WSR 16-09-081
(Washington Apple Health)
[Filed April 19, 2016, 8:01 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-04-001.
Title of Rule and Other Identifying Information: WAC 182-533-0320 Maternity support services—Client eligibility, 182-533-0325 Maternity support services—Provider requirements, 182-533-0327 Maternity support services—Professional staff qualifications and interdisciplinary team, and 182-533-0375 Infant case management—Provider requirements.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at, or directions can be obtained by calling (360) 725-1000), on May 24, 2016, at 10:00 a.m.
Date of Intended Adoption: Not sooner than May 25, 2016.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail, fax (360) 586-9727, by 5:00 p.m. on May 24, 2016.
Assistance for Persons with Disabilities: Contact Amber Lougheed by May 20, 2016, e-mail, (360) 725-1349, or TTY (800) 848-5429 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is making changes to update eligibility programs, provider types, and existing policies, and to incorporate specific state plan language.
Reasons Supporting Proposal: See Purpose above.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Statute Being Implemented: RCW 41.05.021, 41.05.160.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1408; Implementation and Enforcement: Heather Weiher, P.O. Box 45530, Olympia, WA 98504-5530, (360) 725-1293.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has determined that the proposed filing does not impose a disproportionate cost impact on small businesses or nonprofits.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
April 19, 2016
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 15-12-075, filed 5/29/15, effective 7/1/15)
WAC 182-533-0320 Maternity support servicesClient eligibility.
(1) To receive maternity support services (MSS), a client must:
(a) Be covered under the alternative benefit plan, categorically needy, medically needy, or state-funded medical programs under Washington apple health; and
(b) Be within the eligibility period of a maternity cycle as defined in WAC 182-533-0315.
(2) Clients who do not agree with an eligibility decision for MSS have a right to a fair hearing under chapter 182-526 WAC.
AMENDATORY SECTION (Amending WSR 15-12-075, filed 5/29/15, effective 7/1/15)
WAC 182-533-0325 Maternity support servicesProvider requirements.
Maternity support service providers may include community clinics, federally qualified health centers, local health departments, hospitals, nonprofit organizations, and private clinics.
(1) To be paid for providing maternity support services (MSS) and infant case management (ICM) services to eligible clients, a provider must:
(a) Be enrolled as an eligible provider with the medicaid agency (see WAC 182-502-0010).
(b) Be currently approved as an MSS/ICM provider by the medicaid agency.
(c) Meet the requirements in this chapter, chapter 182-502 WAC and the medicaid agency's current billing instructions.
(d) Ensure that professional staff providing services:
(i) Meet the minimum regulatory and educational qualifications for the scope of services provided under WAC 182-533-0327; and
(ii) Follow the requirements in this chapter and the medicaid agency's current billing instructions.
(e) Screen each client for risk factors using the agency's designated MSS screening tool, located on the agency's web site under forms. Agency approval is required for a provider to use an alternate MSS screening tool.
(f) Screen clients for ICM eligibility.
(g) Conduct case conferences under WAC 182-533-0327(2).
(h) Develop and implement an individualized care plan for each client.
(i) Initiate and participate in care coordination activities throughout the maternity cycle with at least MSS interdisciplinary team members, the client's prenatal care provider, and the Women, Infants, and Children (WIC) Nutrition Program.
(j) Comply with Section 1902 (a)(23) of the Social Security Act regarding the client's freedom to choose a provider.
(k) Comply with Section 1915 (g)(1) of the Social Security Act regarding the client's voluntary receipt of services.
(2) MSS providers may provide services in any of the following locations:
(a) A provider's office or clinic.
(b) The client's residence.
(c) An alternate site that is not the client's residence. (The reason for using an alternate site for visitation instead of the home must be documented in the client's record.)
(3) An individual or service organization that has a written contractual agreement with a qualified MSS provider also may provide MSS and ICM services to eligible clients. (((a))) The provider must:
(((i))) (a) Keep a copy of the written subcontractor agreement on file;
(((ii))) (b) Ensure that an individual or service organization staff member providing MSS/ICM services (the subcontractor) meets the minimum regulatory and educational qualifications required of an MSS/ICM provider;
(((iii))) (c) Ensure that the subcontractor provides MSS/ICM services under the requirements of this chapter; ((and
(iv))) (d) Maintain professional, financial, and administrative responsibility for the subcontractor((.
