SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Purpose: To amend WAC 388-865-0335 and 388-865-0340 to repeal provisions that allow consumer disenrollment from a regional support network in accordance with the federal waiver of provisions at Section 1915(b) of the Social Security Act as approved by the Centers for Medicare and Medicaid Services.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-865-0340; and amending WAC 388-865-0335.
Statutory Authority for Adoption: RCW 71.24.035.
Adopted under notice filed as WSR 05-08-122 on April 5, 2005.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 1, Repealed 1; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 1.
Date Adopted: August 17, 2005.
Andy Fernando, Manager
Rules and Policies Assistance Unit3472.4
(2) An enrolled Medicaid ((
consumer)) service recipient
who requests or receives medically necessary nonemergency
community mental health rehabilitation services (( requests and
receives)) may request and receive such service from the
assigned mental health prepaid inpatient health plan through
authorized providers only;
(3) An enrolled Medicaid ((
consumer does not need to
request disenrollment from the mental health division))
service recipient is automatically transferred from the
assigned prepaid inpatient health plan when the recipient
moves from the contracted service area of one mental health
prepaid inpatient health plan to the contracted service area
(4) Services to Medicaid recipients may be provided through alternative means if currently contracted authorized providers are not able to provide those services when:
(a) The services are state Medicaid plan approved services and are medically necessary for the Medicaid service recipient; and
(b) Services are or should be available to other Medicaid service recipients in the local mental health prepaid inpatient health plan; and
(c) The Medicaid service recipient has made reasonable attempts to utilize services through authorized providers; or
(d) The Medicaid service recipient has received a choice of providers and has made an informed decision to request medically necessary services through a provider outside the prepaid inpatient health plan provider network that has cultural or linguistic expertise or both needed to meet medical necessity that are not sufficient within the provider network; or
(e) The Medicaid service recipient has utilized the prepaid inpatient health plan grievance or appeal process and the state administrative hearing process, and a decision has been made in favor of the Medicaid service recipient that Medicaid plan approved services continue to be medically necessary.
[Statutory Authority: RCW 71.05.560, 71.24.035 (5)(c), 71.34.800, 9.41.047, 43.20B.020, and 43.20B.335. 01-12-047, § 388-865-0335, filed 5/31/01, effective 7/1/01.]
The following section of the Washington Administrative Code is repealed:
|WAC 388-865-0340||Consumer disenrollment.|