HEALTH CARE AUTHORITY
[Filed November 26, 2018, 12:43 p.m., effective January 1, 2019]
Effective Date of Rule: January 1, 2019.
Purpose: The agency is amending WAC 182-551-1860 Concurrent care for hospice clients age twenty and younger, to remove language related to exception to rule and allow for medical necessity review of noncovered services. These changes comply with early and periodic screening, diagnostic and treatment (EPSDT) program rules under 42 C.F.R., Sec. 441, Subpart B, and WAC 182-534-0100, EPSDT.
Citation of Rules Affected by this Order: Amending WAC 182-551-1860.
Adopted under notice filed as WSR 18-20-125 on October 3, 2018.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: November 26, 2018.
AMENDATORY SECTION(Amending WSR 17-12-082, filed 6/5/17, effective 7/6/17)
WAC 182-551-1860Concurrent care for hospice clients age twenty and younger.
(1) In accordance with 42 U.S.C. 1396d (o)(1)(C), a client age twenty and younger may voluntarily elect hospice care without waiving any rights to services that the client is entitled to under Title XIX Medicaid and Title XXI Children's Health Insurance Program (CHIP) that are related to the treatment of the client's condition for which a diagnosis of terminal illness has been made.
(2) The related services in subsection (1) of this section and medications requested for clients age twenty and younger are subject to the medicaid agency's specific program rules governing those services or medications.
(3) ((If the services in this section include noncovered services listed in WAC 182-501-0070, the provider must request an exception to rule under WAC 182-501-0160.))When a noncovered service is recommended based on the early and periodic screening, diagnosis, and treatment (EPSDT) program, the agency evaluates the request for medical necessity based on the definition in WAC 182-500-0070 and the process in WAC 182-501-0165.
(4) If the medicaid agency denies a request for a covered service, refer to WAC 182-502-0160, billing a client, for when a client may be responsible to pay for a covered service.