HEALTH CARE AUTHORITY

(Washington Apple Health)

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.

(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.

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.

(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.

Mental health-related services are available to an eligible client((s)) under chapter 388-865 WAC and WAC ((388-531-1400)) 182-531-1400.