Proposed/Adopted	WAC Subsection	Reason
Original WAC 182-532-001 Reproductive health services—Definitions.
Proposed	"Over-the-counter (OTC)" - Drugs, devices, and products that do not require a prescription before they can be sold or dispensed and are approved by the Food and Drug Administration (FDA). (See WAC 182-530-1050((.)))	The agency removed "and are approved by the Food and Drug Administration (FDA)" from the "OTC" definition. This was previously added to the definition in error.
Adopted	"Over-the-counter (OTC)" - Drugs, devices, and products that do not require a prescription ((before they can)) to be sold or dispensed. (See WAC 182-530-1050((.)))
Proposed	N/A	Due to a stakeholder comments, the agency added the following definitions from SB [2SSB] 5602 to WAC 182-532-001: "Reproductive health care services" - Any medical services or treatments, including pharmaceutical and preventive care service or treatments, directly involved in the reproductive system and its processes, functions, and organs involved in reproduction, in all stages of live. Reproductive health care services does not include infertility treatment. "Reproductive system" - Includes, but is not limited to: Genitals, gonads, the uterus, ovaries, fallopian tubes, and breasts.
Adopted	"Reproductive health care services" - Any medical services or treatments, including pharmaceutical and preventive care service or treatments, directly involved in the reproductive system and its processes, functions, and organs involved in reproduction, in all stages of life. Reproductive health care services does not include infertility treatment. "Reproductive system" - Includes, but is not limited to: Genitals, gonads, the uterus, ovaries, fallopian tubes, and breasts.
Original WAC 182-532-110 Reproductive health services—Provider requirements.
Proposed	(4) Educate clients on Food and Drug Administration (FDA)-approved prescription ((birth control)) contraceptive methods, as well as over-the-counter (OTC) ((birth control)) contraceptive drugs, devices, and supplies, and related medical services; (5) Provide medical services related to FDA-approved prescription ((birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and supplies upon request; and (6) Supply or prescribe FDA-approved prescription ((birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and supplies upon request.	The agency revised WAC 182-532-110 to better reflect the definitions of "contraceptive" and "over-the-counter."
Adopted	(4) Educate clients on Food and Drug Administration (FDA)-approved ((prescription birth control)) contraceptive methods((,)) and over-the-counter (OTC) ((birth control)) contraceptive drugs, devices, and ((supplies, and)) products, as well as related medical services; (5) Provide medical services related to FDA-approved ((prescription birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and ((supplies)) products upon request; and (6) Supply or prescribe FDA-approved ((prescription birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and ((supplies)) products upon request.
Original WAC 182-532-120 Reproductive health services—Covered services.
Proposed	(2) Contraception, including: (a) Food and Drug Administration (FDA)-approved prescription and nonprescription contraceptive methods, as described under WAC 182-530-2000;	The agency removed "prescription and nonprescription" from subsection (2)(a) because the distinction was unnecessary.
Adopted	2) Contraception, including: (a) Food and Drug Administration (FDA)-approved contraceptive methods, as described under WAC 182-530-2000;
Original WAC 182-532-510 Family planning only programs—Eligibility.
Proposed	(2)(a)(vi) Have been denied apple health coverage through www.wahealthplanfinder.org within the last thirty days, unless the applicant:	The agency removed the restriction of having been denied apple health coverage through www.wahealthplanfinder.org. This language did not address situations in which applicants who submitted paper applications were denied coverage.
Adopted	(2)(a)(vi) Have been denied apple health coverage within the last thirty days, unless the applicant:
Original WAC 182-532-520 Family planning only programs—Provider requirements.
Proposed	(4) Educate clients on Food and Drug Administration (FDA)-approved prescription ((birth control)) contraceptive methods, as well as over-the-counter (OTC) ((birth control)) contraceptive drugs, devices, and supplies, and related medical services; (5) Provide medical services related to FDA-approved prescription ((birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and supplies as medically necessary; (6) Supply or prescribe FDA-approved prescription ((birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and supplies as medically appropriate; and	The agency revised WAC 182-532-520 to better reflect the definitions of "contraceptive" and "over-the-counter."
Adopted	(4) Educate clients on Food and Drug Administration (FDA)-approved ((prescription birth control)) contraceptive methods((,)) and over-the-counter (OTC) ((birth control)) contraceptive drugs, devices, and ((supplies, and)) products, as well as related medical services; (5) Provide medical services related to FDA-approved ((prescription birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and ((supplies)) products as medically necessary; (6) Supply or prescribe FDA-approved ((prescription birth control)) contraceptive methods((,)) and OTC ((birth control)) contraceptive drugs, devices, and ((supplies)) products as medically appropriate; and
Original WAC 182-532-530 Family planning only programs—Covered services.
Proposed	(3) Contraception, including: (a) Food and Drug Administration (FDA)-approved prescription and nonprescription contraceptive methods, as described under WAC 182-530-2000;	The agency removed "prescription and nonprescription" from subsection (3)(a) because the distinction was unnecessary.
Adopted	(3) Contraception, including: (a) Food and Drug Administration (FDA)-approved contraceptive methods, as described under WAC 182-530-2000;

