WSR 15-15-152 PERMANENT RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed July 21, 2015, 9:45 a.m., effective August 21, 2015] Effective Date of Rule: Thirty-one days after filing.
Purpose: The amendments to these rules are necessary to replace outdated references to "medical assistance" with "Washington apple health" and replace reference to Title 388 WAC with the correct reference to WAC 182-502-0020.
Citation of Existing Rules Affected by this Order: Amending WAC 182-553-100 and 182-553-400.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Adopted under notice filed as WSR 15-11-014 on May 8, 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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.
Date Adopted: July 21, 2015.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 15-08-103, filed 4/1/15, effective 5/2/15)
WAC 182-553-100 Home infusion therapy and parenteral nutrition program—General.
The medicaid agency's home infusion therapy and parenteral nutrition program provides the supplies and equipment necessary for parenteral infusion of therapeutic agents to ((medical assistance)) Washington apple health clients. An eligible client receives equipment, supplies, and parenteral administration of therapeutic agents in a qualified setting to improve or sustain the client's health.
AMENDATORY SECTION (Amending WSR 15-08-103, filed 4/1/15, effective 5/2/15)
WAC 182-553-400 Home infusion therapy and parenteral nutrition program—Provider requirements.
(1) Eligible providers of home infusion supplies and equipment and parenteral nutrition solutions must:
(a) Have a signed core provider agreement with the medicaid agency; and
(b) Be one of the following provider types:
(i) Pharmacy provider;
(ii) Durable medical equipment (DME) provider; or
(iii) Infusion therapy provider.
(2) The agency pays eligible providers for home infusion supplies and equipment and parenteral nutrition solutions only when the providers:
(a) Are able to provide home infusion therapy within their scope of practice;
(b) Have evaluated each client in collaboration with the client's physician, pharmacist, or nurse to determine whether home infusion therapy and parenteral nutrition is an appropriate course of action;
(c) Have determined that the therapies prescribed and the client's needs for care can be safely met;
(d) Have assessed the client and obtained a written physician order for all solutions and medications administered to the client in the client's residence or in a dialysis center through intravenous, epidural, subcutaneous, or intrathecal routes;
(e) Meet the requirements in WAC ((388-502-0020)) 182-502-0020, including keeping legible, accurate, and complete client charts, and providing the following documentation in the client's medical file:
(i) For a client receiving infusion therapy, the file must contain:
(A) A copy of the written prescription for the therapy;
(B) The client's age, height, and weight; and
(C) The medical necessity for the specific home infusion service.
(ii) For a client receiving parenteral nutrition, the file must contain:
(A) All the information listed in (e)(i) of this subsection;
(B) Oral or enteral feeding trials and outcomes, if applicable;
(C) Duration of gastrointestinal impairment; and
(D) The monitoring and reviewing of the client's lab values:
(I) At the initiation of therapy;
(II) At least once per month; and
(III) When the client, the client's lab results, or both, are unstable.
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