WSR 04-07-136

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed March 22, 2004, 4:08 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 03-11-085.

Title of Rule: Chemical-using pregnant (CUP) women program, new WAC 388-533-701, 388-533-710, 388-533-720, and 388-533-730.

Purpose: MAA is codifying the policy for the CUP women program, an established program which assists pregnant women in maintaining sobriety to ensure healthier birth outcomes by offering the following services to a pregnant woman and her fetus in a hospital setting: (1) Acute, medical detoxification; (2) stabilization; (3) medical, and (4) chemical dependency treatment.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.800.

Statute Being Implemented: RCW 74.08.090, 74.09.800.

Summary: See Purpose above.

Reasons Supporting Proposal: The CUP women program policy, requirements, and limitations need to be codified in Washington Administrative Code.

Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, P.O. Box 45533, Olympia, WA 98504-5533, (360) 725-1344; Implementation and Enforcement: Todd Slettvet, P.O. Box 45530, Olympia, WA 98504-5530, (360) 725-1626.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal does not change existing rules. These are new rules.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule and concludes that it does not have more than a minor impact on small businesses.

RCW 34.05.328 applies to this rule adoption. This proposed rule meets the definition of a significant legislative rule as described in RCW 34.05.328. The department has determined this rule proposal does not impose any new costs and the probable benefits exceed any probable costs. A copy of the cost-benefit analysis prepared for this rule is available from the persons listed above.

Hearing Location: Office Building 2, Auditorium, 14th and Jefferson, Olympia, Washington 98504, on April 27, 2004, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact DSHS Rules Coordinator by April 21, 2004, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., on April 27, 2004.

Date of Intended Adoption: Not sooner than April 28, 2004.

March 18, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3386.2
NEW SECTION
WAC 388-533-701   Chemical-using pregnant (CUP) women program -- Purpose.   The chemical-using pregnant (CUP) women program provides immediate access to medical care in a hospital setting to chemical-using or chemical-dependent pregnant women and their fetuses. The purpose of the immediate access to medical care is to reduce harm to and improve birth outcomes for mothers and their fetuses by preventing obstetric and prenatal complications related to chemical dependency.

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NEW SECTION
WAC 388-533-710   Chemical-using pregnant (CUP) women program -- Client eligibility.   (1) To be eligible for the chemical-using pregnant (CUP) women program, a woman must meet all of the following conditions:

(a) Be pregnant;

(b) Be referred and/or approved by an Alcohol and Drug Addiction Treatment and Support Act (ADATSA) assessment agency; and

(c) Be eligible for Medicaid.

(2) Clients meeting the eligibility criteria in WAC 388-533-710(1) who are enrolled in an MAA managed care plan are eligible for CUP services outside their plan. CUP services delivered outside the managed care plan are reimbursed and subject to the same program rules as apply to nonmanaged care clients.

(3) Clients receiving three-day or five-day detoxification services through the department are not eligible for the CUP women program.

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NEW SECTION
WAC 388-533-720   Chemical-using pregnant (CUP) women program -- Provider requirements.   (1) The medical assistance administration (MAA) pays only those providers who:

(a) Have been approved by MAA to provide chemical-using pregnant (CUP) women program services;

(b) Have been certified as chemical dependency service providers by the division of alcohol and substance abuse (DASA) as prescribed in chapter 388-805 WAC;

(c) Meet the hospital standards prescribed by the Joint Commission on Accreditation of Healthcare Organization (JCACHO);

(d) Meet the general provider requirements in chapter 388-502 WAC; and

(e) Are not licensed as an institution for mental disease (IMD) under Centers for Medicare and Medicaid (CMS) criteria.

(2) CUP women program service providers are required to:

(a) Report any changes in their certification, level of care, or program operations to the MAA CUP women program manager;

(b) Have written policies and procedures that include a working statement describing the purpose and methods of treatment for chemical-using/abusing pregnant women;

(c) Provide guidelines and resources for current medical treatment methods by specific drug and/or alcohol type;

(d) Have linkages with state and community providers to ensure a working knowledge exists of current medical and substance abuse resources; and

(e) Ensure that an Alcohol and Drug Addiction Treatment and Support Act (ADATSA) or chemical dependency assessment of the client has been completed:

(i) By an ADATSA assessment agency;

(ii) Using the latest criteria of the American Society of Addiction Medicine (ASAM); and

(iii) No earlier than six months before, and no later than five days after, the client's admission to the CUP women program.

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NEW SECTION
WAC 388-533-730   Chemical-using pregnant (CUP) women program -- Covered services.   (1) The medical assistance administration (MAA) pays for the following covered services for a pregnant client and her fetus under the chemical-using pregnant (CUP) women program:

(a) Primary acute detoxification/medical stabilization;

(b) Secondary sub-acute detoxification/medical stabilization; and

(c) Rehabilitation treatment and services as determined by the provider.

(2) The maximum length of treatment per inpatient stay that MAA will pay for is twenty-six days, unless additional days have been pre-authorized by the MAA CUP women program manager.

(3) If a client leaves or is discharged from an inpatient treatment program and then returns, the provider must obtain authorization from the MAA CUP women program manager to allow the client to either:

(a) Complete the original twenty-six day treatment plan; or

(b) Begin a new twenty-six day treatment plan.

(4) If a client's pregnancy ends before inpatient treatment is completed, a provider may continue the client's treatment through the twenty-sixth day.

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