WSR 06-22-080

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance)

[ Filed October 31, 2006, 3:14 p.m. , effective October 31, 2006 ]


Effective Date of Rule: Immediately.

Purpose: The department is codifying new special terms and conditions in the new family planning/TAKE CHARGE waiver as set forth by the Centers for Medicare and Medicaid Services (CMS) for the state of Washington.

Citation of Existing Rules Affected by this Order: Amending WAC 388-532-050, 388-532-100, 388-532-110, 388-532-120, 388-532-520, 388-532-530, 388-532-700, 388-532-710, 388-532-720, 388-532-730, 388-532-740, 388-532-750, 388-532-760, 388-532-780, and 388-532-790.

Statutory Authority for Adoption: RCW 74.08.090 and 74.09.800.

Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

Reasons for this Finding: This emergency rule adoption is necessary while the permanent rule-making process is being completed because the current rules are out of compliance with special terms and conditions of the new family planning/TAKE CHARGE waiver set forth by the CMS for the state of Washington. The waiver was signed August 31, 2006, and is retroactive effective July 1, 2006. Immediate adoption of this emergency rule is required to prevent loss of 90% federal matching funds for the family planning/TAKE CHARGE program.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 1, Amended 15, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 15, Repealed 0.

Date Adopted: October 30, 2006.

Andy Fernando, Manager

Rules and Policies Assistance Unit

3801.5
AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-050   Reproductive health services -- Definitions.   The following definitions and those found in WAC 388-500-005, Medical definitions, apply to this chapter.

"Complication" -- A condition occurring subsequent to and directly arising from the family planning services received under the rules of this chapter.

"Comprehensive family planning preventive medicine visit" - For the purposes of this program, is a comprehensive, preventive, contraceptive visit which includes:

An age and gender appropriate history and examination offered to female Medicaid clients at-risk for pregnancy;

Education and counseling for risk reduction (ECRR) regarding the prevention of unintended pregnancy; and

For family planning only and TAKE CHARGE clients, routine gonorrhea and chlamydia testing for women thirteen through twenty-five years of age only.

This preventive visit may only be billed once every twelve months, per client by a department-contracted TAKE CHARGE provider and only for female clients needing contraception.

"Contraception" -- Preventing pregnancy through the use of contraceptives.

"Contraceptive" -- A device, drug, product, method, or surgical intervention used to prevent pregnancy.

"Delayed pelvic protocol" - The practice of allowing a woman to postpone a pelvic exam during a contraceptive visit to facilitate initiation or continuation of a hormonal contraceptive method.

"Department" -- The department of social and health services.

"Department-approved family planning provider" -- A physician, advanced registered nurse practitioner (ARNP), or clinic that has:

Agreed to the requirements of WAC 388-532-110;

Signed a core provider agreement with the department;

Assigned a unique family planning provider number by the department; and

((Signed a special agreement that allows the provider)) Agreed to bill for family planning laboratory services provided to clients enrolled in a department-managed care plan through an independent laboratory certified through the Clinical Laboratory Improvements Act (CLIA).

"Family planning services" -- Medically safe and effective medical care, educational services, and/or contraceptives that enable individuals to plan and space the number of children and avoid unintended pregnancies.

"Medical identification card" -- The document the department uses to identify a client's eligibility for a medical program.

"Natural family planning" -- Also known as fertility awareness method, means methods such as observing, recording, and interpreting the natural signs and symptoms associated with the menstrual cycle to identify the fertile days of the menstrual cycle and avoid unintended pregnancies.

"Over-the-counter (OTC)" -- See WAC 388-530-1050 for definition.

"Sexually transmitted disease infection (STD-I)" -- Is a disease or infection acquired as a result of sexual contact.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-050, filed 11/30/05, effective 12/31/05; 04-05-011, 388-532-050, filed 2/6/04, effective 3/8/04. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-050, filed 10/8/02, effective 11/8/02. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800. 00-14-066, 388-532-050, filed 7/5/00, effective 8/5/00.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-100   Reproductive health services -- Client eligibility.   (1) The department covers limited reproductive health services for clients eligible for the following medical assistance programs:

(a) Children's health insurance program (CHIP);

(b) Categorically needy program (CNP);

(c) General assistance unemployable (GAU);

(d) Limited casualty program-medically needy program (LCP-MNP); and

(e) Alcohol and Drug Abuse Treatment and Support Act (ADATSA).

