PDFWAC 182-547-1000

Prior authorization—Clients age twenty and younger.

(1) Prior authorization is not required for clients age twenty and younger for hearing aid(s) and services.
(2) The agency pays for services according to the early and periodic screening, diagnostic, and treatment (EPSDT) provisions, as described in chapter 182-534 WAC. The standard for coverage for EPSDT is that services, treatment, or other measures are medically necessary, safe and effective, and not experimental.
(3) When billing, providers must send claims for clients age twenty and younger directly to the medicaid agency. Providers do not have to obtain authorization from the local children with special health care needs (CSHCN) coordinator.
[Statutory Authority: RCW 41.05.021, 41.05.160 and 2018 c 159. WSR 19-20-043, § 182-547-1000, filed 9/25/19, effective 11/1/19. Statutory Authority: RCW 41.05.021. WSR 13-20-013, § 182-547-1000, filed 9/20/13, effective 10/21/13. WSR 11-14-075, recodified as § 182-547-1000, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.530. WSR 09-12-034, § 388-547-1000, filed 5/27/09, effective 7/1/09.]