Hospital physician-related services not requiring authorization when provided in agency-approved centers of excellence or hospitals authorized to provide the specific services.

The medicaid agency covers the following services without prior authorization when provided in agency-approved centers of excellence. The agency issues periodic publications listing centers of excellence. These services include the following:

(1) All transplant procedures specified in WAC 182-550-1900;

(2) Chronic pain management services, including outpatient evaluation and inpatient treatment, as described under WAC 182-550-2400. See also WAC 182-531-0700;

(3) Sleep studies including, but not limited to, polysomnograms for clients one year of age and older. The agency allows sleep studies only in outpatient hospital settings as described under WAC 182-550-6350. See also WAC 182-531-1500; and

(4) Diabetes education, in a DOH-approved facility, per WAC 182-550-6300.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 17-04-039, § 182-531-0650, filed 1/25/17, effective 2/25/17. WSR 11-14-075, recodified as § 182-531-0650, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-531-0650, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-12-022, § 388-531-0650, filed 5/20/05, effective 6/20/05; WSR 01-01-012, § 388-531-0650, filed 12/6/00, effective 1/6/01.]

PDFWAC 182-531-0650

Hospital physician-related services not requiring authorization when provided in agency-approved centers of excellence or hospitals authorized to provide the specific services.