(2) Clients enrolled in a department managed care plan may self-refer outside their plan for family planning services (excluding sterilizations for clients twenty-one years of age or older), abortions, and STD-I services to any of the following:

(a) A department-approved family planning provider;

(b) A department-contracted local health department/STD-I clinic; ((or))

(c) A department-contracted provider for abortion services; or

(d) A department-contracted pharmacy for:

(i) Over-the-counter contraceptive drugs and supplies;

(ii) Contraceptives and STD-I related prescriptions from a department-approved family planning provider or department-contracted local health department/STD-I clinic.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-100, filed 11/30/05, effective 12/31/05; 04-05-011, 388-532-100, filed 2/6/04, effective 3/8/04. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-100, filed 10/8/02, effective 11/8/02. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800. 00-14-066, 388-532-100, filed 7/5/00, effective 8/5/00.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-110   Reproductive health services -- Provider requirements.   To be reimbursed by the department for reproductive health services provided to eligible clients, physicians, ARNPs, licensed midwives, and department-approved family planning providers must:

(1) Meet the requirements in chapter 388-502 WAC, Administration of medical programs--Provider rules;

(2) Provide only those services that are within the scope of their licenses;

(3) Educate clients on Food and Drug Administration (FDA)-approved prescription birth control methods and over-the-counter (OTC) birth control drugs and supplies and related medical services;

(4) Provide medical services related to FDA-approved prescription birth control methods and OTC birth control drugs and supplies upon request;

(5) Supply or prescribe FDA-approved prescription birth control methods and OTC birth control drugs and supplies upon request; and

(6) Refer the client to an appropriate provider if unable to meet the requirements of subsections (3), (4), and (5) of this section.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-110, filed 11/30/05, effective 12/31/05; 04-05-011, 388-532-110, filed 2/6/04, effective 3/8/04.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-120   Reproductive health -- Covered services.   In addition to those services listed in WAC 388-531-0100 Physician's related services, the department covers the following reproductive health services:

(1) Services for women

(a) ((Cervical, vaginal, and breast cancer screening examination once per year as medically necessary)) One of the following per client, per year as medically necessary:

(i) One comprehensive family planning preventive medicine visit billable by a TAKE CHARGE provider only. Under a delayed pelvic protocol, the comprehensive family planning preventive medicine visit may be split into two visits, per client, per year; or

(ii) A gynecological examination, billed by a provider other than a TAKE CHARGE provider, which may include a cervical and vaginal cancer screening examination, when it is medically necessary.

(b) The comprehensive family planning preventive medicine visit must be:

(i) Provided by one or more of the following TAKE CHARGE trained providers:

(A) Physician or physician's assistant (PA);

(B) An advanced registered nurse practitioner (ARNP); or

(C) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the above listed clinicians.

(ii) Documented in the client's chart with detailed information that would allow for a well-informed follow-up visit.

(((b))) (c) Food and Drug Administration (FDA) approved prescription contraception methods as identified in chapter 388-530 WAC, Pharmacy services.

(((c))) (d) Over-the-counter (OTC) contraceptives, drugs and supplies (as described in chapter 388-530 WAC, Pharmacy services).

(((d))) (e) Sterilization procedures that meet the requirements of WAC 388-531-1550, if it is:

(i) Requested by the client; and

(ii) Performed in an appropriate setting for the procedure.

(((e))) (f) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures.

(((f))) (g) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

(((g))) (h) Mammograms for clients forty years of age and older, once per year;

(((h))) (i) Colposcopy and related medically necessary follow-up services;

(((i))) (j) Maternity-related services as described in chapter 388-533 WAC; and

(((j))) (k) Abortion.

(2) Services for men

(a) Office visits where the primary focus and diagnosis is contraceptive management and/or there is a medical concern;

(b) Over-the-counter (OTC) contraceptives, drugs and supplies (as described in chapter 388-530 WAC, Pharmacy services).

