WSR 24-17-001
PERMANENT RULES
HEALTH CARE AUTHORITY
[Filed August 8, 2024, 7:32 a.m., effective September 8, 2024]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The health care authority is amending WAC 182-543-3300 to update medical necessity criteria based on evidence review(s).
Citation of Rules Affected by this Order: Amending WAC 182-543-3300.
Adopted under notice filed as WSR 24-14-013 on June 21, 2024.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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: August 8, 2024.
Wendy Barcus
Rules Coordinator
OTS-5427.1
AMENDATORY SECTION(Amending WSR 14-08-035, filed 3/25/14, effective 4/25/14)
WAC 182-543-3300Covered—Osteogenesis electrical stimulator (bone growth stimulator)—Noninvasive.
(1) The medicaid agency covers, with prior authorization, noninvasive osteogenesis electrical stimulators, also known as bone growth stimulators, limited to one per client, in a five-year period.
(2) The agency pays for the purchase of nonspinal bone growth stimulators, only when:
(a) The stimulators have pulsed electromagnetic field (PEMF) ((simulation))stimulation; and
(b) The client meets one or more of the following clinical criteria:
(i) Has a nonunion of a long bone fracture (which includes clavicle, humerus, phalanx, radius, ulna, femur, tibia, fibula, metacarpal and metatarsal) where three months have elapsed since the date of injury without healing; or
(ii) Has a failed fusion of a joint, other than in the spine, where a minimum of nine months has elapsed since the last surgery; or
(iii) Diagnosed with congenital pseudarthrosis.
(3) The agency pays for the purchase of spinal bone growth stimulators, when:
(a) Prescribed by a neurologist, an orthopedic surgeon, or a neurosurgeon; and
(b) The client meets one or more of the following clinical criteria:
(i) Has a failed spinal fusion where a minimum of nine months ((have))has elapsed since the last surgery; or
(ii) Is post-op from a multilevel spinal fusion surgery; or
(iii) Is post-op from spinal fusion surgery and there is a history of a previously failed spinal fusion.
(4) The agency pays for the purchase of ultrasonic noninvasive bone growth stimulators when:
(a) Prescribed by a neurologist, an orthopedic surgeon, or a neurosurgeon; and
(b) The client meets all the following clinical criteria:
(i) Nonunion confirmed by two radiographs minimum 90 days apart; and
(ii) Physician statement of no clinical evidence of fracture healing.