(b) The provider must:
(e) Bill for services using the provider's national provider identifier and MSS/ICM taxonomy; and
(((ii))) (f) Reimburse the subcontractor for MSS/ICM services provided under the written agreement.
(4) Providers must obtain agency approval of all MSS/ICM outreach-related materials, including web sites and publications, prior to making those materials available to clients.
AMENDATORY SECTION (Amending WSR 14-09-061, filed 4/16/14, effective 5/17/14)
WAC 182-533-0327 Maternity support servicesProfessional staff qualifications and interdisciplinary team.
(1) MSS providers must use qualified professionals, as specified in this section.
(a) Behavioral health specialists who are currently credentialed or licensed in Washington by the department of health under chapters 246-809, 246-810, and 246-924 WAC as one of the following:
(i) Licensed mental health counselor.
(ii) Licensed independent clinical social worker.
(iii) Licensed social worker.
(iv) Licensed marriage and family therapist.
(v) Licensed psychologist.
(vi) Associate mental health counselor.
(vii) Associate independent clinical social worker.
(viii) Associate social worker.
(ix) Associate marriage and family therapist.
(x) Certified counselor.
(xi) Certified chemical dependency professional.
(b) Certified ((dieticians)) dietitians who are currently registered with the commission on dietetic registration and certified by the Washington state department of health under chapter 246-822 WAC.
(c) Community health nurses who are currently licensed as registered nurses in the state of Washington by the department of health under chapter 246-840 WAC.
(d) Community health workers (CHWs) who have a high school diploma or the equivalent and:
(i) Have a minimum of one year of health care and/or social services experience.
(ii) Carry out all activities under the direction and supervision of a professional member or supervisor of the MSS interdisciplinary team.
(iii) Complete a training plan developed by their provider.
(2) The provider's qualified staff must participate in an MSS interdisciplinary team consisting of at least a community health nurse, a certified registered dietitian, a behavioral health specialist, and, at the discretion of the provider, a community health worker.
(a) The interdisciplinary team must work together to address risk factors identified in a client's care plan.
(b) Each qualified staff member acting within her/his area of expertise must address the variety of client needs identified during the maternity cycle.
(c) An MSS interdisciplinary team case conference is required at least once prenatally for clients who are entering MSS during pregnancy, and are eligible for the maximum level of service. Using clinical judgment and the client's risk factors, the provider may decide which interdisciplinary team members to include in case conferencing.
(3) All Indian health programs, tribes, and any MSS provider within a county with fewer than fifty-five medicaid births per year are ((not)) required to have ((an)) at least one MSS interdisciplinary team((, although they must meet all the other requirements in this chapter. Instead of the interdisciplinary team, these counties and tribes must have at least one of the following qualified professionals)) member, as described in subsection (1) of this section:
(a) A behavioral health specialist;
(b) A registered ((dietician)) dietitian; or
(c) A community health nurse.
AMENDATORY SECTION (Amending WSR 14-09-061, filed 4/16/14, effective 5/17/14)
WAC 182-533-0375 Infant case managementProvider requirements.
(1) Infant case management (ICM) services may be provided only by a qualified infant case manager who is employed by a provider meeting the requirements in WAC 182-533-0325.
(2) The infant case manager must meet at least one of the following qualifications under (a), (b), or (c) of this subsection:
(a) Be a current member of the maternity support services (MSS) interdisciplinary team under WAC 182-533-0327 (1)(a), (b), or (c).
(b) Have a bachelor of arts, bachelor of science, or higher degree in a social service-related field, such as social work, behavioral sciences, psychology, child development, or mental health, plus at least one year of full-time experience working in one or more of the following areas:
(i) Community services;
(ii) Social services;
(iii) Public health services;
(iv) Crisis intervention;
(v) Outreach and referral programs; or
(vi) Other related fields.
(c) Have an associate of arts degree, or an associate's degree in a social service-related field, such as social work, behavioral sciences, psychology, child development, or mental health, plus at least two years of full-time experience working in one or more of the following areas:
(i) Community services;
(ii) Social services;
(iii) Public health services;
(iv) Crisis intervention;
(v) Outreach and referral programs;
(vi) Other related fields.
(3) The medicaid agency requires any staff person qualifying under subsection (2)(c) of this section to be under the supervision of a clinical staff person meeting the criteria in subsection (2)(a) or (b) of this section. Clinical supervision may include face-to-face meetings and/or chart reviews.