PDFWAC 182-556-0400

Limitations on services available to categorically needy Washington apple health clients.

(1) Organ transplants are limited to the cornea, heart, heart-lung, kidney, kidney-pancreas, liver, pancreas, single lung, and bone marrow.
(2) The medicaid agency pays for treatment, dialysis, equipment, and supplies for acute and chronic nonfunctioning kidneys for a client in a home, hospital, or kidney center as described under WAC 182-540-005.
(3) The agency pays for detoxification and medical stabilization to chemical-using pregnant women in a hospital.
(4) The agency pays for detoxification of acute alcohol or other drug intoxication only in a certified detoxification center or in a general hospital that has a detoxification provider agreement with the agency.
(5) The agency pays for outpatient chemical dependency treatment in programs qualified under chapter 275-25 WAC and certified under chapter 275-19 WAC or its successor.
(6) The agency may require a second opinion, or consultation, or both before approving any elective surgical procedure.
(7) The agency designates diagnoses that may require surgical intervention:
(a) Performed in other than a hospital in-patient setting; and
(b) Requiring prior agency approval for a hospital admission.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 15-10-018, § 182-556-0400, filed 4/24/15, effective 5/25/15. WSR 11-14-075, recodified as § 182-556-0400, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 01-02-075, § 388-556-0400, filed 12/29/00, effective 1/29/01. WSR 00-11-183, recodified as § 388-556-0400, filed 5/24/00, effective 5/24/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. WSR 98-18-079, § 388-86-005, filed 9/1/98, effective 9/1/98. Statutory Authority: RCW 74.08.090. WSR 95-22-039 (Order 3913, #100246), § 388-86-005, filed 10/25/95, effective 10/28/95; WSR 93-17-038 (Order 3620), § 388-86-005, filed 8/11/93, effective 9/11/93; WSR 92-03-084 (Order 3309), § 388-86-005, filed 1/15/92, effective 2/15/92; WSR 90-17-122 (Order 3056), § 388-86-005, filed 8/21/90, effective 9/21/90; WSR 90-12-051 (Order 3009), § 388-86-005, filed 5/31/90, effective 7/1/90; WSR 89-18-033 (Order 2860), § 388-86-005, filed 8/29/89, effective 9/29/89; WSR 89-13-005 (Order 2811), § 388-86-005, filed 6/8/89; WSR 88-06-083 (Order 2600), § 388-86-005, filed 3/2/88. Statutory Authority: 1987 1st ex.s. c 7. WSR 88-02-034 (Order 2580), § 388-86-005, filed 12/31/87. Statutory Authority: RCW 74.08.090. WSR 87-12-050 (Order 2495), § 388-86-005, filed 6/1/87; WSR 84-02-052 (Order 2060), § 388-86-005, filed 1/4/84; WSR 83-17-073 (Order 2011), § 388-86-005, filed 8/19/83; WSR 83-01-056 (Order 1923), § 388-86-005, filed 12/15/82; WSR 82-10-062 (Order 1801), § 388-86-005, filed 5/5/82; WSR 82-01-001 (Order 1725), § 388-86-005, filed 12/3/81; WSR 81-16-033 (Order 1685), § 388-86-005, filed 7/29/81; WSR 81-10-015 (Order 1647), § 388-86-005, filed 4/27/81; WSR 80-15-034 (Order 1554), § 388-86-005, filed 10/9/80; WSR 78-06-081 (Order 1299), § 388-86-005, filed 6/1/78; WSR 78-02-024 (Order 1265), § 388-86-005, filed 1/13/78; Order 994, § 388-86-005, filed 12/31/74; Order 970, § 388-86-005, filed 9/13/74; Order 911, § 388-86-005, filed 3/1/74; Order 858, § 388-86-005, filed 9/27/73; Order 781, § 388-86-005, filed 3/16/73; Order 738, § 388-86-005, filed 11/22/72; Order 680, § 388-86-005, filed 5/10/72; Order 630, § 388-86-005, filed 11/24/71; Order 581, § 388-86-005, filed 7/20/71; Order 549, § 388-86-005, filed 3/31/71, effective 5/1/71; Order 453, § 388-86-005, filed 5/20/70, effective 6/20/70; Order 419, § 388-86-005, filed 12/31/69; Order 264 (part); § 388-86-005, filed 11/24/67.]