The following definitions and those found in ((WAC 182-500-0005))chapter 182-500 WAC apply to this chapter.

340B dispensing fee - The medicaid agency's established fee paid to a registered and medicaid-participating 340B drug program provider under the public health service (PHS) act for expenses involved in acquiring, storing and dispensing prescription drugs or drug-containing devices (see WAC 182-530-7900). A dispensing fee is not paid for nondrug items, devices, or supplies (see WAC 182-530-7050).

"Complication" - A condition occurring subsequent to and directly arising from the family planning services received under the rules of this chapter.

"Comprehensive ((prevention visit for family planning))preventive family planning visit" - For the purposes of this program, a comprehensive, preventive, contraceptive visit that includes evaluation and management of an individual, such as: Age appropriate history, examination, counseling/anticipatory guidance, risk factor reduction interventions, and ((labs))laboratory and diagnostic procedures that are covered under the client's respective ((medicaid)) agency program. ((These services may only be provided by and paid to TAKE CHARGE providers.))

"Contraception" - Prevention of pregnancy through the use of contraceptive methods.

"Contraceptive" - ((A))Food and Drug Administration (FDA)-approved prescription and nonprescription methods, including devices, drugs, products, methods, or surgical interventions used to prevent pregnancy, as described in WAC 182-530-2000.

(("Delayed pelvic protocol" - The practice of allowing a woman to postpone a pelvic exam during a contraceptive visit to facilitate the start or continuation of a hormonal contraceptive method.

"Education, counseling and risk reduction intervention (ECRR)" - Client-centered education and counseling services designed to strengthen decision-making skills and support a client's safe and effective use of a chosen contraceptive method. For women, ECRR is part of the comprehensive prevention visit for family planning. For men, ECRR is a stand-alone service for those men who seek family planning services and whose partners are at moderate to high risk of unintended pregnancy.))

"Family planning only – Pregnancy related program" - The program that covers family planning only services for eligible clients for ten months following the sixty-day post pregnancy period.

"Family planning only program" - The program that ((provides an additional ten months of family planning services to eligible women at the end of their pregnancy. This benefit follows the sixty-day postpregnancy coverage for women who received medical assistance benefits during the pregnancy.

"Family planning provider" - For this chapter, a physician or physician's assistant, advanced registered nurse practitioner (ARNP), or clinic that, in addition to meeting requirements in chapter 182-502 WAC, is approved by the medicaid agency to provide family planning services to eligible clients as described in this chapter.))covers family planning only services for eligible clients for twelve months from the date the agency determines eligibility. This program was formerly referred to as TAKE CHARGE.

"Family planning services" - Medically safe and effective medical care, educational services, ((and/or))and contraceptives that enable individuals to plan and space the number of their children and avoid unintended pregnancies.

(("Medicaid agency" - Health care authority.))

"Natural family planning" (also known as fertility awareness method) - Methods to identify the fertile days of the menstrual cycle and avoid unintended pregnancies, such as observing, recording, and interpreting the natural signs and symptoms associated with the menstrual cycle.

"Over-the-counter (OTC)" - Drugs, devices, and products that do not require a prescription ((before they can))to be sold or dispensed. (See WAC 182-530-1050((.)))

"Reproductive health" - The prevention and treatment of illness, disease, and disability related to the function of reproductive systems during all stages of life and includes:

(a) Related, appropriate, and medically necessary care;

(b) Education of clients in medically safe and effective methods of family planning; and

"Reproductive health care services" - Any medical services or treatments, including pharmaceutical and preventive care service or treatments, directly involved in the reproductive system and its processes, functions, and organs involved in reproduction, in all stages of life. Reproductive health care services does not include infertility treatment.