(c) Sterilization procedures that meet the requirements of WAC 388-531-1550(1), if it is:

(i) Requested by the client; and

(ii) Performed in an appropriate setting for the procedure.

(d) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures.

(e) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

(f) Prostate cancer screenings for men ((who are fifty years of age and older)), once per year, when medically necessary.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-120, filed 11/30/05, effective 12/31/05; 04-05-011, 388-532-120, filed 2/6/04, effective 3/8/04.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-520   Family planning only program -- Provider requirements.   To be reimbursed by the department for services provided to clients eligible for the family planning only program, physicians, ARNPs, and/or department-approved family planning providers must:

(1) Meet the requirements in chapter 388-502 WAC, Administration of medical programs--Provider rules;

(2) Provide only those services that are within the scope of their licenses;

(3) Educate clients on Food and Drug Administration (FDA)-approved prescription birth control methods and over-the-counter (OTC) birth control drugs and supplies and related medical services;

(4) Provide medical services related to FDA-approved prescription birth control methods and ((over-the-counter)) OTC birth control drugs and supplies upon request;

(5) Supply or prescribe FDA-approved prescription birth control methods and ((over-the-counter)) OTC birth control drugs and supplies upon request; and

(6) Refer the client to an appropriate provider if unable to meet the requirements of subsections (3), (4), and (5) of this section.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-520, filed 11/30/05, effective 12/31/05; 04-05-011, 388-532-520, filed 2/6/04, effective 3/8/04.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-530   Family planning only program -- Covered services.   The department covers the following services under the family planning only program:

(1) One of the following, per client, per year as medically necessary:

(a) One comprehensive family planning preventive medicine visit billable by a TAKE CHARGE provider only. Under a delayed pelvic protocol, the comprehensive family planning preventive medicine visit may be split into two visits, per client, per year; or

(b) A gynecological examination ((that)), billed by a provider other than a TAKE CHARGE provider, which may include a cervical and vaginal cancer screening examination, one per year when it is:

(((a))) (i) Provided according to the current standard of care; and

(((b))) (ii) Conducted at the time of an office visit with a primary focus and diagnosis of family planning.

(2) The comprehensive family planning preventive medicine visit must be:

(a) Provided by one or more of the following TAKE CHARGE trained providers:

(i) Physician or physician's assistant (PA);

(ii) An advanced registered nurse practitioner (ARNP); or

(iii) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the above listed clinicians.

(b) Documented in the client's chart with detailed information that would allow for a well-informed follow-up visit.

(3) An office visit directly related to a family planning problem, when medically necessary.

(4) Food and Drug Administration (FDA) approved prescription contraception methods meeting the requirements of chapter 388-530 WAC, Pharmacy services.

(((3))) (5) Over-the-counter (OTC) contraceptive, drugs and supplies (as described in chapter 388-530 WAC, Pharmacy services).

(((4))) (6) Sterilization procedure that meets the requirements of WAC 388-531-1550, if it is:

(a) Requested by the client; and

(b) Performed in an appropriate setting for the procedure.

(((5))) (7) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory test and procedures only when the screening and treatment is:

(a) For chlamydia and gonorrhea as part of the comprehensive family planning preventive medicine visit for women thirteen to twenty-five years of age; or

(b) Performed in conjunction with an office visit that has a primary focus and diagnosis of family planning; and

(((b))) (c) Medically necessary for the client to safely, effectively, and successfully use, or to continue to use, her chosen contraceptive method.

(((6))) (8) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-530, filed 11/30/05, effective 12/31/05; 04-05-011, 388-532-530, filed 2/6/04, effective 3/8/04.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-700   TAKE CHARGE program -- Purpose.   TAKE CHARGE is a ((five-year)) family planning demonstration and research program approved by the federal government under a Medicaid program waiver. The purpose of the TAKE CHARGE program is to make family planning services available to men and women with incomes at or below two hundred percent of the federal poverty level. ((TAKE CHARGE is approved by the federal government under a Medicaid program waiver and runs from July 1, 2001, through June 30, 2006 (unless terminated or extended prior to June 30, 2006).)) See WAC 388-532-710 for a definition of TAKE CHARGE.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-700, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-700, filed 10/8/02, effective 11/8/02.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-710   TAKE CHARGE program -- Definitions.   The following definitions and those found in WAC 388-500-0005 medical definitions and WAC 388-532-050 apply to the ((medical assistance administration's (MAA's))) department's TAKE CHARGE program.

