WSR 02-03-099

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed January 18, 2002, 4:17 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 01-20-048.

Title of Rule: Amending WAC 388-534-0100 EPSDT and new section WAC 388-534-0200 Enhanced payments for EPSDT screens for children receiving foster care placement services from the Department of Social and Health Services (DSHS).

Purpose: The department is implementing a program to encourage providers to increase the number of children receiving foster care placement services who receive early periodic screening, diagnosis and treatment (EPSDT) screens, and if necessary, subsequent referrals for treatment. Providers may receive an enhanced payment for providing EPSDT screens to these children. The department is also eliminating the name "healthy kids" from this rule, so the state program name will be the same as the federal program (EPSDT).

Statutory Authority for Adoption: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090, and 42 C.F.R. Part 441, Subpart B.

Statute Being Implemented: RCW 74.04.050, 74.04.055, 74.04.057, and 42 C.F.R. Part 441, Subpart B.

Summary: The department is implementing a program of enhanced payments to providers who furnish EPSDT screens to children receiving foster care placement services, in order to increase the number of these children who receive such screens.

Reasons Supporting Proposal: Increasing the number of children receiving foster care placement services who receive EPSDT screens will promote earlier prevention, detection and treatment of possible medical problems in this population.

Name of Agency Personnel Responsible for Drafting: Ann Myers, 925 Plum Street S.E., Olympia, WA 98501, (360) 725-1345; Implementation and Enforcement: Ann Egerton, 649 Woodland Square Loop Road, Lacey, WA 98502, (360) 725-1633.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The proposed rule will provide enhanced payments to providers who furnish EPSDT screens to children receiving foster care services from the department.

The proposed rule is intended to increase the number of foster care children who receive EPSDT screens.

The anticipated effect of the proposed rule is to increase the number of foster care children who receive EPSDT screens.

Proposal Changes the Following Existing Rules: The rule described above is primarily a new rule that establishes enhanced payments to providers who furnish EPSDT screens for children receiving foster care placement services from the department. The rule also changes the name of the state program from "Healthy Kids" to "EPSDT" so it is the same as the federal program name.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule and concludes that it will have no more than a minor impact on the small businesses affected by it, therefore no small business economic impact statement is required.

RCW 34.05.328 applies to this rule adoption. The department has analyzed the proposed rule and concludes that it makes "significant amendments to a policy or regulatory program." Therefore the department concludes that the rule meets the definition of a "significant legislative rule." An analysis of the probable costs and probable benefits is available from the person listed above.

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on February 26, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by February 22, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., February 26, 2002.

Date of Intended Adoption: No sooner than February 27, 2002.

Bonnie H. Jacques

for Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3037.1
AMENDATORY SECTION(Amending WSR 01-02-076, filed 12/29/00, effective 1/29/01)

WAC 388-534-0100   ((Healthy kids/))EPSDT.   (1) Persons who are eligible for Medicaid are eligible for ((healthy kids (HK))) coverage through the early and periodic screening, diagnosis, and treatment (EPSDT) program up through the day before their twenty-first birthday. ((This coverage is called early and periodic screening, diagnosis and treatment (EPSDT) in federal rule.))

(2) Access and services for ((healthy kids)) EPSDT are governed by federal rules at 42 CFR, Part 441, Subpart B which were in effect as of January 1, 1998.

(a) The standard for coverage for ((healthy kids)) EPSDT is that the services, treatment or other measures are:

(i) Medically necessary;

(ii) Safe and effective; and

(iii) Not experimental.

(b) ((Healthy kids)) EPSDT services are exempt from specific coverage or service limitations which are imposed on the rest of the CN and MN program. Examples of service limits which do not apply to the ((healthy kids)) EPSDT program are the specific numerical limits in WAC 388-545-300, 388-545-500, and 388-545-700((, etc)).

(c) Services not otherwise covered under the Medicaid program are available to children under ((healthy kids)) EPSDT. The services, treatments and other measures which are available include but are not limited to:

(i) Nutritional counseling;

(ii) Chiropractic care;

(iii) Orthodontics; and

(iv) Occupational therapy (not otherwise covered under the MN program).

(d) Prior authorization and referral requirements are imposed on medical service providers under ((healthy kids)) EPSDT. Such requirements are designed as tools for determining that a service, treatment or other measure meets the standards in subsection (2)(a) of this section.

(3) Transportation requirements of 42 CFR 441, Subpart B are met through a contract with transportation brokers throughout the state.

[Statutory Authority: RCW 74.08.090. 01-02-076, 388-534-0100, filed 12/29/00, effective 1/29/01; 00-11-183, recodified as 388-534-0100, filed 5/24/00, effective 5/24/00. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-86-027, filed 7/31/98, effective 9/1/98. Statutory Authority: RCW 74.08.090. 90-12-061 (Order 3019), 388-86-027, filed 5/31/90, effective 7/1/90; 82-01-001 (Order 1725), 388-86-027, filed 12/3/81; 81-10-015 (Order 1647), 388-86-027, filed 4/27/81; 80-15-034 (Order 1554), 388-86-027, filed 10/9/80; 79-12-047 (Order 1457), 388-86-027, filed 11/26/79; Order 1112, 388-86-027, filed 4/15/76; Order 738, 388-86-027, filed 11/22/72.]


NEW SECTION
WAC 388-534-0200   Enhanced payments for EPSDT screens for children receiving foster care placement services from the department of social and health services (DSHS).   The medical assistance administration (MAA) reimburses providers an enhanced flat fee for EPSDT screens provided to children receiving certain foster care placement services from the department of social and health services (DSHS). See MAA's EPSDT billing instructions for specific billing code requirements and the fee.

(1) For the purposes of this section, foster care is defined as twenty-four hour per day, temporary, substitute care for a child:

(a) Placed away from the child's parents or guardians in licensed, paid, out-of-home care; and

(b) For whom the department or a licensed or certified child placing agency has placement and care responsibility.

(2) MAA pays an enhanced flat fee to the providers listed in subsection (3) of this section for EPSDT screens provided to only those children receiving foster care placement services from DSHS.

(3) The following providers are eligible to perform EPSDT screens and bill MAA the enhanced rate for children receiving foster care placement services from DSHS:

(a) EPSDT clinics;

(b) Physicians;

(c) Advanced registered nurse practitioners (ARNPs);

(d) Physician assistants (PAs) working under the guidance and MAA provider number of a physician;

(e) Nurses specially trained through the department of health (DOH) to perform EPSDT screens; and

(f) Registered nurses working under the guidance and MAA provider number of a physician or ARNP.

(4) In order to be paid an enhanced fee, services furnished by the providers listed in subsection (3) of this section must meet the federal requirements for EPSDT screens at 42 CFR Part 441 Subpart B, which were in effect as of December 1, 2001.

(5) The provider must retain documentation of the EPSDT screens in the client's medical file. The provider must use the DSHS Well Child Exam forms or provide equivalent information. DSHS Well Child Exam forms are available at no charge by sending a request in writing or by fax to:

DSHS Warehouse

PO Box 45816

Olympia, WA. 98504-5816

Fax: 360-664-0597

(6) MAA conducts evaluations of client files and payments made under this program. MAA may recover the enhanced payment amount when:

(a) The client was not receiving foster care placement services from DSHS as defined in subsection (1) of this section when the EPSDT screen was provided; or

(b) Documentation was not in the client's medical file (see subsection (5) of this section).

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Washington State Code Reviser's Office