit blood centers that do not charge for the blood or blood products
				  themselves; and
(b) Costs incurred
				  by the center to administer its in-house blood procurement program.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-200 - Epoetin alpha (EPO) therapy

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency reimburses the kidney center for EPO
					 therapy when:
(1) Administered in the
				  kidney center to a client:
(a) With a
				  hematocrit less than thirty-three percent or a hemoglobin less than eleven when
				  therapy is initiated;
(b)
				  Continuing EPO therapy with a hematocrit between thirty and thirty-six percent;
				  or
(c) Medical justification
				  documented in the client's record is required for hematocrits more than
				  thirty-six or hemoglobins more than twelve. Medical justification includes:
(i) Documentation that the dose is being
				  titrated downward to bring a patient's hematocrit back within target range;
				  or
(ii) Documentation that it is
				  medically necessary for the client to have a target hematocrit more than
				  thirty-six percent.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-540 - Kidney disease program and kidney center services › KIDNEY CENTER SERVICES › Section 182-540-210 - Injectable drugs given in the kidney center

Current through Register Vol. 24-14, July 15, 2024
Injectable drugs administered in the kidney center are
					 reimbursed up to the medicaid agency published maximum fees.
11-14-075, recodified as §
												182-540-210, filed 6/30/11,
						effective 7/1/11. Statutory Authority:
						RCW
						74.08.090,
						74.09.510,
						74.09.520,
						74.09.522, and
						42 C.F.R.
						405.2101. 03-21-039, § 388-540-210,
						filed 10/8/03, effective 11/8/03.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-0500 - General

Current through Register Vol. 24-14, July 15, 2024
(1) The federal
				government considers medical equipment, supplies, and appliances, which the
				medicaid agency refers to throughout this chapter as medical equipment,
				services under the medicaid program.
(2) The agency pays for medical equipment,
				including modifications, accessories, and repairs, according to agency rules
				and subject to the limitations and requirements in this chapter when the
				medical equipment is:
(a) Medically necessary,
				as defined in WAC 182-5000070;
(b)
				Authorized, as required within this chapter, chapters 182-501 and 182-502 WAC,
				and the agency's published billing instructions and provider notices;
				and
(c) Billed according to this
				chapter, chapters 182-501 and 182-502 WAC, and the agency's published billing
				instructions and provider notices.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-1100 - Client eligibility

Current through Register Vol. 24-14, July 15, 2024
(1) Refer to the
				table in WAC
				182-501-0060
				to see which Washington apple health programs include home health services,
				including medical equipment and related services, in their benefit
				package.
(2) For clients eligible
				under an alien emergency medical (AEM) program, see WAC
				182-507-0115.
(3) Clients who are eligible for services
				under medicare and medicaid (medically needy program-qualified medicare
				beneficiaries) are eligible for medical equipment and related
				services.
(4) Clients who are
				enrolled in a medicaid agency-contracted managed care organization (MCO) must
				arrange for medical equipment and related services directly through the
				client's agency-contracted MCO. The agency does not pay for medical equipment
				or services provided to a client who is enrolled in an agency-contracted MCO,
				but chose not to use one of the MCO's participating providers.
(5) For clients who reside in a skilled
				nursing facility, see WAC
				182-543-5700.
(6) Clients enrolled in the alternative
				benefits plan (defined in WAC
				182-500-0010
				) are eligible for medical equipment when used as a habilitative service in
				accordance with WAC
				182-545-400.
11-14-075, recodified as §
											182-543-1100, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090 and
					 74.04.050. 11-14-052, §
					 388-543-1100, filed 6/29/11, effective 8/1/11; 07-17-062, § 388-543-1100,
					 filed 8/13/07, effective 9/13/07. Statutory Authority:
					 RCW
					 74.04.050,
					 74.08.090,
					 74.09.530, and
					 74.09.700. 06-24-036, §
					 388-543-1100, filed 11/30/06, effective 1/1/07. Statutory Authority:
					 RCW
					 74.04.050, 74.04.57 [74.04.057], and74.08.090
					 . 05-21-102, § 388-543-1100, filed 10/18/05, effective 11/18/05. Statutory
					 Authority:
					 RCW
					 74.08.090,
					 34.05.353. 03-12-005, §
					 388-543-1100, filed 5/22/03, effective 6/22/03. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.530. 02-16-054, §
					 388-543-1100, filed 8/1/02, effective 9/1/02; 01-01-078, § 388-543-1100,
					 filed 12/13/00, effective 1/13/01.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-2000 - Eligible providers and provider requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid agency pays qualified
				providers for medical equipment and repairs on a fee-for-service basis as
				follows:
(a) Providers who are enrolled with
				medicare for medical equipment and related repair services;
(b) Qualified complex rehabilitation
				technology (CRT) suppliers who are enrolled with medicare;
(c) Medical equipment dealers and pharmacies
				who are enrolled with medicare, and have a national provider identifier (NPI)
				for medical supplies;
(d)
				Prosthetics and orthotics providers who are licensed by the Washington state
				department of health in prosthetics and orthotics. Medical equipment dealers
				and pharmacies that do not require state licensure to provide selected
				prosthetics and orthotics may be paid for those selected prosthetics and
				orthotics only as long as the medical equipment dealers and pharmacies meet the
				medicare enrollment requirement;
(e) Occupational therapists providing
				orthotics who are licensed by the Washington state department of health in
				occupational therapy;
(f)
				Physicians who provide medical equipment in the office; and
(g) Out-of-state prosthetics and orthotics
				providers who meet their state regulations.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-2100 - Requests to include new medical equipment and technology