"Ancillary services" -- Those family planning services provided to TAKE CHARGE clients by ((MAA's)) department-contracted providers who are not TAKE CHARGE providers. These services include, but are not limited to, family planning pharmacy services, family planning laboratory services and sterilization ((surgical)) services.

"Application assistance" -- The process a TAKE CHARGE provider follows in helping a client to complete and submit an application to MAA for the TAKE CHARGE program.

"Education, counseling and risk reduction intervention" or "ECRR" -- ((A stand alone department-designated service, specifically intended for clients at higher risk of contraceptive failure, that strengthen a client's decision-making skills to make the best choice of contraceptive method and reduce the risk of unintended pregnancy. ECRR services must include:

(1) Helping the client critically evaluate which contraceptive method is most acceptable and can be used most effectively by her/him.

(2) Assessing and addressing other client personal considerations, risk factors (including sexually transmitted infections), and behaviors that impact her/his use of contraception.

(3) Facilitating a discussion of the male role in successful use of chosen contraceptive method, as appropriate.

(4) Facilitating contingency planning (the back-up method) regarding the chosen contraceptive method, including planning for emergency contraception.

(5) Scheduling a follow-up appointment as medically necessary for birth control evaluation for the safe, effective and successful use of the client's chosen contraceptive method and to reinforce positive contraceptive and other self protective behaviors.

(6) If no contraceptive method is chosen, discussing the likelihood of a pregnancy and helping the client assess his/her emotional, physical, and financial readiness for pregnancy and/or parenting)) Client-centered education and counseling services designed to strengthen decision making skills and support a client's safe, effective and successful use of his or her chosen contraceptive method. For women, ECRR is part of the annual preventive medicine visit. For men, ECRR is a stand alone service for those men seeking family planning services and whose partners are at moderate to high risk of unintended pregnancy.

(("Intensive follow-up services" or "IFS" -- Those supplemental services specified in some TAKE CHARGE provider contracts that support clients in the successful use of contraceptive methods. Department-selected TAKE CHARGE providers perform IFS as part of the research component of the TAKE CHARGE program (see WAC 388-532-730 (1)(f)).))

"TAKE CHARGE" -- The department's ((five-year)) demonstration and research program approved by the federal government under a Medicaid program waiver to provide family planning services.

"TAKE CHARGE provider" -- A provider who is approved by the department to participate in TAKE CHARGE by:

(1) Being a department-approved family planning provider; and

(2) Having a supplemental TAKE CHARGE agreement to provide TAKE CHARGE family planning services to eligible clients under the terms of the federally approved Medicaid waiver for the TAKE CHARGE program.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-710, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-710, filed 10/8/02, effective 11/8/02.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-720   TAKE CHARGE program -- Eligibility.   (1) The TAKE CHARGE program is for men and women. To be eligible for the TAKE CHARGE program, an applicant must:

(a) Be a United States citizen, U.S. National, or "qualified alien" as described in chapter 388-424 WAC and provide proof of citizenship or qualified alien status, and identity;

(b) Be a resident of the state of Washington as described in WAC 388-468-0005;

(c) Have income at or below two hundred percent of the federal poverty level as described in WAC 388-478-0075;

(d) Need family planning services;

(e) Apply voluntarily for family planning services with a TAKE CHARGE provider; and

(((e) Need family planning services but have:

(i) No family planning coverage through another medical assistance program; or

(ii) Family planning coverage that does not cover one hundred percent of the applicant's chosen birth control)) (f) Not currently covered through another medical assistance program for family planning or have any health insurance that covers family planning.

(2) A client who is currently pregnant or sterilized is not eligible for TAKE CHARGE.

