(1) The medicaid agency pays a hospital that is specifically approved by the agency to provide inpatient chronic pain management services, an all-inclusive per diem facility fee. The agency pays professional fees for chronic pain management services to performing providers under the agency's fee schedule.
(2) A client qualifies for inpatient chronic pain management services when all the following apply:
(a) The client has had pain for at least three months and has not improved with conservative treatment, including tests and therapies;
(b) At least six months have passed since a previous surgical procedure was done concerning the pain problem; and
(c) A client with active substance abuse must have completed a detoxification program, if appropriate, and must be free from drugs and/or alcohol for at least six months.
(3) The agency:
(a) Covers inpatient chronic pain management training to assist eligible clients to manage chronic pain.
(b) Pays for only one inpatient hospital stay, up to a maximum of twenty-one consecutive days, for chronic pain management training per a client's lifetime.
(c) Does not require prior authorization for chronic pain management services.
(d) Does not pay for services unrelated to the chronic pain management services that are provided during the client's inpatient stay, unless the hospital requests and receives prior authorization from the agency.
(4) All applicable claim payment adjustments for client responsibility, third party liability, medicare crossover, etc., apply to the agency.
[Statutory Authority: RCW 41.05.021
. WSR 15-18-065, § 182-550-2400, filed 8/27/15, effective 9/27/15. WSR 11-14-075, recodified as § 182-550-2400, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
. WSR 07-14-018, § 388-550-2400, filed 6/22/07, effective 8/1/07. Statutory Authority: RCW 74.08.090
, [74.09.]500, [74.09.]530 and 43.20B.020
. WSR 98-01-124, § 388-550-2400, filed 12/18/97, effective 1/18/98.]