Original Notice.

     Preproposal statement of inquiry was filed as WSR 06-22-093.

     Title of Rule and Other Identifying Information: The department is amending WAC 388-532-050, 388-532-100, 388-532-110, 388-532-120, 388-532-520, 388-532-530, 388-532-700, 388-532-710, 388-532-720, 388-532-730, 388-532-740, 388-532-745 (new section), 388-532-750, 388-532-760, 388-532-780, 388-532-790, reproductive health/family planning only/TAKE CHARGE.

     Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane, behind Goodyear Tire. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on April 8, 2008, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than April 9, 2008.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail schilse@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on April 8, 2008.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by April 1, 2008, TTY (360) 664-6178 or (360) 664-6097.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed changes are intended to describe the changes in program eligibility and scope of care. These rules:

•	Add a definition for comprehensive family planning preventive medicine visit and delayed pelvic protocol;
•	Change text throughout from "over-the-counter (OTC) birth control and supplies" to "over-the-counter (OTC) birth control drugs and supplies";
•	Clearly identify who is eligible for family planning only and TAKE CHARGE;
•	Add language under provider requirements in all sections (reproductive health, family planning only, and TAKE CHARGE) about "referring the client to available and affordable nonfamily planning primary care services, as needed."
•	Strike the language under the covered section for "services for women" under reproductive health that said "cervical, vaginal, and breast cancer screening examination once per year as medically necessary" and expand the language to allow for an annual comprehensive family planning preventive medicine visit and a gynecological examination for any Medicaid client who is seeking and needing family planning. The department is also including the same language under the family planning only sections and TAKE CHARGE. Requirements for the comprehensive family planning preventive medicine visit is also included;
•	Strike the following language under the covered section for services for men under reproductive health: "Prostate cancer screening for men, who are fifty years of age and older, once per year," and change it to read: "Prostate cancer screening for men, once per year, when medically necessary."
•	Add screening and treatment for chlamydia and gonorrhea as part of the comprehensive family planning preventive medicine visit for women thirteen to twenty-five years of age under the covered section for family planning only and TAKE CHARGE;
•	Update the definition for education, counseling and risk reduction intervention (ECRR) in the TAKE CHARGE section and remove the definition for intensive follow-up services.
•	Include federal requirements for TAKE CHARGE eligibility which states that an applicant must provide proof of citizenship or qualified alien status and identity, must need family planning services, and must not be currently covered through another medical assistance program for family planning or have any health insurance that covers family planning.
•	Change language under TAKE CHARGE program provider requirements that the "provider must document that each individual responsible for providing TAKE CHARGE services is trained on all aspects of the TAKE CHARGE program." The word "document" replaces the word "assure."
•	Add "within seven working days of receipt" to the existing requirement for TAKE CHARGE providers to forward the client's medical ID card to them;
•	Include language in the TAKE CHARGE section about "informing the client of their right to see any TAKE CHARGE provider within the state."
•	Incorporate into rule current policy that abortions and other pregnancy-related services are not covered under the TAKE CHARGE program.
•	Change the language under the TAKE CHARGE - Good cause exemption section from TAKE CHARGE applicants who are either adolescents or young adults, to "eighteen years of age or younger" and change domestic violence victims to those "domestic violence victims who depend on their spouses insurance...."
•	Identify when TAKE CHARGE providers are exempt from billing third parties.

     Reasons Supporting Proposal: The department previously proposed these rules under WSR 07-07-102 and held a public hearing on May 9, 2007.

     Revisions to this rule are necessary in order to bring the program into compliance with special terms and conditions of the new family planning/TAKE CHARGE waiver set forth by the Centers for Medicare and Medicaid Services (CMS) for the state of Washington. Adoption of the revisions is critical to prevent loss of 90% federal match funds for the family planning/TAKE CHARGE program.

     Statutory Authority for Adoption: RCW 74.08.090 and 74.09.800.

