The medicaid agency pays contracted school districts, educational service districts, charter schools, and tribal schools for school-based health care services provided to medicaid-eligible children who require early intervention or special education and related services consistent with Sections 1903(c) and 1905(a) of the Social Security Act. The agency pays school districts through fee-for-service. Covered services must:
(1) Identify, treat, and manage the disabilities of a child who requires early intervention or special education and related services;
(2) Be prescribed or recommended by licensed physicians or other licensed health care providers within their scope of practice under state law;
(3) Be medically necessary;
(4) Be included in the child's current individualized education program (IEP) or individualized family service plan (IFSP); and
(5) Be provided in a school setting, the natural environment, an alternate placement in accordance with the Individuals with Disabilities Education Act (IDEA), or by telemedicine.
[Statutory Authority: RCW
41.05.021 and
41.05.160. WSR 20-14-062, § 182-537-0100, filed 6/26/20, effective 7/27/20; WSR 19-04-095, § 182-537-0100, filed 2/5/19, effective 3/8/19; WSR 16-07-141, § 182-537-0100, filed 3/23/16, effective 4/23/16. Statutory Authority: RCW
41.05.021. WSR 13-05-017, § 182-537-0100, filed 2/7/13, effective 3/10/13. WSR 11-14-075, recodified as § 182-537-0100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW
74.08.090,
74.09.500, and 42 C.F.R. 440.110. WSR 09-07-004, § 388-537-0100, filed 3/4/09, effective 4/4/09. Statutory Authority: RCW
74.08.090. WSR 01-02-076, § 388-537-0100, filed 12/29/00, effective 1/29/01. Statutory Authority: RCW
74.04.050 and
74.08.090. WSR 00-01-088, § 388-537-0100, filed 12/14/99, effective 1/14/00.]