PDFWAC 182-550-1800

Hospital specialty services not requiring prior authorization.

The medicaid agency pays for certain specialty services without requiring prior authorization when such services are provided consistent with agency medical necessity and utilization review standards. These services include, but are not limited to, the following:
(1) All transplant procedures specified in WAC 182-550-1900(2) under the conditions established in WAC 182-550-1900;
(2) Chronic pain management services, including outpatient evaluation and inpatient treatment, as described under WAC 182-550-2400;
(3) Polysomnograms and multiple sleep latency tests, as described under WAC 182-531-1500;
(4) Diabetes education (allowed only in outpatient hospital setting), as described under WAC 182-550-6400; and
(5) Weight loss program (allowed only in outpatient hospital setting), as described under WAC 182-550-6450.
[Statutory Authority: RCW 41.05.021. WSR 13-07-029, § 182-550-1800, filed 3/13/13, effective 4/13/13. WSR 11-14-075, recodified as § 182-550-1800, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-14-018, § 388-550-1800, filed 6/22/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-1800, filed 12/18/97, effective 1/18/98.]