WSR 14-02-077
(Medicaid Program)
[Filed December 30, 2013, 12:46 p.m., effective January 1, 2014]
Effective Date of Rule: January 1, 2014.
Purpose: The agency is amending WAC 182-502-0002 and 182-502-0003 in response to amendments the agency is making to chapter 182-531 WAC for applied behavior analysis, filed under WSR 12-14-100 on July 7, 2012; and chapter 182-543 WAC for complex rehabilitation technology, filed under WSR 13-15-072 on July 16, 2013.
Citation of Existing Rules Affected by this Order: Amending WAC 182-502-0002 and 182-502-0003.
Statutory Authority for Adoption: RCW 41.05.021; chapter 178, Laws of 2013 (E2SHB 1445); and 3ESSB 5034, section 213, Line 40, chapter 4, Laws of 2013, 63rd legislature.
Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: Emergency adoption of these rules is necessary to allow the following providers to be eligible for agency reimbursement:
1. Applied behavior analysis (ABA) providers - In response to a court-approved settlement agreement, the agency is adopting rules concerning coverage for ABA services for children with autism spectrum disorders.
2. Suppliers of complex rehabilitation technologies (CRT) - As directed by the legislature in E2SHB 1445, the agency is establishing rules for a separate recognition for individually configured, CRT products and services for complex medical-need clients in the medical assistance program.
3. Naturopathic physicians - As directed by the legislature in ESSB [3ESSB] 5034, the agency will reimburse for primary care services provided by naturopathic physicians.
The agency is proceeding with the permanent rule adoption process. The agency sent draft of the rules to external stakeholders on December 11, 2013, and anticipates filing the CR-102 in early 2014.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 2, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.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 2, Repealed 0.
Date Adopted: December 30, 2013.
Kevin M. Sullivan
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-502-0002 Eligible provider types.
The following health care professionals, health care entities, suppliers or contractors of service may request enrollment with the Washington state ((department of social and health services)) health care authority (medicaid agency) to provide covered health care services to eligible clients. For the purposes of this chapter, health care services include((s)) treatment, equipment, related supplies, and drugs.
(1) Professionals:
(a) Advanced registered nurse practitioners;
(b) Anesthesiologists;
(c) Applied behavior analysis (ABA) professionals, as provided in WAC 182-531-1410 through 182-531-1436:
(i) Certified agency-affiliated counselors;
(ii) Certified counselors; and
(iii) Certified counselor advisors.
(d) Audiologists;
(((d))) (e) Chemical dependency professionals:
(i) Mental health care providers; and
(ii) Peer counselors.
(((e))) (f) Chiropractors;
(((f))) (g) Dentists;
(((g))) (h) Dental hygienists;
(((h))) (i) Denturists;
(((i))) (j) Dietitians or nutritionists;
(((j))) (k) Hearing aid fitters/dispensers;
(((k))) (l) Marriage and family therapists((, only as provided in WAC 388-531-1400));
(((l))) (m) Mental health counselors((, only as provided in WAC 388-531-1400));
(((m))) (n) Mental health care providers;
(((n))) (o) Midwives;
(((o))) (p) Naturopathic physicians;
(q) Nurse anesthetist;
(r) Occularists;
(((p))) (s) Occupational therapists;
(((q))) (t) Ophthalmologists;
(((r))) (u) Opticians;
(((s))) (v) Optometrists;
(((t))) (w) Orthodontists;
(((u))) (x) Orthotist;
(((v))) (y) Osteopathic physicians;
(((w))) (z) Osteopathic physician assistants;
(((x))) (aa) Peer counselors;
(((y))) (bb) Podiatric physicians;
(((z))) (cc) Pharmacists;
(((aa))) (dd) Physicians;
(((bb))) (ee) Physician assistants;
(((cc))) (ff) Physical therapists;
(((dd))) (gg) Prosthetist;
(((ee))) (hh) Psychiatrists;
(((ff))) (ii) Psychologists;
(((gg))) (jj) Radiologists;
(((hh))) (kk) Registered nurse delegators;
(((ii))) (ll) Registered nurse first assistants;
(((jj))) (mm) Respiratory therapists;
(((kk))) (nn) Social workers((, only as provided in WAC 388-531-1400)); and
(((ll))) (oo) Speech/language pathologists.
