Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-501 - Administration of medical programs-General › Section 182-501-0065 - Health care coverage-Description of service categories

Current through Register Vol. 24-14, July 15, 2024
This rule provides a brief description of the medical,
				  dental, mental health, and substance use disorder (SUD) service categories
				  listed in the table in WAC
				  182-501-0060. The description of
				  services under each category is not intended to be all inclusive.
(1) For alternative benefits plan (ABP),
				categorically needy (CN), medically needy (MN), and medical care services
				(MCS), refer to the WAC citations listed in the following descriptions for
				specific details regarding each service category.
(2) The following service categories are
				subject to the exclusions, limitations, restrictions, and eligibility
				requirements contained in agency rules:
(a)
Ambulance
- Emergency medical transportation and ambulance
				transportation for nonemergency medical needs. (WAC
				182-546-0001 through
				182-546-4000.)
(b)
Applied behavior analysis
				(ABA)
- (Chapter 182-531A WAC.)
(c)
Behavioral health services
-
				(Chapter 182-538D WAC, Behavioral health services, WAC
				182-531-1400 Psychiatric
				physician-related services and other professional mental health services, and
				chapter 246-341 WAC, Behavioral health services administrative
				requirements.)
(d)
Blood,
				blood products, and related services
- Blood and/or blood derivatives,
				including synthetic factors, plasma expanders, and their administration. (WAC
				182-550-1400 and
				182-550-1500.)
(e)
Community behavioral health support
				services (CBHS)
- (Chapter 182-561 WAC.)
(f)
Dental services
- Diagnosis
				and treatment of dental problems including emergency treatment and preventive
				care. (Chapters 182-535 and 182-535A WAC.)
(g)
Diagnostic services
-
				Clinical testing and imaging services. (WAC
				182-531-0100; WAC
				182-550-1400 and
				182-550-1500.)
(h)
Early and periodic screening,
				diagnosis, and treatment (EPSDT)
- (Chapter 182-534 WAC and WAC
				182-501-0050(10).)
(i)
Enteral nutrition program
-
				Enteral nutrition products, equipment, and related supplies. (Chapter 182-554
				WAC.)
(j)
Habilitative
				services
- (Chapter 182-545 WAC.)
(k)
Health care professional
				services
- The following services found in chapter 182-531 WAC:
(i) Office visits and vaccinations;
(ii) Screening/brief intervention/referral to
				treatment (SBIRT), emergency room, and nursing facility services;
(iii) Home-based and hospital-based
				services;
(iv) Surgery, anesthesia,
				pathology, radiology, and laboratory services;
(v) Obstetric services;
(vi) Kidney dialysis and renal disease
				services;
(vii) Advanced registered
				nurse practitioner, naturopathy, osteopathy, podiatry, physiatry, and
				pulmonary/respiratory services; and
(viii) Allergen immunotherapy
				services.
(l)
Health homes
- (Chapter 182-557 WAC.)
(m)
Hearing evaluations
- The
				following services found in WAC
				182-531-0375:
(i) Audiology;
(ii) Diagnostic evaluations; and
(iii) Hearing exams and testing.
(n)
Hearing aids
-
				(Chapter 182-547 WAC.)
(o)
Home health services
- Intermittent, short-term skilled nursing
				care, occupational therapy, physical therapy, speech therapy, home infusion
				therapy, and health aide services, provided in the home. (WAC 182-551-2000
				through 182-551-2220.)
(p)
Home infusion therapy/parenteral nutrition program
- Supplies and
				equipment necessary for parenteral infusion of therapeutic agents. (Chapter
				182-553 WAC.)
(q)
Hospice
				services
- Physician services, skilled nursing care, medical social
				services, counseling services for client and family, drugs, medications
				(including biologicals), medical equipment and supplies needed for palliative
				care, home health aide, homemaker, personal care services, medical
				transportation, respite care, and brief inpatient care. This benefit also
				includes services rendered in a hospice care center and pediatric palliative
				care services. (WAC
				182-551-1210 through
				182-551-1850.)
