WSR 00-14-068

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed July 5, 2000, 9:21 a.m. ]

Date of Adoption: July 5, 2000.

Purpose: The department incorporated the policy in WAC 388-86-024 Enhanced benefits for pregnant women, into new WAC 388-533-0300 Enhanced benefits for pregnant women, so that all maternity-related benefits program rules are in one area of Title 388 WAC. The rule is written to comply with the Governor's Executive Order 97-02 on regulatory reform and ensures that all long-standing operational policy is reflected in the rule.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-86-024.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.770, and 74.09.800.

Adopted under notice filed as WSR 00-09-041 on April 14, 2000.

Changes Other than Editing from Proposed to Adopted Version: Changes that have been incorporated were the result of oral comments received after the filing of the CR-102 and the result of written testimony received in connection with the public hearing.

WAC 388-533-0300:

(2) MAA requires providers to have specific MAA approval to provide prior to becoming an approved maternity support services (MAA) to eligible clients provider.

(5) In addition to the client's standard scope of care, MAA covers the following enhanced benefits (MSS) for eligible women before and after their pregnancy.

(5)(b) Chemical dependency assessment and treatment when appropriate. A client may choose to be referred to either inpatient or outpatient drug and alcohol treatment services; and Assessment, counseling, education, and interventions by those qualified professionals described in subsections (2) and (3) of this section; and

(5)(c) MSS services, which include all of the following: Child care for the client's children (see subsection (7) of this section).

(6) MAA requires the MAA provider to document all of the following for child care:

(a) That the MSS provider arranged and authorized the child care;

(b) That the child care arrangement is safe and appropriate; and;

(c) That child care is necessary in order to assist the eligible client in obtaining necessary services. The MSS provider may authorize child care for any of the following reasons:

(i) Health care appointments for the client;

(ii) The maternity services medical provider ordered bed rest for the client; or

(iii) Other circumstances that the MSS provider considers necessary and are specifically approved by MAA.

(6) MSS providers refer a client who may need chemical dependency assessment to a provider who is contracted with the division of alcohol and substance abuse (DASA)(see chapter 444-22 WAC). Enhanced benefits for eligible pregnant women through DASA include:

(a) Assessment for alcohol/drug use;

(b) Parenting education; and

(c) Treatment for alcohol/drug use.

(7) MAA covers up to ten MSS visits. If it is determined that a client is at high risk for a poor birth outcome, MAA may cover up to twenty MSS visits. The MSS provider must maintain documentation of the high risk circumstance in the client's file.

(7) MAA requires the MSS provider to do the following for child care under this section:

(a) Screen for the eligible woman's need for child care;

(b) Discuss and encourage a safe and healthy child care plan; and

(c) Authorize the child care. The MSS provider may authorize child care for any of the following reasons:

(i) Health care appointments for the client;

(ii) The maternity services medical provider ordered bed rest for the client; or

(iii) Other circumstances that the MSS provider considers necessary and are specifically approved by MAA.

(8) MAA allows a provider to bill only once per client per pregnancy for childbirth education. The provider must document that the client attended at least one childbirth education session in order for MAA to cover the service.

(8) MAA covers up to ten MSS visits. If it is determined that a client is at high-risk for a poor birth outcome (see the maternity case management program), MAA may cover up to twenty visits. The MSS provider must maintain documentation of the high-risk circumstances in the client's file.

(9) MAA allows a provider to bill only once per client per pregnancy for childbirth education. The provider must document that the client attended at least one childbirth education session in order for MAA to reimburse for the service.

(10) MAA published MSS program billing instructions that contain specific process requirements for the MSS program.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 1.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 1.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 1. Effective Date of Rule: Thirty-one days after filing.

July 5, 2000

Edith M. Rice, Chief

Office of Legal Affairs

2664.6
NEW SECTION
WAC 388-533-0300
Enhanced benefits for pregnant women.

The medical assistance administration (MAA) provides enhanced services to eligible women during and after their pregnancy.

(1) Refer to WAC 388-462-0015 for client eligibility requirements.

(2) MAA requires providers to have specific MAA approval prior to becoming an approved maternity support services (MSS) provider. MSS services must be provided by professionals from all of the following fields:

(a) Community health nursing;

(b) Nutrition; and

(c) Social work.

(3) MAA allows paraprofessional community health workers to provide MSS services to eligible clients when both of the following are met:

(a) The services are provided under the supervision of one of the qualified professionals described in subsection (2) of this section; and

(b) The services provided are limited to basic health education.

(4) A client may choose to receive MSS services from any MAA-approved MSS provider.

(5) In addition to the client's standard scope of care, MAA covers the following enhanced benefits (MSS) for eligible women during and after their pregnancy:

(a) One childbirth education course per pregnancy (see subsection (9) in this section);

(b) Assessment, counseling, education, and interventions by those qualified professionals described in subsections (2) and (3) of this section; and

(c) Child care for the client's children (see subsection (7) of this section).

(6) MSS providers refer a client who may need chemical dependency assessment to a provider who is contracted with the division of alcohol and substance abuse (DASA)(see chapter 440-22 WAC). Enhanced benefits for eligible pregnant women through DASA include:

(a) Assessment for alcohol/drug use;

(b) Parenting education; and

(c) Treatment for alcohol/drug use.

(7) MAA requires the MSS provider to do the following for child care under this section:

(a) Screen for the eligible woman's need for child care;

(b) Discuss and encourage a safe and healthy child care plan; and

(c) Authorize the child care. The MSS provider may authorize child care for any of the following reasons:

(i) Health care appointments for the client;

(ii) The maternity services medical provider ordered bed rest for the client; or

(iii) Other circumstances that the MSS provider considers necessary and are specifically approved by MAA.

(8) MAA covers up to ten MSS visits. If it is determined that a client is at high-risk for a poor birth outcome (see the maternity case management program), MAA may cover up to twenty visits. The MSS provider must maintain documentation of the high-risk circumstances in the client's file.

(9) MAA allows a provider to bill only once per client per pregnancy for childbirth education. The provider must document that the client attended at least one childbirth education session in order for MAA to reimburse for the service.

(10) MAA publishes MSS program billing instructions that contain specific process requirements for the MSS program.

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2631.1
REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 388-86-024 Enhanced benefits for pregnant women.

Washington State Code Reviser's Office