(3) A client is authorized for TAKE CHARGE coverage for one year from the date the department determines eligibility or for the duration of the demonstration and research program, whichever is shorter, as long as the criteria in subsection (1) and (2) of this section continue to be met. Upon reapplication for TAKE CHARGE by the client, the department may renew the coverage for additional periods of up to one year each, or for the duration of the demonstration and research program, whichever is shorter.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-720, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-057, 388-532-720, filed 7/13/04, effective 8/13/04. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-720, filed 10/8/02, effective 11/8/02.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-730   TAKE CHARGE program -- Provider requirements.   (1) A TAKE CHARGE provider must:

(a) Be a department-approved family planning provider as described in WAC 388-532-050;

(b) Sign the supplemental TAKE CHARGE agreement to participate in the TAKE CHARGE demonstration and research program according to the department's TAKE CHARGE program guidelines;

(c) Participate in the department's specialized training for the TAKE CHARGE demonstration and research program prior to providing TAKE CHARGE services. Providers must ((assure)) document that each individual responsible for providing TAKE CHARGE services is trained on all aspects of the TAKE CHARGE program;

(d) Comply with the required general department and TAKE CHARGE provider policies, procedures, and administrative practices as detailed in the department's billing instructions and provide referral information to clients regarding available and affordable nonfamily planning primary care services; ((and))

(e) If requested by the department, participate in the research and evaluation component of the TAKE CHARGE demonstration and research program. ((If selected by the department for the research and evaluation component, the provider must accept assignment to either:

(i) A randomly selected group of providers that give intensive follow-up service (IFS) to TAKE CHARGE clients under a TAKE CHARGE research component client services contract. See WAC 388-532-740(2) for a related limitation; or

(ii) A randomly selected control group of providers subject to a TAKE CHARGE research component client services contract.))

(f) Unless otherwise requested in writing by the client, forward the client's medical identification card and TAKE CHARGE brochure to the client within seven working days of receipt;

(g) Inform the client of their right to see any TAKE CHARGE provider within the state; and

(h) Refer the client to available and affordable non-family planning care services, as needed.

(2) Department providers (e.g., pharmacies, laboratories, surgeons performing sterilization procedures) who are not TAKE CHARGE providers may furnish family planning ((ancil take charge lary)) ancillary TAKE CHARGE services, as defined in this chapter, to eligible clients. The department reimburses for these services under the rules and fee schedules applicable to the specific services provided under the department's other programs.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-730, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-730, filed 10/8/02, effective 11/8/02.]

Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-740   TAKE CHARGE program -- Covered services for women.   (1) The department covers the following TAKE CHARGE services for ((men and)) women:

(a) One session of application assistance per client, per year;

(b) Food and Drug Administration (FDA) approved prescription and nonprescription contraceptives as provided in chapter 388-530 WAC;

(c) Over-the-counter (OTC) contraceptives, drugs, and supplies (as described in chapter ((388-538)) 388-530 WAC, Pharmacy services);

(d) ((Gynecological examination that may include a cervical and vaginal cancer screening exam, one per year when it is:

(i) Provided according to the current standard of care; and

(ii) Conducted at the time of an office visit with a primary focus and diagnosis of family planning.

(e) Education, counseling, and risk reduction (ECRR) intervention, specifically intended for clients at higher risk of contraceptive failure, that have identified or demonstrated risks of unintended pregnancy. MAA limits ECRR as follows:

(i) For women at risk of unintended pregnancy, limited to one ECRR service every ten months;

(ii) For men whose sexual partner is at risk of unintended pregnancy, limited to one ECRR service every twelve months;

(iii) Must be a minimum of thirty minutes in duration;

(iv) Must be appropriate and individualized to the client's needs, age, language, cultural background, risk behaviors, sexual orientation, and psychosocial history;

(v) Must be provided by one of the following TAKE CHARGE trained providers:

(A) An advanced registered nurse practitioner (ARNP);

(B) Registered nurse (RN), licensed practical nurse (LPN);

(C) Physician or physician's assistant (PA); or

(D) A trained and experienced health educator or medical assistant when used for assisting and augmenting the above listed clinicians.

