WSR 15-07-082 PROPOSED RULES HEALTH CARE AUTHORITY
(Washington Apple Health)
[Filed March 17, 2015, 1:15 p.m.]
Original Notice.
Proposal is exempt under RCW 34.05.310(4) or 34.05.330(1).
Title of Rule and Other Identifying Information: WAC 182-556-0100 Chemical dependency treatment services, 182-556-0200 Chiropractic services for children, 182-556-0300 Personal care services, 182-556-0400 Limitations on services available to recipients of categorically needy medical assistance, and 182-556-0600 Mental health services.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Pear Conference Room, CSP 107, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at http://www.hca.wa.gov/documents/directions_to_csp.pdf or directions can be obtained by calling (360) 725-1000), on April 21, 2015, at 10:00 a.m.
Date of Intended Adoption: Not sooner than April 22, 2015.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail arc@hca.wa.gov, fax (360) 586-9727, by April 21, 2015.
Assistance for Persons with Disabilities: Contact Kelly Richters by April 13, 2015, TTY (800) 848-5429 or (360) 725-1307 or e-mail kelly.richters@hca.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: These are housekeeping changes to correct agency names, program names, rule numbers, and to make other clarifications that do not change the effect of the rules.
Reasons Supporting Proposal: These changes will provide the reader with correct information and improve clarity.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1408.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed filing is exempt from the small business economic impact statement requirement under chapter 19.85 RCW.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
March 17, 2015
Jason R. P. Crabbe
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-556-0100 Chemical dependency treatment services.
The ((department)) medicaid agency covers chemical dependency treatment services((, as defined in)) under chapter ((388-805)) 388-877B WAC((,)) for ((medicaid and children's)) Washington apple health clients. ((Coverage)) The agency's payment is limited to services performed by providers ((defined in)) under WAC ((388-502-0002)) 182-502-0002.
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-556-0200 Chiropractic services for children.
(1) The ((department will)) medicaid agency pays only for chiropractic services:
(a) For clients who are:
(i) Under age twenty-one ((years of age)); and
(ii) Referred by a screening provider under the healthy kids/early and periodic screening, diagnosis, and treatment (EPSDT) program.
(b) That are:
(i) Medically necessary under WAC 182-500-0070, safe, effective, and not experimental;
(ii) Provided by a chiropractor licensed in the state where services are provided; and
(iii) Within the scope of the chiropractor's license.
(c) Limited to:
(i) Chiropractic manipulative treatments of the spine; and
(ii) X rays of the spine.
(2) Chiropractic services are paid according to fees established by the ((department)) agency using methodology set ((forth)) out in WAC ((388-531-1850)) 182-531-1850.
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-556-0300 Personal care services.
The ((department)) medicaid agency pays for personal care services for a Title XIX categorically needy ((medicaid client as provided)) Washington apple health client under chapter 388-71 WAC, Home and community services and programs.
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-556-0400 Limitations on services available to ((recipients of)) categorically needy ((medical assistance)) Washington apple health clients.
(1) Organ transplants are limited to the cornea, heart, heart-lung, kidney, kidney-pancreas, liver, pancreas, single lung, and bone marrow.
(2) The ((department shall provide)) medicaid agency pays for treatment, dialysis, equipment, and supplies for acute and chronic nonfunctioning kidneys ((when the client is in the)) for a client in a home, hospital, or kidney center as described under WAC ((388-540-005)) 182-540-005.
(3) The agency pays for detoxification and medical stabilization ((are provided)) to ((chemically-using)) chemical-using pregnant women in a hospital.
(4) The ((department shall provide)) agency pays for detoxification of acute alcohol or other drug intoxication only in a certified detoxification center or in a general hospital ((having)) that has a detoxification provider agreement with the ((department)) agency.
(5) The ((department shall provide)) agency pays for outpatient chemical dependency treatment in programs qualified under chapter 275-25 WAC and certified under chapter 275-19 WAC or its successor.
(6) The ((department)) agency may require a second opinion ((and/or)), or consultation, or both before ((the approval of)) approving any elective surgical procedure.
(7) The ((department)) agency designates diagnoses that may require surgical intervention:
(a) Performed in other than a hospital in-patient setting; and
(b) Requiring prior agency approval ((by the department)) for a hospital admission.
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-556-0600 Mental health services.
Mental health-related services are available to an eligible client((s)) under chapter 388-865 WAC and WAC ((388-531-1400)) 182-531-1400.
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