     Statute Being Implemented: RCW 74.08.090 and 74.09.800.

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

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting: Wendy L. Boedigheimer, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1306; Implementation and Enforcement: Maureen Considine, P.O. Box 45530, Olympia, WA 98504-5530, (360) 725-1652.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has determined that the proposed rule will not create more than minor costs for affected small businesses.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Maureen Considine, FP/TAKE CHARGE Program Manager, P.O. Box 45530, Olympia, WA 98504-5530, phone (360) 725-1652, e-mail consicm@dshs.wa.gov.

February 12, 2008

Stephanie E. Schiller

Rules Coordinator

     "Complication" -- A condition occurring subsequent to and directly arising from the family planning services received under the rules of this chapter.

     "Comprehensive family planning preventive medicine visit" -- For the purposes of this program, is a comprehensive, preventive, contraceptive visit which includes:

     • An age and gender appropriate history and examination offered to female Medicaid clients who are at-risk for unintended pregnancies;

     • Education and counseling for risk reduction (ECRR) regarding the prevention of unintended pregnancy; and

     • For family planning only and TAKE CHARGE clients, routine gonorrhea and chlamydia testing for women thirteen through twenty-five years of age only.

     This preventive visit may be billed only once every twelve months, per client, by a department-contracted TAKE CHARGE provider and only for female clients needing contraception.

     "Contraception" -- Preventing pregnancy through the use of contraceptives.

     "Contraceptive" -- A device, drug, product, method, or surgical intervention used to prevent pregnancy.

     "Delayed pelvic protocol"--The practice of allowing a woman to postpone a pelvic exam during a contraceptive visit to facilitate initiation or continuation of a hormonal contraceptive method.

     "Department" -- The department of social and health services.

     "Department-approved family planning provider" -- A physician, advanced registered nurse practitioner (ARNP), or clinic that has:

     • Agreed to the requirements of WAC 388-532-110;

     • Signed a core provider agreement with the department;

     • Been assigned a unique family planning provider number by the department; and

     • ((Signed a special agreement that allows the provider)) Agreed to bill for family planning laboratory services provided to clients enrolled in a department-managed care plan through an independent laboratory certified through the Clinical Laboratory Improvements Act (CLIA).

     "Family planning services" -- Medically safe and effective medical care, educational services, and/or contraceptives that enable individuals to plan and space the number of children and avoid unintended pregnancies.

     "Medical identification card" -- The document the department uses to identify a client's eligibility for a medical program.

     "Natural family planning" -- (Also known as fertility awareness method((,))) Means methods such as observing, recording, and interpreting the natural signs and symptoms associated with the menstrual cycle to identify the fertile days of the menstrual cycle and avoid unintended pregnancies.

     "Over-the-counter (OTC)" -- See WAC 388-530-1050 for definition.

     "Sexually transmitted disease infection (STD-I)" -- ((Is)) A disease or infection acquired as a result of sexual contact.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-050, filed 11/30/05, effective 12/31/05; 04-05-011, § 388-532-050, filed 2/6/04, effective 3/8/04. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-050, filed 10/8/02, effective 11/8/02. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800. 00-14-066, § 388-532-050, filed 7/5/00, effective 8/5/00.]

     (a) State children's health insurance program (SCHIP);

     (b) Categorically needy program (CNP);

     (c) General assistance unemployable (GAU) program;

     (d) Limited casualty program-medically needy program (LCP-MNP); and

     (e) Alcohol and Drug Abuse Treatment and Support Act (ADATSA) services.

