PDFWAC 182-551-2100

Skilled nursing services.

(1) The medicaid agency covers home health skilled nursing services up to service limitations without prior authorization. See WAC 182-501-0169 for information on limitation extension.
(2) The home health skilled nursing services must be furnished by a qualified provider in any setting where normal life activities take place.
(3) The medicaid agency pays for the following home health skilled nursing services, subject to program rules and the provisions in this section:
(a) Full skilled nursing services that require the skills of a registered nurse or a licensed practical nurse under the supervision of a registered nurse, if the services involve one or more of the following:
(i) Observation;
(ii) Assessment;
(iii) Treatment;
(iv) Teaching;
(v) Training;
(vi) Management; and
(vii) Evaluation.
(b) A brief skilled nursing visit if only one of the following activities is performed during the visit:
(i) An injection;
(ii) Blood draw; or
(iii) Placement of medications in containers (e.g., envelopes, cups, medisets).
(c) Home infusion therapy only if the client:
(i) Is willing and capable of learning and managing the client's infusion care; or
(ii) Has a volunteer caregiver willing and capable of learning and managing the client's infusion care.
(d) Infant phototherapy for an infant diagnosed with hyperbilirubinemia:
(i) When provided by a medicaid agency-approved home health agency with an infant phototherapy provider; and
(ii) For up to five skilled nursing visits per infant.
(e) Limited high-risk obstetrical services:
(i) For a medical diagnosis that complicates pregnancy and may result in a poor outcome for the birth parent, unborn, or newborn;
(ii) For up to three home health visits per pregnancy if enrolled in or referred to a first steps maternity support services (MSS) provider. The visits are provided by a registered nurse who has either:
(A) National perinatal certification; or
(B) A minimum of one year of labor, delivery, and postpartum experience at a hospital within the last five years.
(4) The medicaid agency pays for up to two skilled nursing visits, per client, per day.
[Statutory Authority: RCW 41.05.021, 41.05.160, and P.L. 114-255. WSR 23-24-026, § 182-551-2100, filed 11/29/23, effective 1/1/24. Statutory Authority: RCW 41.05.021, 41.05.160, and 42 C.F.R. Section 440.70. WSR 18-24-023, § 182-551-2100, filed 11/27/18, effective 1/1/19. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-03-035, § 182-551-2100, filed 1/12/16, effective 2/12/16. WSR 11-14-075, recodified as § 182-551-2100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, chapter 74.09 RCW, and 2009 c 326. WSR 10-10-087, § 388-551-2100, filed 5/3/10, effective 6/3/10. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.530, and 74.09.500. WSR 02-15-082, § 388-551-2100, filed 7/15/02, effective 8/15/02. Statutory Authority: RCW 74.08.090 and 74.09.530. WSR 99-16-069, § 388-551-2100, filed 8/2/99, effective 9/2/99.]