SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: April 29, 2004.
Purpose: MAA is codifying the policy for the chemical-using pregnant (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, new sections WAC 388-533-701, 388-533-710, 388-533-720, and 388-533-730.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.800.
Adopted under notice filed as WSR 04-07-136 on March 22, 2004.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 4, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: Thirty-one days after filing.
April 29, 2004
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3386.2
(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.
(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.
(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.