The following health care professionals, health care entities, suppliers or contractors of service may request enrollment with the Washington state health care authority (medicaid agency) to provide covered health care services to eligible clients. For the purposes of this chapter, health care services include treatment, equipment, related supplies, and drugs.

(1) Professionals:

(a) Advanced registered nurse practitioners;

(b) Advanced social workers;

(d) Anesthesiologists;

(((c)))(e) Applied behavior analysis (ABA) professionals, as provided in WAC 182-531A-0800:

(i) Licensed behavior analyst;

(ii) Licensed assistant behavior analyst; and

(iii) Certified behavior technician((.));

(((d)))(f) Audiologists;

(((e)))(g) Chiropractors;

(((f)))(h) Dentists;

(((g)))(i) Dental health aide therapists, as provided in chapter 70.350 RCW;

(((h)))(j) Dental hygienists;

(((i)))(k) Denturists;

(((j)))(l) Dietitians or nutritionists;

(((k)))(m) Hearing aid fitters/dispensers;

(((l)))(n) Home health aide credentialed with DOH as nursing assistant certified or nursing assistant registered;

(((m)))(o) Independent clinical social workers;

(p) Independent clinical social worker associates;

(q) Licensed practical nurse;

(((n)))(r) Marriage and family therapists;

(((o)))(s) Mental health counselors;

(((p)))(t) Mental health counselor associates;

(u) Mental health care providers;

(((q)))(v) Midwives;

(((r)))(w) Naturopathic physicians;

(((s)))(x) Nurse anesthetist;

(((t) Occularists;

(u)))(y) Ocularists;

(z) Occupational therapists;

(((v)))(aa) Ophthalmologists;

(((w)))(bb) Opticians;

(((x)))(cc) Optometrists;

(((y)))(dd) Orthodontists;

(((z)))(ee) Orthotist;

(((aa)))(ff) Osteopathic physicians;

(((bb)))(gg) Osteopathic physician assistants;

(((cc)))(hh) Peer counselors;

(((dd)))(ii) Podiatric physicians;

(((ee)))(jj) Pharmacists;

(((ff)))(kk) Physicians;

(((gg)))(ll) Physician assistants;

(((hh)))(mm) Physical therapists;

(((ii)))(nn) Prosthetist;

(((jj)))(oo) Psychiatrists;

(((kk)))(pp) Psychologists;

(((ll)))(qq) Radiologists;

(((mm)))(rr) Registered nurse;

(((nn)))(ss) Registered nurse delegators;

(((oo)))(tt) Registered nurse first assistants;

(((pp)))(uu) Respiratory therapists;

(((qq) Social workers; and

(rr)))(vv) Speech/language pathologists; and

(((ss)))(ww) Substance use disorder professionals:

(i) Mental health providers; and

(ii) Peer counselors.

(2) Agencies, centers and facilities:

(a) Adult day health centers;

(b) Ambulance services (ground and air);

(d) Birthing centers (licensed by the department of health);

(e) Cardiac diagnostic centers;

(f) Case management agencies;

(g) Substance use disorder treatment facilities certified by the department of health (DOH);

(h) Withdrawal management treatment facilities certified by DOH;

(i) Community AIDS services alternative agencies;

(j) Community behavioral health support services provider facilities;

(k) Community mental health centers;

(((k)))(l) Diagnostic centers;

(((l)))(m) Early and periodic screening, diagnosis, and treatment (EPSDT) clinics;

(((m)))(n) Family planning clinics;

(((n)))(o) Federally qualified health centers (designated by the federal department of health and human services);

(((o)))(p) Genetic counseling agencies;

(((p)))(q) Health departments;

(((q)))(r) Health maintenance organization (HMO)/managed care organization (MCO);

(((r)))(s) HIV/AIDS case management;

(((s)))(t) Home health agencies;

(((t)))(u) Hospice agencies;

(((u)))(v) Hospitals;

(((v)))(w) Indian health service facilities/tribal 638 facilities;

(((w)))(x) Tribal or urban Indian clinics;

(((x)))(y) Inpatient psychiatric facilities;

(((y)))(z) Intermediate care facilities for individuals with intellectual disabilities (ICF-IID);

(((z)))(aa) Kidney centers;

(((aa)))(bb) Laboratories (CLIA certified);

(((bb)))(cc) Maternity support services agencies; maternity case managers; infant case management, first steps providers;

(((cc)))(dd) Neuromuscular and neurodevelopmental centers;

(((dd)))(ee) Nurse services/delegation;

(((ee)))(ff) Nursing facilities (approved by the DSHS aging and long-term support administration);

(((ff)))(gg) Pathology laboratories;

(((gg)))(hh) Pharmacies;

(((hh)))(ii) Private duty nursing agencies;

(((ii)))(jj) Radiology - Stand-alone clinics;

(((jj)))(kk) Rural health clinics (medicare-certified);

(((kk)))(ll) School districts and educational service districts; and

(((ll)))(mm) Sleep study centers((; and

(mm) Washington state school districts and educational service districts)).

