WSR 15-11-014 EXPEDITED RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed May 8, 2015, 2:26 p.m.]
Title of Rule and Other Identifying Information: WAC 182-553-100 Home infusion therapy and parenteral nutrition program—General and 182-553-400 Home infusion therapy and parenteral nutrition program—Provider requirements.
NOTICE
THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Jason R. P. Crabbe, Rules Coordinator, Health Care Authority, P.O. Box 42716, Olympia, WA 98504-2716, or deliver to Cherry Street Plaza, 626 8th Avenue S.E., Olympia, WA 98504, e-mail arc@hca.wa.gov, fax (360) 586-9727, AND RECEIVED BY July 20, 2015.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rules replace outdated references to "medical assistance" with "Washington apple health" and replaces a reference to Title 388 WAC with the correct reference to WAC 182-502-0020.
Reasons Supporting Proposal: See Purpose above.
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: Health care authority, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Chantelle Diaz, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1842.
May 8, 2015
Jason R. P. Crabbe
Rules Coordinator
AMENDATORY SECTION (Amending WSR 15-08-103, filed 4/1/15, effective 5/2/15)
WAC 182-553-100 Home infusion therapy and parenteral nutrition program—General.
The medicaid agency's home infusion therapy and parenteral nutrition program provides the supplies and equipment necessary for parenteral infusion of therapeutic agents to ((medical assistance)) Washington apple health clients. An eligible client receives equipment, supplies, and parenteral administration of therapeutic agents in a qualified setting to improve or sustain the client's health.
AMENDATORY SECTION (Amending WSR 15-08-103, filed 4/1/15, effective 5/2/15)
WAC 182-553-400 Home infusion therapy and parenteral nutrition program—Provider requirements.
(1) Eligible providers of home infusion supplies and equipment and parenteral nutrition solutions must:
(a) Have a signed core provider agreement with the medicaid agency; and
(b) Be one of the following provider types:
(i) Pharmacy provider;
(ii) Durable medical equipment (DME) provider; or
(iii) Infusion therapy provider.
(2) The agency pays eligible providers for home infusion supplies and equipment and parenteral nutrition solutions only when the providers:
(a) Are able to provide home infusion therapy within their scope of practice;
(b) Have evaluated each client in collaboration with the client's physician, pharmacist, or nurse to determine whether home infusion therapy and parenteral nutrition is an appropriate course of action;
(c) Have determined that the therapies prescribed and the client's needs for care can be safely met;
(d) Have assessed the client and obtained a written physician order for all solutions and medications administered to the client in the client's residence or in a dialysis center through intravenous, epidural, subcutaneous, or intrathecal routes;
(e) Meet the requirements in WAC ((388-502-0020)) 182-502-0020, including keeping legible, accurate, and complete client charts, and providing the following documentation in the client's medical file:
(i) For a client receiving infusion therapy, the file must contain:
(A) A copy of the written prescription for the therapy;
(B) The client's age, height, and weight; and
(C) The medical necessity for the specific home infusion service.
(ii) For a client receiving parenteral nutrition, the file must contain:
(A) All the information listed in (e)(i) of this subsection;
(B) Oral or enteral feeding trials and outcomes, if applicable;
(C) Duration of gastrointestinal impairment; and
(D) The monitoring and reviewing of the client's lab values:
(I) At the initiation of therapy;
(II) At least once per month; and
(III) When the client, the client's lab results, or both, are unstable.
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