WSR 15-09-073
(Washington Apple Health)
[Filed April 15, 2015, 2:57 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 15-04-091.
Title of Rule and Other Identifying Information: WAC 182-534-0200 Enhanced payments for EPSDT screens for children in out-of-home placement.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Conference Room, 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 26, 2015, at 10:00 a.m.
Date of Intended Adoption: Not sooner than May 27, 2015.
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 26, 2015.
Assistance for Persons with Disabilities: Contact Kelly Richters by May 19, 2015, TTY (800) 848-5429 or (360) 725-1307 or e-mail
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is removing two provider types from the list of providers who are eligible to perform EPSDT screens and bill an enhanced rate: (1) Nurses trained through the department of health to perform EPSDT screens; and (2) registered nurses.
Reasons Supporting Proposal: The department of health no longer trains nurses to perform EPSDT screens. Registered nurses are independent practitioners and are not allowed to make plans for patients.
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: Sean Sullivan, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1348; Implementation and Enforcement: Tonja Nichols, P.O. Box 45502, Olympia, WA 98504-5502, (360) 725-1658.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has analyzed the proposed rules and concludes they do not impose more than minor costs for affected small businesses.
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 15, 2015
Jason P. Crabbe
Rules Coordinator
AMENDATORY SECTION (Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-534-0200 Enhanced payments for EPSDT screens for children in out-of-home placement.
The ((department reimburses)) medicaid agency pays providers an enhanced fee for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) screens provided to children in out-of-home placement. See the ((department's)) agency's EPSDT ((billing instructions)) provider guide for specific billing code requirements, and see the agency's fee schedule for the fee.
(1) For the purposes of this section, out-of-home placement ((is defined as)) means temporary, twenty-four hour per day((, temporary)), substitute care for a child:
(a) Placed away from the child's parents or guardians in licensed, paid, out-of-home care; and
(b) For whom the department of social and health services or a licensed or certified child placing agency has placement and care responsibility.
(2) The ((department)) agency pays an enhanced fee to the providers listed in subsection (3) of this section for EPSDT screens provided to only those children in out-of-home placement.
(3) The following providers are eligible to perform EPSDT screens and bill the enhanced rate for children in out-of-home placement:
(a) EPSDT clinics;
(b) Physicians;
(c) Advanced registered nurse practitioners (ARNPs); and
(d) Physician assistants (PAs) working under ((the guidance of a physician;
(e) Nurses specially trained through the department of health (DOH) to perform EPSDT screens; and
(f) Registered nurses working under the guidance of a physician or ARNP)) a physician's guidance.
(4) ((In order)) To be paid an enhanced fee, services furnished by the providers listed in subsection (3) of this section must meet the federal requirements for EPSDT screens at 42 C.F.R. Part 441 Subpart B((, which were in effect as of December 1, 2001)).
(5) The provider must retain documentation of the EPSDT screens in the client's medical file. The provider must use the ((department's)) agency's Well Child Exam forms or provide equivalent information. The Well Child Exam forms include the required elements for an EPSDT screen. The Well Child Exam forms (((DSHS 13-683A through 13-686B))) are available for downloading at no charge at ((
(6) The ((department conducts evaluations of)) agency evaluates client files and payments made under this program. The ((department)) agency may recover the enhanced payment amount when:
(a) The client was not in out-of-home placement as defined in subsection (1) of this section when the EPSDT screen was provided; or
(b) Documentation was not in the client's medical file (see subsection (5) of this section).