(3) Suppliers of:

(a) Blood, blood products, and related services;

(b) Durable and nondurable medical equipment and supplies;

(d) Infusion therapy equipment and supplies;

(e) Prosthetics/orthotics;

(f) Hearing aids; and

(g) Respiratory care, equipment, and supplies.

(4) Contractors:

(a) Transportation brokers;

(b) Spoken language interpreter services agencies;

(d) Eyeglass and contact lens providers.

(1) The mental health services covered in this section are different from the mental health services covered under community mental health and involuntary treatment programs in chapter 182-538D WAC.

(2) Inpatient and outpatient mental health services not covered under chapter 182-538D WAC may be covered by the agency under this section.

Inpatient mental health services

(3) For hospital inpatient psychiatric admissions, providers must comply with chapter 182-538D WAC.

(4) The agency covers professional inpatient mental health services as follows:

(a) When provided by a psychiatrist, psychiatric advanced registered nurse practitioner (ARNP), psychiatric mental health nurse practitioner-board certified (PMHNP-BC), or psychologist in conjunction with the prescribing provider;

(b) The agency pays only for the total time spent on direct psychiatric client care during each visit, including services provided when making rounds. The agency considers services provided during rounds to be direct client care services and may include, but are not limited to:

(i) Individual psychotherapy up to one hour;

(ii) Family/group therapy; or

(iii) Electroconvulsive therapy.

Outpatient mental health services

(5) The agency covers outpatient mental health services when provided by the following licensed health care practitioners who are eligible providers under chapter 182-502 WAC:

(a) Psychiatrists;

(b) Psychologists;

(d) Psychiatric mental health nurse practitioners-board certified (PMHNP-BC);

(e) Mental health counselors;

(f) Mental health counselor associates;

(g) Independent clinical social workers;

(((g)))(h) Independent clinical social worker associates;

(i) Advanced social workers; ((or

(h)))(j) Advanced social worker associates;

(k) Marriage and family therapists; or

(l) Marriage and family therapist associates.

(6) With the exception of child psychiatrists, as defined in RCW 71.34.020, qualified practitioners listed in subsection (5) of this section who diagnose and treat clients age 18 and younger must meet one of the following:

(a) The education and experience requirements for a child mental health specialist found in WAC 182-538D-0200; or

(b) Be working under the supervision of a practitioner who meets these requirements.

(7) The agency does not limit the total number of outpatient mental health visits a licensed health care professional can provide.

(8) The agency evaluates a request for covered outpatient mental health services in excess of the limitations in this section under WAC 182-501-0169.

(9) The agency covers outpatient mental health services with the following limitations:

(a) Diagnostic evaluations. One psychiatric diagnostic evaluation, per provider, per client, per calendar year, unless significant change in the client's circumstances renders an additional evaluation medically necessary and is authorized by the agency.

(i) For clients 20 years of age and younger, additional evaluations are paid for when medically necessary and authorized by the agency, per WAC 182-534-0100 and 182-501-0165.

(ii) For clients five years of age and younger, the agency pays for the following without requiring prior authorization:

(A) Up to five sessions to complete a psychiatric diagnostic evaluation; and

(B) Evaluations in the home or community setting, including reimbursement for provider travel.

(iii) For clients age five through age 20, the services in (a)(ii)(A) and (B) of this subsection are paid for when medically necessary and authorized by the agency.

(b) Psychotherapy. One or more individual or family/group psychotherapy visits, with or without the client, per day, per client, when medically necessary.

(c) Medication management. One psychiatric medication management service, per client, per day, in an outpatient setting when performed by one of the following:

(i) Psychiatrist;

(ii) Psychiatric advanced registered nurse practitioner (ARNP); or

(iii) Psychiatric mental health nurse practitioner-board certified (PMHNP-BC).

(10) To receive payment for providing mental health services, providers must bill the agency using the agency's published billing instructions.