WSR 18-18-021
[Filed August 24, 2018, 3:29 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 18-04-066.
Title of Rule and Other Identifying Information: WAC 182-550-6300 Outpatient nutritional counseling; and new chapter 182-555 WAC, Medical nutrition therapy.
Hearing Location(s): On October 9, 2018, at 10:00 a.m., at the Health Care Authority (HCA), Cherry Street Plaza, 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.
Date of Intended Adoption: Not sooner than October 10, 2018.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email, fax 360-586-9727, by October 9, 2018.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication relay services 711, email, by October 5, 2018.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency removed the outdated language in WAC 182-550-6300. The agency has created a new chapter 182-555 WAC to establish updated definitions, eligibility requirements, provider requirements, covered services, and documentation requirements for medical nutrition therapy provided by a registered dietitian for clients age twenty and younger.
Reasons Supporting Proposal: See purpose.
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: Vance Taylor, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1344; