SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Effective Date of Rule: July 1, 2009.
Purpose: Under sections 201 and 209 of the operating budget for fiscal years 2010 and 2011, funding for maternity support services (First Steps program) is reduced by 20% from current levels. The department is amending language in sections in chapter 388-533 WAC, in order to meet these targeted budget expenditure levels. The changes include redefining the eligibility criteria for maternity support services and reducing the number of pregnant women and their infants who qualify for enhanced MSS services. The maximum number of units eligible clients may receive has been reduced.
Citation of Existing Rules Affected by this Order: Amending WAC 388-533-0315, 388-533-0320, and 388-533-0345.
Statutory Authority for Adoption: RCW 74.08.090 and 74.09.760 through 74.09.910.
Other Authority: 2009-11 omnibus operating budget (ESHB 1244).
Under RCW 34.05.350 the agency for good cause finds that in order to implement the requirements or reductions in appropriations enacted in any budget for fiscal years 2009, 2010, or 2011, which necessitates the need for the immediate adoption, amendment, or repeal of a rule, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the fiscal needs or requirements of the agency.
Reasons for this Finding: Emergency rule adoption is required in order for the department to comply with sections 201 and 209 of the operating budget for fiscal years 2010 and 2011 with respect to maternity support services. A CR-101 for the permanent rule was filed as WSR 09-04-069 on February 2, 2009.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 3, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.
Date Adopted: June 19, 2009.
Stephanie E. Schiller
"Advocacy" -- For the purposes of the MSS program, means actions taken to support the parent(s) in accessing needed services or goods and helping the parent(s) to develop skills to access services.
"Assurances document" -- A signed agreement documenting that the provider understands and agrees to maintain certain required program elements; and to work toward integrating other specifically recommended practices. Also referred to as the MSS/ICM assurances document.
"Basic health messages" -- For the purposes of the MSS program, means the preventative health education messages designed to promote healthy pregnancies, healthy newborns and healthy parenting during the first year of life.
"Case management" -- For the purposes of the MSS program, means services to assist individuals who are eligible under the medicaid state plan, to gain access to needed medical, social, educational, and other services.
"Childbirth education classes (CBE)" -- A series of educational sessions offered in a group setting and led by an approved instructor to prepare a pregnant woman and her support person for an upcoming childbirth.
"DASA (division of alcohol and substance abuse)" -- Childcare for women attending DASA-funded outpatient alcohol or drug treatment services that may be provided through the treatment facility.
"First Steps" -- Childcare funded through the First Steps
Program for the care of children of pregnant or postpregnant
women who are attending appointments for medicaid-covered
services, pregnant women on physician ordered bed rest, and
for visits to the neonatal intensive care unit (NICU) after
"Community and family health (CFH)" -- Refers to the division within the state department of health whose mission is to improve the health and well-being of Washington residents with a special focus on infants, children, youth, pregnant woman, and prospective parents.
"Consultation" -- For the purposes of the MSS program, means the practice of conferring with other professionals to share knowledge and problem solve with the intent of providing the best possible care to clients.
"Core services" -- For the purposes of the MSS program,
means the services that provide the framework for
interdisciplinary, client-centered maternity support services
and infant case management. These services include: Client
screening, basic health messages, basic linkages, and
minimum)) appropriate interventions.
"Department of health (DOH)" -- The agency whose mission is to protect and improve the health of people in Washington state.
"Department of social and health services (DSHS)" -- The state agency that administers social and health services programs for the state of Washington.
"First Steps" -- The 1989 Maternity Care Access Act, known as First Steps. This program provides enhanced maternity care for pregnant and postpregnant women, and health care for infants. The program is managed collaboratively by DSHS and DOH. First Steps maternity care consists of obstetrical care, maternity support services, childbirth education classes, and infant case management.
"First Steps Childcare" -- See childcare.))
"Home visit" -- For the purposes of the MSS program, means services delivered in the client's place of residence or other setting as described in the medical assistance administration's published MSS/ICM billing instructions.
"Infant case management (ICM)" -- A program that provides case management services to eligible high-risk infants and their families. Eligibility for ICM may be established at the end of the maternity cycle and up to the infant's first birthday.
"Interagency agreement" -- A written letter of agreement between two agencies for the exchange of referrals or service provision (e.g., a written agreement in letter format that agrees to an exchange of referrals or services for MSS/ICM clients).
"Interdisciplinary team" -- Members from different professions and occupations that work closely together and communicate frequently to optimize care for the client (pregnant woman and infant). Each team member contributes specialized knowledge, skills and experience to support and augment the contributions of the other team members.
"Linkages" -- Networking and/or collaboration between agencies in order to assure proper referral of clients and avoid duplication of services.
"Maternal and infant health (MIH)" -- A section within the state department of health. MIH works collaboratively with DSHS to provide clinical consultation, oversight and monitoring of the MSS/ICM programs.
"Maternity cycle" -- An eligibility period for maternity support services that begins during pregnancy and continues to the end of the month in which the sixtieth-day postpregnancy occurs.
"Maternity support services (MSS)" -- Preventive health services for pregnant/postpregnant women including: Professional observation, assessment, education, intervention and counseling. MSS services are provided by an interdisciplinary team consisting of at minimum, a community health nurse, a nutritionist, and a behavioral health specialist. Additional MSS services may be provided by community health workers.
"Medical assistance administration (MAA)" -- The administration within DSHS authorized to administer medical assistance programs.
"Minimum interventions" -- Defined levels of client
assessment, education, intervention and outcome evaluation for
specific risk factors found in client screening for MSS/ICM
services, or identified during ongoing services.))
"Performance measure" -- An indicator used to measure the results of a focused intervention or initiative.
"Risk factors" -- The biopsychosocial factors that could
lead to ((
negative pregnancy or parenting)) poor birth
outcomes. (( The MSS/ICM program design identifies specific
risk factors and corresponding minimum interventions.))
"Service plan" -- The written plan of care that must be developed and maintained throughout the eligibility period for each client in the MSS/ICM programs.
"Staff" -- For the purposes of the MSS program, means the personnel employed by providers.
"Unit of service" -- Fifteen minutes of one-to-one
service delivered face-to-face.))
[Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. 04-13-049, § 388-533-0315, filed 6/10/04, effective 7/11/04.]
(a) Be covered under one of the following medical
(i) Categorically needy program (CNP);
Categorically needy program)) CNP -- Children's
health insurance program; (( (CNP-Children's health insurance
Categorically needy program)) CNP -- Emergency
medical only (( (CNP-Emergency medical only); and)); or
(iv) Medically needy program (MNP).
Pregnant or still within the maternity cycle)) Be
within the eligibility period of a maternity cycle as defined
in WAC 388-533-0315; and
(c) Meet any other eligibility criteria as determined by the department and published in the department's current billing instructions and/or numbered memoranda.
(2) Clients meeting the eligibility criteria in ((
WAC 388-533-0320(1))) this section who are enrolled in (( an MAA))
a department-contracted managed care plan, are eligible for
MSS (( services)) outside their plan. (( MSS services delivered
outside the managed care plan are reimbursed on a
fee-for-service basis and subject to the same program rules as
apply to nonmanaged care clients.))
(3) Clients receiving MSS before July 1, 2009, are subject to the transition plan as determined and published by the department in numbered memoranda.
[Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. 04-13-049, § 388-533-0320, filed 6/10/04, effective 7/11/04.]
MAA reimburses under this program only for services
billed using approved procedure codes and modifiers as
identified in MAA's published MSS/ICM billing instructions;))
MSS must be:
(a) Provided to a client who meets the eligibility requirements in WAC 388-533-0320;
(b) Provided by a qualified staff person who meets the criteria established in WAC 388-533-0325;
(c) Provided according to the department's current published maternity support services/infant case management (MSS/ICM) billing instructions and/or numbered memoranda;
(d) Billed using:
(i) The appropriate procedure codes and modifiers identified in the department's current published MSS/ICM billing instructions; and
(ii) The department-assigned MSS provider number.
MAA reimburses)) The department:
(a) Pays for MSS ((
services)) in units of time with one
unit being equal to fifteen minutes of one-to-one service
(b) Determines the maximum number of units allowed to comply with the legislature's targeted budget expenditure levels for payment of MSS; and
(c) Publishes the maximum number of units allowed in the MSS/ICM billing instructions and/or numbered memoranda.
(3) MAA reimburses a maximum of:
(a) Six units per client, per day for any combination of office or home visits;
(b) Sixty total units per client, from all disciplines, over the maternity cycle;
(c) A one-time-only fee per client for the family planning performance measure; and
(d) A one-time-only fee per client per pregnancy for the tobacco cessation performance measure.))
[Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. 04-13-049, § 388-533-0345, filed 6/10/04, effective 7/11/04.]