HEALTH CARE AUTHORITY
[Filed February 28, 2019, 10:51 a.m., effective April 1, 2019]
Effective Date of Rule: April 1, 2019.
Purpose: The agency is revising WAC 182-533-0370 to remove subsection (3) to allow the infant and infant's parents to receive infant case management and maternity support services if a parent becomes pregnant. The agency is also revising WAC 182-533-0390 to reduce the minimum hours of childbirth education instruction required from eight to six.
Citation of Rules Affected by this Order: Amending WAC 182-533-0370 and 182-533-0390.
Adopted under notice filed as WSR 19-03-051 on January 9, 2019.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.
Date Adopted: February 28, 2019.
AMENDATORY SECTION(Amending WSR 14-09-061, filed 4/16/14, effective 5/17/14)
WAC 182-533-0370Infant case management—Client eligibility.
(1) To be eligible to receive infant case management (ICM), an infant must meet all the following criteria:
(a) Be covered under categorically needy, medically needy, or state-funded medical programs under Washington apple health.
(b) Meet the age requirement for ICM, which is the day after the maternity cycle (defined in WAC 182-533-0315) ends, through the last day of the month of the infant's first birthday.
(c) Reside with at least one parent who provides the infant's day-to-day care and is:
(i) The infant's natural or adoptive parent(s);
(ii) A person other than a foster parent who has been granted legal custody of the infant; or
(iii) A person who is legally obligated to support the infant.
(d) Have a parent(s) who needs assistance in accessing medical, social, educational and/or other services to meet the infant's basic health and safety needs.
(e) Not be receiving any case management services funded through Title XIX medicaid that duplicate ICM services.
(2) Clients who meet the eligibility criteria and are enrolled in a medicaid agency-contracted managed care organization (MCO) are eligible for ICM services outside their plan.
(3) ((If the infant's mother becomes pregnant during the ICM eligibility period and she is eligible for maternity support services (MSS), the infant and the infant's mother are no longer eligible to receive ICM services.
(4))) Clients who do not agree with an eligibility decision by the medicaid agency for ICM have a right to a fair hearing under chapter 182-526 WAC.
AMENDATORY SECTION(Amending WSR 12-01-097, filed 12/20/11, effective 1/20/12)
WAC 182-533-0390Childbirth education (CBE) classes.
(1) Purpose. The purpose of childbirth education (CBE) classes is to help prepare the client and ((her))the client's support person(s):
(a) For the physiological, emotional, and psychological changes experienced during and after pregnancy;
(b) To develop self-advocacy skills;
(c) To increase knowledge about and access to local community resources;
(d) To improve parenting skills; and
(e) To improve the likelihood of positive birth outcomes.
(2) Definitions. The definitions in chapter 182-500 WAC, ((medial))medical assistance definitions, and WAC 182-533-0315, maternity support services definitions, also apply to this section.
(3) Client eligibility. To be eligible for CBE classes, a client must be:
(a) Pregnant; and
(b) Covered under one of the medical assistance programs described in WAC 182-533-0320 (1)(a)(i) and (iv).
(4) Provider requirements. To be paid for providing CBE classes to eligible clients, an approved instructor must:
(a) Have a core provider agreement on file with the health care authority (the agency);
(b) Ensure that individuals providing CBE classes have credentials and/or certification as outlined in the agency's current published billing instructions;
(c) Deliver CBE classes in a series of group sessions; and
(d) Provide curriculum containing topics outlined in the agency's CBE curriculum checklist found in the agency's current published billing instructions. Topics include, but are not limited to:
(ii) Labor and birth;
(iii) Newborns; and
(iv) Family adjustment.
(5) Documentation. Providers must:
(a) Follow the health care record requirements found in WAC 182-502-0020; and
(b) Maintain the following additional documentation:
(i) An original signed copy of each client's Freedom of Choice/Consent for Services form;
(ii) A client sign-in sheet for each class; and
(iii) Names and ProviderOne Client ID numbers of eligible clients attending CBE classes and the date(s) they participated in each CBE class.
(a) The agency covers one CBE class series per client, per pregnancy. The client must attend at least one CBE session for the provider to be paid.
(b) CBE classes must include a minimum of ((eight))six hours of instruction and are subject to the restrictions and limitations in this section and other applicable WAC.
(7) Payment. The agency pays for the CBE classes described in subsection (6) of this section on a fee-for-service basis subject to the following:
(a) CBE must:
(i) Include all classes, core materials, publications, and educational materials provided throughout the class series. Clients must receive the same materials as are offered to other attendees; and
(ii) Be billed according to the agency's current published billing instructions.
(b) The provider must accept the agency's fee as payment in full for classes provided to a client in accordance with 42 C.F.R. § 447.15.