(vi) Must be documented in the client's chart with detailed information that would allow for a well-informed follow-up visit;

(vii) A client who does not have identified or demonstrated risks of unintended pregnancy and who is not at increased risk of contraceptive failure is not eligible for ECRR.

(f))) One comprehensive family planning preventive medicine visit billable by a TAKE CHARGE provider only. Under a delayed pelvic protocol, the comprehensive family planning preventive medicine visit may be split into two visits, per client, per year.

(e) Sterilization procedure that meets the requirements of WAC 388-531-1550, if the service is:

(i) Requested by the TAKE CHARGE client; and

(ii) Performed in an appropriate setting for the procedure.

(((g))) (f) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures, only when the screening and treatment is:

(i) For chlamydia and gonorrhea as part of the comprehensive family planning preventive medicine visit for women thirteen to twenty-five years of age; or

(ii) Performed in conjunction with an office visit that has a primary focus and diagnosis of family planning; and

(((ii))) (iii) Medically necessary for the client to safely, effectively, and successfully use, or continue to use, his or her chosen contraceptive method.

(((h))) (g) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

(2) ((The department covers intensive follow-up services (IFS) for certain clients as part of the research component of the TAKE CHARGE demonstration and research program. Only those clients served by the department's randomly selected research sites receive IFS (see WAC 388-532-730 (1)(e)(i)). The specific elements of IFS are negotiated with each research site)) The comprehensive family planning preventive medicine visit must be:

(a) Provided by one or more of the following TAKE CHARGE trained providers:

(i) Physician or physician's assistant (PA);

(ii) An advanced registered nurse practitioner (ARNP); or

(iii) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the above listed clinicians.

(b) Documented in the client's chart with detailed information that would allow for a well-informed follow-up visit.

(3) An office visit directly related to a family planning problem, when medically necessary.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-740, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-740, filed 10/8/02, effective 11/8/02.]


NEW SECTION
WAC 388-532-745   TAKE CHARGE Program - Covered services for men.   The department covers the following TAKE CHARGE services for men:

(1) One session of application assistance per client, per year;

(2) Over-the-counter (OTC) contraceptives, drugs, and supplies (as described in chapter 388-530 WAC, Pharmacy Services);

(3) Sterilization procedure that meets the requirements of WAC 388-531-1550, if the service is:

(a) Requested by the TAKE CHARGE client; and

(b) Performed in an appropriate setting for the procedure.

(4) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures, only when the screening and treatment is related to, and medically necessary for, a sterilization procedure.

(5) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

(6) One education and counseling session for risk reduction (ECRR) per client, every twelve months. ECRR must be:

(a) Provided by one or more of the following TAKE CHARGE trained providers:

(i) Physician or physician's assistant (PA);

(ii) An advanced registered nurse practitioner (ARNP); or

(iii) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the above listed clinicians; and

(b) Documented in the client's chart with detailed information that would allow for a well-informed follow-up visit.

[]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-750   TAKE CHARGE program -- Noncovered services.   The department does not cover medical services under the TAKE CHARGE program ((unless those services are)):

(1) Abortions and other pregnancy-related services;

(2) Any other medical services, unless those services are:

(a) Performed in relation to a primary focus and diagnosis of family planning; and

(((2))) (b) Medically necessary for the client to safely, effectively, and successfully use, or continue to use, his or her chosen contraceptive method.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-750, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-750, filed 10/8/02, effective 11/8/02.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-760   TAKE CHARGE program -- Documentation requirements.   In addition to the documentation requirements in WAC 388-502-0020, TAKE CHARGE providers must keep the following records:

(1) TAKE CHARGE ((preapplication worksheet)) application form(s) ((and application(s)));

(2) Signed supplemental TAKE CHARGE agreement to participate in the TAKE CHARGE program;

(3) Documentation of the department's specialized TAKE CHARGE training and/or in-house in-service TAKE CHARGE training for each individual responsible for providing TAKE CHARGE.