"Reproductive system" - Includes, but is not limited to: Genitals, gonads, the uterus, ovaries, fallopian tubes, and breasts.

"Sexually transmitted infection (STI)" - A disease or infection acquired as a result of sexual contact.

(("TAKE CHARGE" - The medicaid agency's demonstration and research program approved by the federal government under a medicaid program waiver to provide family planning services.

"TAKE CHARGE provider" - A family planning provider who has a TAKE CHARGE agreement to provide TAKE CHARGE family planning services to eligible clients under the terms of the federally approved medicaid waiver for the TAKE CHARGE program. (See WAC 182-532-730 for provider requirements.)))

(1) The medicaid agency covers ((limited)) reproductive health services ((for clients eligible for the following:

(a) Children's health insurance program (CHIP);

(b) Categorically needy program (CNP);

(d) Limited casualty program-medically needy program (LCP-MNP); and

(e) Alcohol and Drug Abuse Treatment and Support Act (ADATSA) services)), as described under WAC 182-532-120, for clients covered by one of the Washington apple health programs as listed in the table in WAC 182-501-0060.

(2) A client((s)) enrolled in ((a medicaid))an agency-contracted managed care organization (MCO) may self-refer outside their MCO for reproductive health care services including, but not limited to, family planning ((services (excluding sterilizations for clients twenty-one years of age or older))), abortion((s)), and sexually transmitted infection (STI) services((. These clients may seek services from any of the following:

(a) A medicaid agency-approved family planning provider;

(b) A medicaid agency-contracted local health department/STI clinic;

(d) A medicaid agency-contracted pharmacy))from any agency-approved provider.

(3) A client who is age twenty-one or older may not self-refer outside their MCO for sterilizations.

To ((be paid by the medicaid agency for reproductive health services provided to eligible clients, family planning providers, including licensed midwives,))receive payment for reproductive health services, a provider must:

(1) Meet the requirements ((in))under this chapter and chapters 182-501 and 182-502 WAC;

(2) Provide only those services that are within the scope of their licenses;

(3) ((Comply with the required general medicaid agency and reproductive health provider policies, procedures, and administrative practices as detailed in the agency's billing instructions))Bill the agency according to the agency's published billing guides;

(4) Educate clients on Food and Drug Administration (FDA)-approved ((prescription birth control))contraceptive methods((,))and over-the-counter (OTC) ((birth control))contraceptive drugs, devices, and ((supplies, and))products, as well as related medical services;

(5) Provide medical services related to FDA-approved ((prescription birth control))contraceptive methods((,)) and OTC ((birth control))contraceptive drugs, devices, and ((supplies))products upon request; and

(6) Supply or prescribe FDA-approved ((prescription birth control))contraceptive methods((,)) and OTC ((birth control))contraceptive drugs, devices, and ((supplies))products upon request.

(((1) Along with))In addition to the services listed in WAC 182-531-0100, the medicaid agency covers ((one))all of the following ((yearly exams per client per year:

(a) A cervical, vaginal, and breast cancer screening exam; or

(b) A comprehensive prevention visit for family planning. (Under a delayed pelvic protocol, the comprehensive prevention visit for family planning may be split into two visits, per client, per year.)

(2) The cervical, vaginal, and breast cancer screening examination:

(a) Must follow the guidelines of a nationally recognized protocol; and

(b) May be billed by a provider other than a TAKE CHARGE provider.

(3) The comprehensive prevention visit for family planning:

(a) Must be provided by one or more qualified TAKE CHARGE providers. (See WAC 182-532-730.)

(b) Must include:

(i) A clinical breast examination and pelvic examination that follows the guidelines of a nationally recognized protocol; and

(ii) Client-centered counseling that incorporates risk factor reduction for unintended pregnancy and anticipatory guidance about the advantages and disadvantages of all contraceptive methods.

(d) Must be documented in the client's chart with detailed information that allows for a well-informed follow-up visit.

(e) Must be billed by a TAKE CHARGE provider only))reproductive health services:

(1) For a client capable of reproducing, one comprehensive preventive family planning visit once every twelve months, based on nationally recognized clinical guidelines, including:

(a) Sexually transmitted infection (STI) and cancer screenings; and

(b) Comprehensive and client-centered counseling, education, risk reduction, and initiation or management of contraceptive methods.

