WSR 15-14-038 PERMANENT RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed June 24, 2015, 10:33 a.m., effective July 25, 2015] Effective Date of Rule: Thirty-one days after filing.
Purpose: The agency is changing the hospital accreditation standards for the chemical using pregnant (CUP) women program providers found in WAC 182-533-0720. The agency also made housekeeping changes to WAC 182-533-0710, 182-533-0720, and 182-533-0730.
Citation of Existing Rules Affected by this Order: Amending WAC 182-533-0710, 182-533-0720, and 182-533-0730.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Adopted under notice filed as WSR 15-11-006 on May 7, 2015.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 3, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.
Date Adopted: June 24, 2015.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-533-0710 Chemical-using pregnant (CUP) women program—Client eligibility.
(1) To be eligible for the chemical-using pregnant (CUP) women program, a woman must ((meet all of the following conditions)) be:
(a) ((Be)) Pregnant; and
(b) ((Be)) Eligible for medicaid.
(2) A client((s meeting the eligibility criteria in WAC 388-533-0710(1) who are)) eligible under subsection (1) of this section who is enrolled in ((an MAA)) a medicaid agency managed care plan ((are)) is eligible for CUP services outside ((their)) her plan((, except Washington medicaid integration partnership clients)). CUP services and reimbursement are delivered outside ((the)) a managed care plan ((are reimbursed and subject to the same program rules as apply to nonmanaged care clients)) and are subject to fee-for-services rules.
(3) A client((s)) receiving three-day or five-day detoxification services through the ((department are)) agency is not eligible for the CUP women program.
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-533-0730 Chemical-using pregnant (CUP) women program—Covered services.
(1) The ((medical assistance administration (MAA))) medicaid agency pays for the following covered services for a pregnant client and her fetus under the chemical-using pregnant (CUP) women program:
(a) Primary acute detoxification((/)) and medical stabilization;
(b) Secondary subacute detoxification((/)) and medical stabilization; and
(c) Rehabilitation treatment and services as determined by the provider.
(2) The maximum length of treatment per inpatient stay that ((MAA)) the agency will pay for is twenty-six days, unless additional days have been preauthorized by the ((MAA)) agency CUP women program manager.
(3) If a client's pregnancy ends before inpatient treatment is completed, a provider may continue ((the client's)) her treatment through the twenty-sixth day.
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-533-0720 Chemical-using pregnant (CUP) women program—Provider requirements.
(1) The ((medical assistance administration (MAA))) medicaid agency pays only those providers who:
(a) Have been approved by ((MAA)) the agency to provide chemical-using pregnant (CUP) women program services;
(b) Have been certified as chemical dependency service providers by the division of ((alcohol and substance abuse (DASA) as prescribed in chapter 388-805 WAC;
(c) Meet the hospital standards prescribed by the Joint Commission on Accreditation of Healthcare Organizations (JCACHO))) behavioral health and recovery (DBHR) under chapter 388-877 WAC;
(c) Meet the department of health hospital accreditation standards in chapter 246-320 WAC;
(d) Meet the general provider requirements in chapter ((388-502)) 182-502 WAC; and
(e) Are not licensed as an institution for mental disease (IMD) under Centers for Medicare and Medicaid Services (CMS) criteria.
(2) ((CUP women program service)) Providers ((are required to)) must:
(a) Report any changes in their certification, level of care, or program operations to the ((MAA)) agency CUP women program manager;
(b) Have written policies and procedures that include a working statement describing the purpose and methods of treatment for chemical-using((/abusing)) or chemical-dependent pregnant women;
(c) Provide guidelines and resources for current medical treatment methods by specific ((drug and/or alcohol)) chemical type;
(d) Have linkages with state and community providers to ensure a working knowledge exists of current medical and substance abuse resources; and
(e) Ensure that a chemical dependency assessment of the client has been completed:
(i) By a chemical dependency professional ((as defined in)) under chapter 246-811 WAC;
(ii) Using the latest criteria of the American Society of Addiction Medicine (ASAM); and
(iii) No earlier than six months before, and no later than five days after, the client's admission to the CUP women program.
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