(4) Chart notes that reflect the primary focus and diagnosis of the visit was family planning;

(5) Contraceptive methods discussed with the client;

(6) Notes on any discussions of emergency contraception and needed prescription(s);

(7) The client's plan for the contraceptive method to be used, or the reason for no contraceptive method and plan;

(8) Documentation of the education, counseling and risk reduction (ECRR) service, if provided, ((including all of the required components as defined in WAC 388-532-710)) with sufficient detail that allows for follow-up;

(9) Documentation of referrals to or from other providers;

(10) A form signed by the client authorizing release of information for referral purposes, as necessary; ((and))

(11) The client's written and signed consent requesting that his or her medical identification card be sent to the TAKE CHARGE provider's office to protect confidentiality;

(12) A copy of the client's picture identification;

(13) Documentation used to establish US citizenship or legal permanent resident; and

(14) If applicable, a copy of the completed DSHS sterilization consent form [DSHS 13-364 - available for download at http://www.dshs.wa.gov/msa/forms/eforms.html] (see WAC 388-531-1550).

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-760, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-760, filed 10/8/02, effective 11/8/02.]

Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-780   TAKE CHARGE program -- Reimbursement and payment limitations.   (1) The department limits reimbursement under the TAKE CHARGE program to those services that:

(a) Have a primary focus and diagnosis of family planning as determined by a qualified licensed medical practitioner; and

(b) Are medically necessary for the client to safely, effectively, and successfully use, or continue to use, his or her chosen contraceptive method.

(2) The department reimburses providers for covered TAKE CHARGE services according to the department's published TAKE CHARGE fee schedule.

(3)(((3))) The department limits reimbursement for TAKE CHARGE ((intensive follow-up services (IFS) to those randomly selected research sites described in WAC 388-532-740(2). See WAC 388-532-730 (1)(e)(i) for related information)) research and evaluation activities to selected research sites.

(4) Federally qualified health centers (FQHCs), rural health centers (RHCs), and Indian health providers who choose to become TAKE CHARGE providers must bill the department for TAKE CHARGE services without regard to their special rates and fee schedules. The department does not reimburse FQHCs, RHCs or Indian health providers under the encounter rate structure for TAKE CHARGE services.

(5) The department requires TAKE CHARGE providers to meet the billing requirements of WAC 388-502-0150 (billing time limits). In addition, all final billings and billing adjustments related to the TAKE CHARGE program must be completed no later than ((June 30, 2008, or no later than)) two years after the demonstration and research program terminates((, whichever occurs first)). The department will not accept new billings or billing adjustments that increase expenditures for the TAKE CHARGE program after the cut-off date ((in this subsection)).

(6) The department does not cover inpatient services under the TAKE CHARGE program. However, inpatient charges may be incurred as a result of complications arising directly from a covered TAKE CHARGE service. If this happens, providers of TAKE CHARGE related inpatient services that are not otherwise covered by third parties or other medical assistance programs must submit to the department a complete report of the circumstances and conditions that caused the need for inpatient services for the department to consider payment under WAC 388-501-0165.

(7) The department requires a provider under WAC 388-501-0200 to seek timely reimbursement from a third party when a client has available third party resources. The exceptions to this requirement are described under WAC 388-501-0200 (2) and (3) and 388-532-790.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-780, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-780, filed 10/8/02, effective 11/8/02.]


AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-790   TAKE CHARGE program -- Good cause exemption from billing third party insurance.   (1) TAKE CHARGE applicants who are ((either adolescents or young adults)) eighteen years of age or younger and ((who)) depend on their parents' medical insurance, or individuals who are domestic violence victims who depend on their spouses insurance may request an exemption of available third party family planning coverage due to "good cause." Under the TAKE CHARGE program, "good cause" means that use of the third party coverage would violate his or her privacy because the third party:

(a) Routinely or randomly sends verification of services to the third party subscriber and that subscriber is other than the applicant; and/or

(b) Requires the applicant to use a primary care provider who is likely to report the applicant's request for family planning services to another party.

(2) If subsection (1)(a) or (1)(b) of this section applies, the applicant is considered for TAKE CHARGE without regard to the available third party family planning coverage.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, 388-532-790, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 2(12). 02-21-021, 388-532-790, filed 10/8/02, effective 11/8/02.]

Washington State Code Reviser's Office