(2) Contraception, including:

(a) Food and Drug Administration (FDA)-approved contraceptive methods, as described under WAC 182-530-2000;

(b) Education and supplies for FDA-approved contraceptives, natural family planning, and abstinence; and

(3) Cervical, breast, and prostate cancer screenings, according to nationally recognized clinical guidelines;

(4) STI screening, testing, and treatment, according to nationally recognized clinical guidelines;

(5) Human papillomavirus (HPV) immunization, administered according to the recommended schedule published by the Centers for Disease Control and Prevention (CDC);

(6) Diagnostic services, follow-up visits, imaging, and laboratory services related to the services listed under WAC 182-532-120; and

(7) Pregnancy-related services including:

(a) Maternity-related services, as described under chapter 182-533 WAC; and

(b) Abortion.

((A woman is eligible for family planning only services if:

(1) She received medical assistance coverage during her pregnancy; or

(2) She is determined eligible for a retroactive period covering the end of the pregnancy.))To be eligible for one of the family planning only programs listed in this section, a client must meet the qualifications for that program.

(1) Family planning only - Pregnancy related program.

(a) To be eligible for family planning only - Pregnancy related services, as defined in WAC 182-532-001, a client must be determined eligible for Washington apple health for pregnant clients during the pregnancy, or determined eligible for a retroactive period covering the end of a pregnancy. See WAC 182-505-0115.

(b) A client is automatically eligible for the family planning only - Pregnancy related program when the client's pregnancy ends.

(c) A client may apply for the family planning only program in subsection (2) of this section up to sixty days before the expiration of the family planning only - Pregnancy related program.

(2) Family planning only program.

(a) To be eligible for family planning only services, as defined in WAC 182-532-001, a client must:

(i) Be a United States citizen, U.S. National, or "qualified alien" as described under WAC 182-503-0535;

(ii) Provide a valid Social Security number (SSN) or meet good cause criteria listed in WAC 182-503-0515(2);

(iii) Be a Washington state resident, as described under WAC 182-503-0520;

(iv) Have an income at or below two hundred sixty percent of the federal poverty level, as described under WAC 182-505-0100;

(v) Need family planning services; and

(vi) Have been denied apple health coverage within the last thirty days, unless the applicant:

(A) Is age eighteen and younger and seeking services in confidence;

(B) Is a domestic violence victim who is seeking services in confidence; or

(C) Has an income of one hundred fifty percent to two hundred sixty percent of the federal poverty level, as described in WAC 182-505-0100.

(b) A client is not eligible for family planning only medical if the client is:

(i) Pregnant;

(ii) Sterilized;

(iii) Covered under another apple health program that includes family planning services; or

(iv) Covered by concurrent creditable coverage, as defined in RCW 48.66.020, unless they meet criteria in (a)(vi) of this subsection.

(c) A client may reapply for coverage under the family planning only program up to sixty days before the expiration of the twelve-month coverage period. The agency does not limit the number of times a client may reapply for coverage.

To be ((reimbursed))paid by the medicaid agency for services provided to clients eligible for ((the)) family planning only programs, ((family planning)) providers must:

(1) Meet the requirements ((in))under this chapter and chapters 182-501 and 182-502 WAC;

(2) Provide only those services that are within the scope of their licenses;

(3) ((Comply with the required general medicaid agency and family planning only provider policies, procedures, and administrative practices as detailed in the agency's billing instructions))Bill the agency according to the agency's published billing guides;

(6) Supply or prescribe FDA-approved ((prescription birth control))contraceptive methods((,)) and OTC ((birth control))contraceptive drugs, devices, and ((supplies))products as medically appropriate; and

(7) Refer the client to available and affordable nonfamily planning primary care services, as needed.

(((1))) The medicaid agency covers ((one))all of the following services ((per client per year, as medically necessary:

(a) A cervical, vaginal, and breast cancer screening exam; or

(b) A comprehensive prevention visit for family planning. (Under a delayed pelvic protocol, the comprehensive prevention visit for family planning may be split into two visits, per client, per year.)

(2) The cervical, vaginal, and breast cancer screening exam:

(a) Must be:

(i) Provided following the guidelines of a nationally recognized protocol; and

(ii) Conducted at the time of an office visit with a primary focus and diagnosis of family planning.

(b) May be billed by a provider other than a TAKE CHARGE provider.

(3) The comprehensive prevention visit for family planning:

(a) Must be provided by one or more qualified TAKE CHARGE trained providers. (See WAC 182-532-730.)