(2) Agencies, centers and facilities:
(a) Adult day health centers;
(b) Ambulance services (ground and air);
(c) Ambulatory surgery centers (medicare-certified);
(d) Birthing centers (licensed by the department of health);
(e) ((Blood banks;
(f))) Cardiac diagnostic centers;
(((g))) (f) Case management agencies;
(((h))) (g) Chemical dependency treatment facilities certified by the department of social and health services (DSHS) division of ((alcohol and substance abuse (DASA))) behavioral health and recovery (DBHR), and contracted through either:
(i) A county under chapter 388-810 WAC; or
(ii) ((DASA)) DBHR to provide chemical dependency treatment services.
(((i))) (h) Centers for the detoxification of acute alcohol or other drug intoxication conditions (certified by ((DASA)) DBHR);
(((j))) (i) Community AIDS services alternative agencies;
(((k))) (j) Community mental health centers;
(((l))) (k) Diagnostic centers;
(((m))) (l) Early and periodic screening, diagnosis, and treatment (EPSDT) clinics;
(((n))) (m) Family planning clinics;
(((o))) (n) Federally qualified health centers (designated by the federal department of health and human services);
(((p))) (o) Genetic counseling agencies;
(((q))) (p) Health departments;
(((r))) (q) Health maintenance organization (HMO)/managed care organization (MCO);
(((s))) (r) HIV/AIDS case management;
(((t))) (s) Home health agencies;
(((u))) (t) Hospice agencies;
(((v))) (u) Hospitals;
(((w))) (v) Indian health service facilities/tribal 638 facilities;
(((x))) (w) Tribal or urban Indian clinics;
(((y))) (x) Inpatient psychiatric facilities;
(((z))) (y) Intermediate care facilities for the mentally retarded (ICF-MR);
(((aa))) (z) Kidney centers;
(((bb))) (aa) Laboratories (CLIA certified);
(((cc))) (bb) Maternity support services agencies; maternity case managers; infant case management, first steps providers;
(((dd))) (cc) Neuromuscular and neurodevelopmental centers;
(((ee))) (dd) Nurse services/delegation;
(((ff))) (ee) Nursing facilities (approved by the DSHS aging and ((disability services)) long-term support administration);
(((gg))) (ff) Pathology laboratories;
(((hh))) (gg) Pharmacies;
(((ii))) (hh) Private duty nursing agencies;
(((jj))) (ii) Radiology - Stand-alone clinics;
(((kk))) (jj) Rural health clinics (medicare-certified);
(((ll))) (kk) School districts and educational service districts;
(((mm))) (ll) Sleep study centers; and
(((nn))) (mm) Washington state school districts and educational service districts.
(3) Suppliers of:
(a) Blood, blood products, and related services;
(b) Durable and nondurable medical equipment and supplies;
(((b))) (c) Complex rehabilitation technologies;
(d) Infusion therapy equipment and supplies;
(((c))) (e) Prosthetics/orthotics;
(((d))) (f) Hearing aids; and
(((e) Oxygen)) (g) Respiratory care, equipment, and supplies.
(4) Contractors:
(a) Transportation brokers;
(b) Spoken language interpreter services agencies;
(c) Independent sign language interpreters; and
(d) Eyeglass and contact lens providers.
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-502-0003 Noneligible provider types.
The ((department)) medicaid agency does not enroll licensed or unlicensed health care practitioners not specifically listed in WAC ((388-502-0002)) 182-502-0002, including, but not limited to:
(1) Acupuncturists;
(2) ((Counselors, except as provided in WAC 388-531-1400;
(3))) Sanipractors;
(((4) Naturopaths;
(5))) (3) Homeopaths;
(((6))) (4) Herbalists;
(((7))) (5) Massage therapists;
(((8) Social workers, except as provided in WAC 388-531-1400 and 388-537-0350;
(9))) (6) Christian science practitioners, theological healers, and spiritual healers;
(((10))) (7) Chemical dependency professional trainee (CDPT); and
(((11))) (8) Mental health trainee (MHT).