     (2) Clients enrolled in a department managed care ((plan)) organization (MCO) may self-refer outside their ((plan)) MCO for family planning services (excluding sterilizations for clients twenty-one years of age or older), abortions, and STD-I services to any of the following:

     (a) A department-approved family planning provider;

     (b) A department-contracted local health department/STD-I clinic; ((or))

     (c) A department-contracted provider for abortion services; or

     (d) A department-contracted pharmacy for:

     (i) Over-the-counter contraceptive drugs and supplies, including emergency contraception; and

     (ii) Contraceptives and STD-I related prescriptions from a department-approved family planning provider or department-contracted local health department/STD-I clinic.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-100, filed 11/30/05, effective 12/31/05; 04-05-011, § 388-532-100, filed 2/6/04, effective 3/8/04. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-100, filed 10/8/02, effective 11/8/02. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800. 00-14-066, § 388-532-100, filed 7/5/00, effective 8/5/00.]

     (1) Meet the requirements in chapter 388-502 WAC, Administration of medical programs--Provider rules;

     (2) Provide only those services that are within the scope of their licenses;

     (3) Educate clients on Food and Drug Administration (FDA)-approved prescription birth control methods and over-the-counter (OTC) birth control drugs and supplies and related medical services;

     (4) Provide medical services related to FDA-approved prescription birth control methods and OTC birth control drugs and supplies upon request;

     (5) Supply or prescribe FDA-approved prescription birth control methods and OTC birth control drugs and supplies upon request; ((and))

     (6) Refer the client to an appropriate provider if unable to meet the requirements of subsections (3), (4), and (5) of this section; and

     (7) Refer the client to available and affordable nonfamily planning primary care services, as needed.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-110, filed 11/30/05, effective 12/31/05; 04-05-011, § 388-532-110, filed 2/6/04, effective 3/8/04.]

     (1) Services for women:

     (a) ((Cervical, vaginal, and breast cancer screening examination once per year as medically necessary)) The department covers one of the following per client, per year as medically necessary:

     (i) A gynecological examination, billed by a provider other than a TAKE CHARGE provider, which may include a cervical and vaginal cancer screening examination when medically necessary; or

     (ii) One comprehensive family planning preventive medicine visit, billable by a TAKE CHARGE provider only. Under a delayed pelvic protocol, the comprehensive family planning preventive medicine visit may be split into two visits, per client, per year. The comprehensive family planning preventive medicine visit must be:

     (A) Provided by one or more of the following TAKE CHARGE trained providers:

     (I) A physician or physician's assistant (PA);

     (II) An advanced registered nurse practitioner (ARNP); or

     (III) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the clinicians listed in (I) and (II) in subsection (1) of this section.

     (B) Documented in the client's chart with detailed information that allows for a well-informed follow-up visit.

     (b) Food and Drug Administration (FDA) approved prescription contraception methods as identified in chapter 388-530 WAC, Pharmacy services.

     (c) Over-the-counter (OTC) ((contraceptives,)) family planning drugs, devices, and drug-related supplies without a prescription when the department determines it necessary for client access and safety ((())as described in chapter 388-530 WAC, ((Pharmacy services))) Prescription Drugs (Outpatient).

     (d) Sterilization procedures that meet the requirements of WAC 388-531-1550, if ((it is)):

     (i) Requested by the client; and

     (ii) Performed in an appropriate setting for the procedure.

     (e) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures.

     (f) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

     (g) Mammograms for clients forty years of age and older, once per year;

     (h) Colposcopy and related medically necessary follow-up services;

     (i) Maternity-related services as described in chapter 388-533 WAC; and

     (j) Abortion.

     (2) Services for men:

     (a) Office visits where the primary focus and diagnosis is contraceptive management and/or there is a medical concern;

     (b) Over-the-counter (OTC) contraceptives, drugs and supplies (as described in chapter 388-530 WAC, ((Pharmacy services)) Prescription Drugs (Outpatient)).

     (c) Sterilization procedures that meet the requirements of WAC 388-531-1550(1), if ((it is)):

     (i) Requested by the client; and

     (ii) Performed in an appropriate setting for the procedure.

     (d) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures.

