WSR 15-12-074 PERMANENT RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed May 29, 2015, 12:50 p.m., effective July 1, 2015] Effective Date of Rule: July 1, 2015.
Purpose: The agency is removing two provider types from the list of providers who are eligible to perform EPSDT screens and bill an enhanced rate: (1) Nurses trained through the department of health to perform EPSDT screens and (2) registered nurses.
Citation of Existing Rules Affected by this Order: Amending WAC 182-534-0200.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Adopted under notice filed as WSR 15-09-073 on April 15, 2015.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: May 29, 2015.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-534-0200 Enhanced payments for EPSDT screens for children in out-of-home placement.
The ((department reimburses)) medicaid agency pays providers an enhanced fee for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screens provided to children in out-of-home placement. See the ((department's)) agency's EPSDT ((billing instructions)) provider guide for specific billing code requirements, and see the agency's fee schedule for the fee.
(1) For the purposes of this section, out-of-home placement ((is defined as)) means temporary, 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 of social and health services or a licensed or certified child placing agency has placement and care responsibility.
(2) The ((department)) agency pays an enhanced fee to the providers listed in subsection (3) of this section for EPSDT screens provided to only those children in out-of-home placement.
(3) The following providers are eligible to perform EPSDT screens and bill the enhanced rate for children in out-of-home placement:
(a) EPSDT clinics;
(b) Physicians;
(c) Advanced registered nurse practitioners (ARNPs); and
(d) Physician assistants (PAs) working under ((the guidance 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 of a physician or ARNP)) a physician's guidance.
(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 C.F.R. 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 ((department's)) agency's Well Child Exam forms or provide equivalent information. The Well Child Exam forms include the required elements for an EPSDT screen. The Well Child Exam forms (((DSHS 13-683A through 13-686B))) are available for downloading at no charge at ((http://www1.dshs.wa.gov/msa/forms/eforms.html)) http://www.hca.wa.gov/medicaid/forms/Pages/index.aspx.
(6) The ((department conducts evaluations of)) agency evaluates client files and payments made under this program. The ((department)) agency may recover the enhanced payment amount when:
(a) The client was not in out-of-home placement 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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