Current through Register Vol. 24-14, July 15, 2024
(1) An interested
				party may request the medicaid agency to include new medical equipment in the
				agency's medical equipment billing guide.
(2) The request must include credible
				evidence, including but not limited to:
(a)
				Manufacturer's literature;
(b)
				Manufacturer's pricing;
(c)
				Clinical research/case studies including FDA approval, if required);
(d) Proof of certification from the Centers
				for Medicare and Medicaid Services (CMS), if applicable; and
(e) Any additional information the requester
				feels would aid the agency in its determination.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-2200 - Proof of delivery

Current through Register Vol. 24-14, July 15, 2024
(1) When a provider
				delivers an item directly to the client or the client's authorized
				representative, the provider must furnish the proof of delivery when the
				medicaid agency requests that information. All of the following apply:
(a) The agency requires a delivery slip as
				proof of delivery. The proof of delivery slip must:
(i) Include the client's name and a detailed
				description of the item(s) delivered, including the quantity and brand name;
				and
(ii) For medical equipment
				that may require future repairs, include the serial number.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-2250 - Rental or purchase

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency bases its decision to rent or purchase medical equipment on the length
				of time the client needs the equipment.
(2) A provider must not bill the agency for
				the rental or purchase of equipment supplied to the provider at no cost by
				suppliers/manufacturers.
(3) The
				agency purchases new medical equipment only.
(a) A new medical equipment item that is
				placed with a client initially as a rental item is considered a new item by the
				agency at the time of purchase.
(b)
				A used medical equipment item that is placed with a client initially as a
				rental item must be replaced by the supplier with a new item prior to purchase
				by the agency.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-3000 - Covered - Hospital beds, mattresses, and related equipment

Current through Register Vol. 24-14, July 15, 2024
(1) Hospital beds.
(a) The medicaid agency covers, with prior
				authorization, one hospital bed in a ten-year period, per client, with the
				following limitations:
(i) A manual hospital
				bed as the primary option when the client has full-time caregivers;
				or
(ii) A semi-electric hospital
				bed only when:
(A) The client's medical need
				requires the client to be positioned in a way that is not possible in a regular
				bed and the position cannot be attained through less costly alternatives (e.g.,
				the use of bedside rails, a trapeze, pillows, bolsters, rolled up towels or
				blankets);
(B) The client's medical
				condition requires immediate position changes;
(C) The client is able to operate the
				controls independently; and
(D) The
				client needs to be in the Trendelenburg position.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-3100 - Patient lifts/traction, equipment/fracture, and frames/transfer boards

Current through Register Vol. 24-14, July 15, 2024
The medicaid agency covers the purchase of the following,
				  with the stated limitations, without prior authorization:
(1) Patient lift, hydraulic, with seat or
				sling - One per client in a five-year period.
(2) Traction equipment - One per client in a
				five-year period.
(3) Trapeze bars
				- One per client in a five-year period. The agency requires prior authorization
				for rental.
(4) Fracture frames -
				One per client in a five-year period. The agency requires prior authorization
				for rental.
(5) Transfer board or
				devices - One per client in a five-year period.
11-14-075, recodified as §
											182-543-3100, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090 and
					 74.04.050. 11-14-052, §
					 388-543-3100, filed 6/29/11, effective
					 8/1/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-3200

Current through Register Vol. 24-14, July 15, 2024
11-14-075, recodified as §
											182-543-3200, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090 and
					 74.04.050. 11-14-052, §
					 388-543-3200, filed 6/29/11, effective
					 8/1/11.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-3300 - Covered - Osteogenesis electrical stimulator (bone growth stimulator)

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency covers, with prior authorization, noninvasive osteogenesis electrical
				stimulators, limited to one per client, in a five-year period.
(2) The agency pays for the purchase of
				nonspinal bone growth stimulators, only when:
(a) The stimulators have pulsed
				electromagnetic field (PEMF) simulation; and
(b) The client meets one or more of the
				following clinical criteria:
(i) Has a
				nonunion of a long bone fracture (which includes clavicle, humerus, phalanx,
				radius, ulna, femur, tibia, fibula, metacarpal and metatarsal) where three
				months have elapsed since the date of injury without healing; or
(ii) Has a failed fusion of a joint other
				than in the spine where a minimum of nine months has elapsed since the last
				surgery.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-3400 - Covered - Communication devices/speech generating devices (SGD)

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency covers:
(a) One artificial larynx, any
				type, without prior authorization, per client in a five-year period;
				and
(b) One speech generating
				device (SGD), with prior authorization, per client every two years.
Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-543 - Medical equipment, supplies, and appliances › Section 182-543-3500 - Covered - Ambulatory aids (canes, crutches, walkers, related supplies)

Current through Register Vol. 24-14, July 15, 2024
(1) The medicaid
				agency covers the purchase of the following ambulatory aids with stated
				limitations, without prior authorization:
(a)
				Canes - One per client in a five-year period.
(b) Crutches - One per client in a five-year
				period.
(c) Walkers - One per
				client in a five-year period.