Hospital and medical criteria requirements for bariatric surgery.
(1) The medicaid agency pays a hospital for bariatric surgery and bariatric surgery-related services only when the surgery is provided in an inpatient hospital setting and only when:
(a) The client:
(i) Qualifies for bariatric surgery by successfully completing all requirements under WAC 182-531-1600
(ii) Continues to meet the criteria to qualify for bariatric surgery under WAC 182-531-1600
up to the actual surgery date.
(b) The hospital:
(i) Is accredited by the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP); and
(ii) Receives prior authorization from the agency before performing a bariatric surgery for a Washington apple health client.
(2) See WAC 182-531-1600
(13) for requirements for surgeons who perform bariatric surgery.
(3) Authorization does not guarantee payment. Authorization for bariatric surgery and bariatric surgery-related services is valid only if:
(a) The client is eligible on the date of admission and date of service; and
(b) The hospital and professional providers meet the criteria in this section and other applicable WAC to perform bariatric surgery or to provide bariatric surgery-related services.
[Statutory Authority: RCW 41.05.021
. WSR 17-24-107, § 182-550-2301, filed 12/6/17, effective 1/6/18; WSR 15-18-065, § 182-550-2301, filed 8/27/15, effective 9/27/15. WSR 11-14-075, recodified as § 182-550-2301, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
. WSR 07-14-018, § 388-550-2301, filed 6/22/07, effective 8/1/07. Statutory Authority: RCW 74.08.090
. WSR 05-12-022, § 388-550-2301, filed 5/20/05, effective 6/20/05.]