     (e) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

     (f) Prostate cancer screenings for men ((who are fifty years of age and older)), once per year, when medically necessary.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-120, filed 11/30/05, effective 12/31/05; 04-05-011, § 388-532-120, filed 2/6/04, effective 3/8/04.]

     (1) Meet the requirements in chapter 388-502 WAC, Administration of medical programs--Provider rules;

     (2) Provide only those services that are within the scope of their licenses;

     (3) Educate clients on Food and Drug Administration (FDA)-approved prescription birth control methods and over-the-counter (OTC) birth control drugs and supplies and related medical services;

     (4) Provide medical services related to FDA-approved prescription birth control methods and ((over-the-counter)) OTC birth control drugs and supplies upon request;

     (5) Supply or prescribe FDA-approved prescription birth control methods and ((over-the-counter)) OTC birth control drugs and supplies upon request; ((and))

     (6) Refer the client to an appropriate provider if unable to meet the requirements of subsections (3), (4), and (5) of this section; and

     (7) Refer the client to available and affordable nonfamily planning primary care services, as needed.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-520, filed 11/30/05, effective 12/31/05; 04-05-011, § 388-532-520, filed 2/6/04, effective 3/8/04.]

     (1) One of the following, per client, per year as medically necessary:

     (a) One comprehensive family planning preventive medicine visit billable by a TAKE CHARGE provider only. Under a delayed pelvic protocol, the comprehensive family planning preventive medicine visit may be split into two visits, per client, per year. The comprehensive family planning preventive medicine visit must be:

     (I) Provided by one or more of the following TAKE CHARGE trained providers:

     (A) Physician or physician's assistant (PA);

     (B) An advanced registered nurse practitioner (ARNP); or

     (C) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the clinicians listed in subsection (A) and (B) of this section.

     (II) Documented in the client's chart with detailed information that allows for a well-informed follow-up visit; or

     (b) A gynecological examination ((that)), billed by a provider other than a TAKE CHARGE provider, which may include a cervical and vaginal cancer screening examination, one per year when it is:

     (((a))) (i) Provided according to the current standard of care; and

     (((b))) (ii) Conducted at the time of an office visit with a primary focus and diagnosis of family planning.

     (2) An office visit directly related to a family planning problem, when medically necessary.

     (3) Food and Drug Administration (FDA) approved prescription contraception methods meeting the requirements of chapter 388-530 WAC, ((Pharmacy services)) Prescription Drugs (Outpatient).

     (((3))) (4) Over-the-counter (OTC) ((contraceptive,)) family-planning drugs, devices, and drug-related supplies without a prescription when the department determines it necessary for client access and safety (as described in chapter 388-530 WAC, ((Pharmacy services)) Prescription Drugs (Outpatient)).

     (((4))) (5) Sterilization procedure that meets the requirements of WAC 388-531-1550, if it is:

     (a) Requested by the client; and

     (b) Performed in an appropriate setting for the procedure.

     (((5))) (6) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory test and procedures only when the screening and treatment is:

     (a) For chlamydia and gonorrhea as part of the comprehensive family planning preventive medicine visit for women thirteen to twenty-five years of age; or

     (b) Performed in conjunction with an office visit that has a primary focus and diagnosis of family planning; and

     (((b))) (c) Medically necessary for the client to safely, effectively, and successfully use, or to continue to use, her chosen contraceptive method.

     (((6))) (7) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-530, filed 11/30/05, effective 12/31/05; 04-05-011, § 388-532-530, filed 2/6/04, effective 3/8/04.]

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-700, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-700, filed 10/8/02, effective 11/8/02.]

     "Ancillary services" -- Those family planning services provided to TAKE CHARGE clients by ((MAA's)) department-contracted providers who are not TAKE CHARGE providers. These services include, but are not limited to, family planning pharmacy services, family planning laboratory services and sterilization ((surgical)) services.

     "Application assistance" -- The process a TAKE CHARGE provider follows in helping a client to complete and submit an application to ((MAA)) the department for the TAKE CHARGE program.