(b) Must include:

(i) A clinical breast examination and pelvic examination that follows the guidelines of a nationally recognized protocol; and

(ii) Client-centered counseling that incorporates risk factor reduction for unintended pregnancy and anticipatory guidance about the advantages and disadvantages of all contraceptive methods.

(i) A pap smear according to current, nationally recognized clinical guidelines; and

(ii) For women ages thirteen through twenty-five, routine gonorrhea and chlamydia testing and treatment.

(d) Must be documented in the client's chart with detailed information that allows for a well-informed follow-up visit.

(e) Must be billed by a TAKE CHARGE provider only)):

(1) One comprehensive preventive family planning visit once every twelve months, based on nationally recognized clinical guidelines. This visit must have a primary focus and diagnosis of family planning and include counseling, education, risk reduction, and initiation or management of contraceptive methods;

(2) Assessment and management of family planning or contraceptive problems, when medically necessary;

(3) Contraception, including:

(a) Food and Drug Administration (FDA)-approved contraceptive methods, as described under WAC 182-530-2000;

(b) Education and supplies for Federal Drug Administration (FDA)-approved contraceptive, natural family planning, and abstinence; and

(4) The following services, when appropriate, during a visit focused on family planning:

(a) Pregnancy testing;

(b) Cervical cancer screening, according to nationally recognized clinical guidelines;

(c) Gonorrhea and chlamydia screening and treatment for clients age thirteen through twenty-five, according to nationally recognized clinical guidelines;

(d) Syphilis screening and treatment for clients who have an increased risk for syphilis, according to nationally recognized guidelines; and

(e) Sexually transmitted infection (STI) screening, testing, and treatment, when medically indicated by symptoms or report of exposure, and medically necessary for the client's safe and effective use of their chosen contraceptive method.

(1) The medicaid agency limits ((reimbursement))payment under the family planning only programs to services that:

(a) Have a primary focus and diagnosis of family planning as determined by a qualified licensed medical practitioner; and

(b) Are medically necessary for the client to safely and effectively use, or continue to use, ((her))the client's chosen contraceptive method.

(2) The ((medicaid)) agency ((reimburses))pays:

(a) Providers for covered family planning ((only)) services using the agency's published fee schedules((.

(3)));

(b) For family planning pharmacy services, family planning ((lab))laboratory services, and sterilization services ((are reimbursed by the medicaid agency under the rules and fee schedules applicable to these specific programs.

(4) The medicaid agency pays))using the agency's published fee schedules; and

(c) A dispensing fee only for contraceptive drugs ((that are)) purchased through the 340B program of the Public Health Service Act. (See chapter 182-530 WAC((.)))

(((5) Under WAC 182-501-0200, the medicaid agency requires a provider to))(3) The agency does not pay for inpatient services under the family planning only programs, except for complications arising from covered family planning services.

(4) The agency requires providers to:

(a) Meet the timely billing requirements of WAC 182-502-0150; and

(b) Seek timely reimbursement from a third party when a client has available third-party resources, as described under WAC 182-501-0200. ((The))Exceptions to this requirement are described under WAC 182-501-0200 (2) and (3) and 182-532-570.

(5) Services provided to family planning clients by federally qualified health centers (FQHCs), rural health centers (RHCs), and Indian health care providers (IHCP) do not qualify for encounter or enhanced rates.

WAC 182-532-123	Reproductive health—Other covered services for women.
WAC 182-532-125	Reproductive health—Covered services for men.
WAC 182-532-533	Family planning only program—Other covered services.
WAC 182-532-540	Family planning only program—Noncovered services.
WAC 182-532-700	TAKE CHARGE program—Purpose.
WAC 182-532-720	TAKE CHARGE program—Eligibility.
WAC 182-532-730	TAKE CHARGE program—Provider requirements.
WAC 182-532-740	TAKE CHARGE program—Covered yearly exams for women.
WAC 182-532-743	TAKE CHARGE program—Other covered services for women.
WAC 182-532-745	TAKE CHARGE program—Covered services for men.
WAC 182-532-750	TAKE CHARGE program—Noncovered services.
WAC 182-532-760	TAKE CHARGE program—Documentation requirements.
WAC 182-532-780	TAKE CHARGE program—Reimbursement and payment limitations.
WAC 182-532-790	TAKE CHARGE program—Good cause exemption from billing third party insurance.