WSR 05-05-085

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed February 15, 2005, 3:53 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-22-066.

Title of Rule and Other Identifying Information: Chemical using pregnant (CUP) women program; WAC 388-533-0710 CUP client eligibility, 388-533-0720 CUP provider requirements, and 388-533-0730 CUP covered services.

Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on March 22, 2005, at 10:00 a.m.

Date of Intended Adoption: Not sooner than March 23, 2005.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., March 22, 2005.

Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by March 18, 2005, TTY (360) 664-6178 or (360) 664-6097.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: To remove unnecessary barriers for clients to access services from CUP providers.

Reasons Supporting Proposal: See above.

Statutory Authority for Adoption: RCW 74.08.090 and 74.09.800.

Statute Being Implemented: RCW 74.08.090 and 74.09.800.

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

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

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.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule change does not impact small businesses.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kevin Sullivan, Department of Social and Health Services, Medical Assistance Administration, P.O. Box 45533, Olympia, WA 98504-5533, phone (360) 725-1344, fax (360) 586-9727, e-mail sullikm@dshs.wa.gov.

February 11, 2005

Andy Fernando, Manager

Rules and Policies Assistance Unit

3516.1
AMENDATORY SECTION(Amending WSR 04-11-008, filed 5/5/04, effective 6/5/04)

WAC 388-533-0710   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; and

(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))) 388-533-0710(1) who are enrolled in an MAA managed care plan are eligible for CUP services outside their plan, except Washington Medicaid Integration Partnership clients. 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.

[Statutory Authority: RCW 74.08.090, 74.09.800. 04-11-008, 388-533-710 (codified as WAC 388-533-0710), filed 5/5/04, effective 6/5/04.]


AMENDATORY SECTION(Amending WSR 04-11-008, filed 5/5/04, effective 6/5/04)

WAC 388-533-0720   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 Organizations (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)) a chemical dependency assessment of the client has been completed:

(i) By ((an ADATSA assessment agency)) a chemical dependency professional as defined in chapter 246-811 WAC;

(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.

[Statutory Authority: RCW 74.08.090, 74.09.800. 04-11-008, 388-533-720 (codified as WAC 388-533-0720), filed 5/5/04, effective 6/5/04.]


AMENDATORY SECTION(Amending WSR 04-11-008, filed 5/5/04, effective 6/5/04)

WAC 388-533-0730   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 subacute 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 preauthorized 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.

[Statutory Authority: RCW 74.08.090, 74.09.800. 04-11-008, 388-533-730 (codified as WAC 388-533-0730), filed 5/5/04, effective 6/5/04.]

Washington State Code Reviser's Office