     "Education, counseling and risk reduction intervention" or "ECRR" -- ((A stand alone department-designated service, specifically intended for clients at higher risk of contraceptive failure, that strengthen a client's decision-making skills to make the best choice of contraceptive method and reduce the risk of unintended pregnancy. ECRR services must include:

     (1) Helping the client critically evaluate which contraceptive method is most acceptable and can be used most effectively by her/him.

     (2) Assessing and addressing other client personal considerations, risk factors (including sexually transmitted infections), and behaviors that impact her/his use of contraception.

     (3) Facilitating a discussion of the male role in successful use of chosen contraceptive method, as appropriate.

     (4) Facilitating contingency planning (the back-up method) regarding the chosen contraceptive method, including planning for emergency contraception.

     (5) Scheduling a follow-up appointment as medically necessary for birth control evaluation for the safe, effective and successful use of the client's chosen contraceptive method and to reinforce positive contraceptive and other self protective behaviors.

     (6) If no contraceptive method is chosen, discussing the likelihood of a pregnancy and helping the client assess his/her emotional, physical, and financial readiness for pregnancy and/or parenting)) Client-centered education and counseling services designed to strengthen decision making skills and support a client's safe, effective and successful use of his or her chosen contraceptive method. For women, ECRR is part of the annual preventive medicine visit. For men, ECRR is a stand alone service for those men seeking family planning services and whose partners are at moderate to high risk of unintended pregnancy.

     (("Intensive follow-up services" or "IFS" -- Those supplemental services specified in some TAKE CHARGE provider contracts that support clients in the successful use of contraceptive methods. Department-selected TAKE CHARGE providers perform IFS as part of the research component of the TAKE CHARGE program (see WAC 388-532-730 (1)(f)).))

     "TAKE CHARGE" -- The department's ((five-year)) demonstration and research program approved by the federal government under a Medicaid program waiver to provide family planning services.

     "TAKE CHARGE provider" -- A provider who is approved by the department to participate in TAKE CHARGE by:

     (1) Being a department-approved family planning provider; and

     (2) Having a supplemental TAKE CHARGE agreement to provide TAKE CHARGE family planning services to eligible clients under the terms of the federally approved Medicaid waiver for the TAKE CHARGE program.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-710, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-710, filed 10/8/02, effective 11/8/02.]

     (a) Be a United States citizen, U.S. National, or "qualified alien" as described in chapter 388-424 WAC and provide proof of citizenship or qualified alien status, and identity;

     (b) Be a resident of the state of Washington as described in WAC 388-468-0005;

     (c) Have income at or below two hundred percent of the federal poverty level as described in WAC 388-478-0075;

     (d) Need family planning services;

     (e) Apply voluntarily for family planning services with a TAKE CHARGE provider; and

     (((e) Need family planning services but have:

     (i) No family planning coverage through another medical assistance program; or

     (ii) Family planning coverage that does not cover one hundred percent of the applicant's chosen birth control)) (f) Not be currently covered through another medical assistance program for family planning or have any health insurance that covers family planning, except as provided in WAC 388-530-790.

     (2) A client who is ((currently)) pregnant or sterilized is not eligible for TAKE CHARGE.

     (3) A client is authorized for TAKE CHARGE coverage for one year from the date the department determines eligibility or for the duration of the demonstration and research program, whichever is shorter, as long as the criteria in subsection (1) and (2) of this section continue to be met. Upon reapplication for TAKE CHARGE by the client, the department may renew the coverage for additional periods of up to one year each, or for the duration of the demonstration and research program, whichever is shorter.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-720, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-057, § 388-532-720, filed 7/13/04, effective 8/13/04. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-720, filed 10/8/02, effective 11/8/02.]

