(1) The agency covers the enteral nutrition products, equipment, and related supplies listed in this chapter, according to medicaid agency rules and subject to the limitations and requirements in this chapter.
(2) The agency pays for covered enteral nutrition products, equipment and related supplies if they are:
(a) Within the scope of the eligible client's medical care program;
(c) Authorized and billed, as required within this chapter, chapters
182-501 and
182-502 WAC, and the agency's published billing instructions.
(3) The agency requires prior authorization (PA) for covered enteral nutrition products, equipment and related supplies when the clinical criteria described in this chapter are not met, including the criteria associated with the expedited prior authorization process. The agency evaluates requests requiring PA on a case-by-case basis to determine whether they are medically necessary under WAC
182-501-0165.
(4) The agency evaluates a request for a covered service that is experimental or investigational under WAC
182-531-0550 and
182-501-0165.
(5) The agency may terminate a provider's core provider agreement under chapter
182-502 WAC.
[Statutory Authority: RCW
41.05.021 and
41.05.160. WSR 17-08-009, § 182-554-100, filed 3/24/17, effective 5/1/17. WSR 11-14-075, recodified as § 182-554-100, filed 6/30/11, effective 7/1/11. Statutory Authority: 2009 c 564 § 1109, RCW
74.04.050, and
74.08.090. WSR 10-01-138, § 388-554-100, filed 12/21/09, effective 1/21/10. Statutory Authority: RCW
74.08.090,
74.09.530 and chapter
74.09 RCW. WSR 05-04-059, § 388-554-100, filed 1/28/05, effective 3/1/05.]