(r)
Hospital
				services-Inpatient/outpatient
- Emergency room; hospital room and board
				(includes nursing care); inpatient services, supplies, equipment, and
				prescription drugs; surgery, anesthesia; diagnostic testing, laboratory work,
				blood/blood derivatives; radiation and imaging treatment and diagnostic
				services; and outpatient or day surgery, and obstetrical services. (Chapter
				182-550 WAC.)
(s)
Intermediate care facility/services for persons with intellectual
				disabilities
- Habilitative training, health-related care, supervision,
				and residential care. (Chapter 388-835 WAC.)
(t)
Maternity care and delivery
				services
- Community health nurse visits, nutrition visits, behavioral
				health visits, midwife services, maternity and infant case management services,
				family planning services and community health worker visits. (WAC
				182-533-0330.)
(u)
Medical equipment, supplies, and
				appliances
- Medical equipment and appliances, including wheelchairs,
				hospital beds, respiratory equipment; casts, splints, crutches, trusses, and
				braces. Medical supplies, including antiseptics, germicides, bandages,
				dressings, tape, blood monitoring/testing supplies, braces, belts, supporting
				devices, decubitus care products, ostomy supplies, syringes, needles, and
				urological supplies. (Chapter 182-543 WAC.)
(v)
Medical nutrition therapy
-
				Outpatient medical nutrition therapy and associated follow-ups. (Chapter
				182-555 WAC.)
(w)
Nursing
				facility services
- Nursing, therapies, dietary, and daily care services
				delivered in a licensed nursing facility. (Chapter 388-97 WAC.)
(x)
Organ transplants
- Solid
				organs, e.g., heart, kidney, liver, lung, pancreas, and small bowel; bone
				marrow and peripheral stem cell; skin grafts; and corneal transplants. (WAC
				182-550-1900 and
				182-556-0400.)
(y)
Orthodontic services
-
				(Chapter 182-535A WAC.)
(z)
Out-of-state services
- (WAC
				182-502-0120.)
(aa)
Outpatient rehabilitation services
				(OT, PT, ST)
- Evaluations, assessments, and treatment. (WAC
				182-545-200.)
(bb)
Personal care services
-
				Assistance with activities of daily living (e.g., bathing, dressing, eating,
				managing medications) and routine household chores (e.g., meal preparation,
				housework, essential shopping, transportation to medical services). (Chapters
				388-106 and 388-845 WAC.)
(cc)
Prescription drugs
- Outpatient drugs (including in nursing
				facilities), both generic and brand name; drug devices and supplies; some
				over-the-counter drugs; oral, topical, injectable drugs; vaccines,
				immunizations, and biologicals; and family planning drugs, devices, and
				supplies. (WAC
				182-530-2000.) Additional
				coverage for medications and prescriptions is addressed in specific program WAC
				sections.
(dd)
Private duty
				nursing
- Continuous skilled nursing services provided in a private
				residence, including client assessment, administration of treatment, and
				monitoring of medical equipment and client care. For benefits for clients age
				17 and younger, see WAC
				182-551-3000 through
				182-551-3400. For benefits for
				clients age 18 and older, see WAC
				388-106-1000 through
				388-106-1055.
(ee)
Prosthetic/orthotic devices
- Artificial limbs and other external body parts; devices that prevent,
				support, or correct a physical deformity or malfunction. (WAC
				182-543-5000.)
(ff)
Reproductive health
				services
- Gynecological exams; contraceptives, drugs, and supplies,
				including prescriptions; sterilization; screening and treatment of sexually
				transmitted diseases; and educational services. (WAC
				182-532-001 through
				182-532-140.)
(gg)
Respiratory care (oxygen)
-
				All services, oxygen, equipment, and supplies related to respiratory care.
				(Chapter 182-552 WAC.)
(hh)
School-based health care services
- Early intervention services or
				special education health-related services provided in schools to
				medicaid-eligible children ages birth through 20 who have an individualized
				education program (IEP) or individualized family service plan (IFSP). (Chapter
				182-537 WAC.)
(ii)
Vision
				care
- Eye exams, refractions, fittings, visual field testing, vision
				therapy, ocular prosthetics, and surgery. (WAC
				182-531-1000.)
(jj)
Vision hardware
- Frames
				and lenses. (Chapter 182-544 WAC.)