     (a) Be a department-approved family planning provider as described in WAC 388-532-050;

     (b) Sign the supplemental TAKE CHARGE agreement to participate in the TAKE CHARGE demonstration and research program according to the department's TAKE CHARGE program guidelines;

     (c) Participate in the department's specialized training for the TAKE CHARGE demonstration and research program prior to providing TAKE CHARGE services. Providers must ((assure)) document that each individual responsible for providing TAKE CHARGE services is trained on all aspects of the TAKE CHARGE program;

     (d) Comply with the required general department and TAKE CHARGE provider policies, procedures, and administrative practices as detailed in the department's billing instructions and provide referral information to clients regarding available and affordable nonfamily planning primary care services; ((and))

     (e) If requested by the department, participate in the research and evaluation component of the TAKE CHARGE demonstration and research program. ((If selected by the department for the research and evaluation component, the provider must accept assignment to either:

     (i) A randomly selected group of providers that give intensive follow-up service (IFS) to TAKE CHARGE clients under a TAKE CHARGE research component client services contract. See WAC 388-532-740(2) for a related limitation; or

     (ii) A randomly selected control group of providers subject to a TAKE CHARGE research component client services contract.))

     (f) Forward the client's medical identification card and TAKE CHARGE brochure to the client within seven working days of receipt unless otherwise requested in writing by the client;

     (g) Inform the client of his or her right to seek services from any TAKE CHARGE provider within the state; and

     (h) Refer the client to available and affordable non-family planning primary care services, as needed.

     (2) Department providers (e.g., pharmacies, laboratories, surgeons performing sterilization procedures) who are not TAKE CHARGE providers may furnish family planning ancillary TAKE CHARGE services, as defined in this chapter, to eligible clients. The department reimburses for these services under the rules and fee schedules applicable to the specific services provided under the department's other programs.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-730, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-730, filed 10/8/02, effective 11/8/02.]

     Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION(Amending WSR 05-24-032, filed 11/30/05, effective 12/31/05)

WAC 388-532-740   TAKE CHARGE program -- Covered services for women.   (((1))) The department covers the following TAKE CHARGE services for ((men and)) women:

     (((a))) (1) One session of application assistance per client, per year;

     (((b))) (2) Food and Drug Administration (FDA) approved prescription and nonprescription contraceptives as provided in chapter 388-530 WAC, Prescription Drugs (Outpatient);

     (((c))) (3) Over-the-counter (OTC) ((contraceptives,)) family planning drugs, devices, and drug-related supplies without a prescription when the department determines it necessary for client access and safety (as described in chapter ((388-538)) 388-530 WAC, ((Pharmacy services)) Prescription Drugs (Outpatient));

     (((d))) (4) ((Gynecological examination that may include a cervical and vaginal cancer screening exam, one per year when it is:

     (i) Provided according to the current standard of care; and

     (ii) Conducted at the time of an office visit with a primary focus and diagnosis of family planning.

     (e) Education, counseling, and risk reduction (ECRR) intervention, specifically intended for clients at higher risk of contraceptive failure, that have identified or demonstrated risks of unintended pregnancy. MAA limits ECRR as follows:

     (i) For women at risk of unintended pregnancy, limited to one ECRR service every ten months;

     (ii) For men whose sexual partner is at risk of unintended pregnancy, limited to one ECRR service every twelve months;

     (iii) Must be a minimum of thirty minutes in duration;

     (iv) Must be appropriate and individualized to the client's needs, age, language, cultural background, risk behaviors, sexual orientation, and psychosocial history;

     (v) Must be provided by one of the following TAKE CHARGE trained providers:

     (A) An advanced registered nurse practitioner (ARNP);

     (B) Registered nurse (RN), licensed practical nurse (LPN);

     (C) Physician or physician's assistant (PA); or

     (D) A trained and experienced health educator or medical assistant when used for assisting and augmenting the above listed clinicians.

