WASHINGTON STATE REGISTER

WSR 10-01-138

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed December 21, 2009, 12:02 p.m. , effective January 21, 2010 ]

аааааEffective Date of Rule: Thirty-one days after filing.

аааааPurpose: Major change: The department is no longer covering orally-administered enteral nutrition for clients twenty-one years of age and older.

аааа Other changes/updates to the enteral nutrition chapter 388-554 WAC include:

Х Reorganized the chapter to mirror other recently reorganized medical program chapters.

Х Changed references from "MAA" to the "department."

Х Clarified when the department will pay for enteral nutrition products.

Х Updated the definition for "women, infants, and children (WIC) program" to match the department of health's current definition.

Х Added children's healthcare programs as defined in WAC 388-505-0210 to the list of eligible clients.

Х Clarified that "emergency medical only programs" are eligible only when the services are necessary to treat the client's emergency medical condition.

Х Removed language that the department would pay separately for oral enteral nutrition for a client who resides in a nursing facility when the client's need for enteral nutrition meets one hundred percent of the client's nutritional needs. Adult family homes, assisted living facilities, boarding homes, or any other residence where the provision of food is part of the per diem rate are require [required] to provide food for their clients.

Х Added the "client's caregiver" as a sufficient person for providers to confirm with whether the client's next months delivery of authorized orally administered enteral nutrition products is necessary. Current language states that the provider must confirm with the client.

Х Clarified that when a client has indicated that he or she is not using the enteral nutrition product as prescribed, in addition to notifying the client's physician, the provider must also document the notification in the client's file.

Х Clarified what the department means by a "valid" prescription.

Х Clarified that providers must request prior authorization for covered orally-administered enteral nutrition products and tube-delivered enteral equipment and related supplies as required in the chapter or when the clinical criteria is not met. Requests for prior authorization must be submitted to the department on DSHS 13-743 form (Oral Enteral Nutrition Worksheet Prior Authorization Request).

Х Codified expedited prior authorization (EPA) criteria for oral enteral nutrition for clients twenty years of age and younger.

Х Created a new noncovered section (WAC 388-554-800) to include orally-administered enteral nutrition for clients twenty-one years of age and older and nonmedical equipment, supplies, and related services, including but not limited to, backpacks, pouches, bags, baskets, or other carrying containers. The department does not pay for these items but needed to codify this.

аааааCitation of Existing Rules Affected by this Order: Amending WAC 388-554-100, 388-554-200, 388-554-300, 388-554-400, 388-554-500, 388-554-600, 388-554-700, and 388-554-800.

аааааStatutory Authority for Adoption: Section 1109, chapter 564, Laws of 2009 (ESHB 1244); RCW 74.04.050, 74.08.090.

ааааа Adopted under notice filed as WSR 09-18-093 on September 1, 2009.

аааааA final cost-benefit analysis is available by contacting Maureen GuzmanЦDSHS/HRSA, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-2033, fax (360) 586-9727, e-mail guzmam@dshs.wa.gov.

аааааNumber 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.

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

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

аааааNumber of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 8, Repealed 0.

аааааNumber of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; аааааPilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 8, Repealed 0.

аааааDate Adopted: December 11, 2009.

Susan N. Dreyfus

Secretary

аааааReviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 10-02 issue of the Register.

Х	Reorganized the chapter to mirror other recently reorganized medical program chapters.
Х	Changed references from "MAA" to the "department."
Х	Clarified when the department will pay for enteral nutrition products.
Х	Updated the definition for "women, infants, and children (WIC) program" to match the department of health's current definition.
Х	Added children's healthcare programs as defined in WAC 388-505-0210 to the list of eligible clients.
Х	Clarified that "emergency medical only programs" are eligible only when the services are necessary to treat the client's emergency medical condition.
Х	Removed language that the department would pay separately for oral enteral nutrition for a client who resides in a nursing facility when the client's need for enteral nutrition meets one hundred percent of the client's nutritional needs. Adult family homes, assisted living facilities, boarding homes, or any other residence where the provision of food is part of the per diem rate are require [required] to provide food for their clients.
Х	Added the "client's caregiver" as a sufficient person for providers to confirm with whether the client's next months delivery of authorized orally administered enteral nutrition products is necessary. Current language states that the provider must confirm with the client.
Х	Clarified that when a client has indicated that he or she is not using the enteral nutrition product as prescribed, in addition to notifying the client's physician, the provider must also document the notification in the client's file.
Х	Clarified what the department means by a "valid" prescription.
Х	Clarified that providers must request prior authorization for covered orally-administered enteral nutrition products and tube-delivered enteral equipment and related supplies as required in the chapter or when the clinical criteria is not met. Requests for prior authorization must be submitted to the department on DSHS 13-743 form (Oral Enteral Nutrition Worksheet Prior Authorization Request).
Х	Codified expedited prior authorization (EPA) criteria for oral enteral nutrition for clients twenty years of age and younger.
Х	Created a new noncovered section (WAC 388-554-800) to include orally-administered enteral nutrition for clients twenty-one years of age and older and nonmedical equipment, supplies, and related services, including but not limited to, backpacks, pouches, bags, baskets, or other carrying containers. The department does not pay for these items but needed to codify this.

й Washington State Code Reviser's Office