     (vi) Must be documented in the client's chart with detailed information that would allow for a well-informed follow-up visit;

     (vii) A client who does not have identified or demonstrated risks of unintended pregnancy and who is not at increased risk of contraceptive failure is not eligible for ECRR.

     (f))) One comprehensive family planning preventive medicine visit billable by a TAKE CHARGE provider only. Under a delayed pelvic protocol, the comprehensive family planning preventive medicine visit may be split into two visits, per client, per year. The comprehensive family planning preventive medicine visit must be:

     (a) Provided by one or more of the following TAKE CHARGE trained providers:

     (i) Physician or physician's assistant (PA);

     (ii) An advanced registered nurse practitioner (ARNP); or

     (iii) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the above listed clinicians.

     (b) Documented in the client's chart with detailed information that allows for a well-informed follow-up visit.

     (5) Sterilization procedure that meets the requirements of WAC 388-531-1550, if the service is:

     (i) Requested by the TAKE CHARGE client; and

     (ii) Performed in an appropriate setting for the procedure.

     (((g))) (6) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures, only when the screening and treatment is:

     (((i))) (a) For chlamydia and gonorrhea as part of the comprehensive family planning preventive medicine visit for women thirteen to twenty-five years of age; or

     (b) Performed in conjunction with an office visit that has a primary focus and diagnosis of family planning; and

     (((ii))) (c) Medically necessary for the client to safely, effectively, and successfully use, or continue to use, his or her chosen contraceptive method.

     (((h))) (7) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

     (((2) The department covers intensive follow-up services (IFS) for certain clients as part of the research component of the TAKE CHARGE demonstration and research program. Only those clients served by the department's randomly selected research sites receive IFS (see WAC 388-532-730 (1)(e)(i)). The specific elements of IFS are negotiated with each research site.))

     (8) An office visit directly related to a family planning problem, when medically necessary.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-740, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-740, filed 10/8/02, effective 11/8/02.]

     (1) One session of application assistance per client, per year;

     (2) Over-the-counter (OTC) contraceptives, drugs, and supplies (as described in chapter 388-530 WAC, Prescription Drugs (Outpatient));

     (3) Sterilization procedure that meets the requirements of WAC 388-531-1550, if the service is:

     (a) Requested by the TAKE CHARGE client; and

     (b) Performed in an appropriate setting for the procedure.

     (4) Screening and treatment for sexually transmitted diseases-infections (STD-I), including laboratory tests and procedures, only when the screening and treatment is related to, and medically necessary for, a sterilization procedure.

     (5) Education and supplies for FDA-approved contraceptives, natural family planning and abstinence.

     (6) One education and counseling session for risk reduction (ECRR) per client, every twelve months. ECRR must be:

     (a) Provided by one or more of the following TAKE CHARGE trained providers:

     (i) Physician or physician's assistant (PA);

     (ii) An advanced registered nurse practitioner (ARNP); or

     (iii) A registered nurse (RN), licensed practical nurse (LPN), a trained and experienced health educator, medical assistant, or certified nursing assistant when used for assisting and augmenting the clinicians listed in subsection (i) and (ii) of this section; and

     (b) Documented in the client's chart with detailed information that allows for a well-informed follow-up visit.

[]

     (1) Abortions and other pregnancy-related services; and

     (2) Any other medical services, unless those services are:

     (a) Performed in relation to a primary focus and diagnosis of family planning; and

     (((2))) (b) Medically necessary for the client to safely, effectively, and successfully use, or continue to use, his or her chosen contraceptive method.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-750, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-750, filed 10/8/02, effective 11/8/02.]

     (1) TAKE CHARGE ((preapplication worksheet)) application form(s) ((and application(s)));

     (2) Signed supplemental TAKE CHARGE agreement to participate in the TAKE CHARGE program;

     (3) Documentation of the department's specialized TAKE CHARGE training and/or in-house in-service TAKE CHARGE training for each individual responsible for providing TAKE CHARGE.

     (4) Chart notes that reflect the primary focus and diagnosis of the visit was family planning;

     (5) Contraceptive methods discussed with the client;

     (6) Notes on any discussions of emergency contraception and needed prescription(s);

     (7) The client's plan for the contraceptive method to be used, or the reason for no contraceptive method and plan;

     (8) Documentation of the education, counseling and risk reduction (ECRR) service, if provided, ((including all of the required components as defined in WAC 388-532-710)) with sufficient detail that allows for follow-up;

     (9) Documentation of referrals to or from other providers;

     (10) A form signed by the client authorizing release of information for referral purposes, as necessary; ((and))

     (11) The client's written and signed consent requesting that his or her medical identification card be sent to the TAKE CHARGE provider's office to protect confidentiality;

     (12) A copy of the client's picture identification;

     (13) A copy of the documentation used to establish United States citizenship or legal permanent residency; and

     (14) If applicable, a copy of the completed DSHS sterilization consent form (([))(DSHS 13-364 - available for download at http://www.dshs.wa.gov/msa/forms/eforms.html((]))) (see WAC 388-531-1550).

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-760, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-760, filed 10/8/02, effective 11/8/02.]

     (a) Have a primary focus and diagnosis of family planning as determined by a qualified licensed medical practitioner; and

     (b) Are medically necessary for the client to safely, effectively, and successfully use, or continue to use, his or her chosen contraceptive method.

     (2) The department reimburses providers for covered TAKE CHARGE services according to the department's published TAKE CHARGE fee schedule.

     (3) (((3))) The department limits reimbursement for TAKE CHARGE ((intensive follow-up services (IFS) to those randomly selected research sites described in WAC 388-532-740(2). See WAC 388-532-730 (1)(e)(i) for related information)) research and evaluation activities to selected research sites.

     (4) Federally qualified health centers (FQHCs), rural health centers (RHCs), and Indian health providers who choose to become TAKE CHARGE providers must bill the department for TAKE CHARGE services without regard to their special rates and fee schedules. The department does not reimburse FQHCs, RHCs or Indian health providers under the encounter rate structure for TAKE CHARGE services.

     (5) The department requires TAKE CHARGE providers to meet the billing requirements of WAC 388-502-0150 (billing time limits). In addition, all final billings and billing adjustments related to the TAKE CHARGE program must be completed no later than ((June 30, 2008, or no later than)) two years after the demonstration and research program terminates((, whichever occurs first)). The department will not accept new billings or billing adjustments that increase expenditures for the TAKE CHARGE program after the cut-off date ((in this subsection)).

     (6) The department does not cover inpatient services under the TAKE CHARGE program. However, inpatient charges may be incurred as a result of complications arising directly from a covered TAKE CHARGE service. If this happens, providers of TAKE CHARGE related inpatient services that are not otherwise covered by third parties or other medical assistance programs must submit to the department a complete report of the circumstances and conditions that caused the need for inpatient services for the department to consider payment under WAC 388-501-0165.

     (7) The department requires a provider under WAC 388-501-0200 to seek timely reimbursement from a third party when a client has available third party resources. The exceptions to this requirement are described under WAC 388-501-0200 (2) and (3) and 388-532-790.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-780, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-780, filed 10/8/02, effective 11/8/02.]

     (a) Routinely or randomly sends verification of services to the third party subscriber and that subscriber is other than the applicant; and/or

     (b) Requires the applicant to use a primary care provider who is likely to report the applicant's request for family planning services to ((another party)) the subscriber.

     (2) If subsection (1)(a) or (1)(b) of this section applies, the applicant is ((considered)) eligible for TAKE CHARGE without regard to the available third party family planning coverage.

[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. 05-24-032, § 388-532-790, filed 11/30/05, effective 12/31/05. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.800, and SSB 5968, 1999 c 392 § 2(12). 02-21-021, § 388-532-790, filed 10/8/02, effective 11/8/02.]

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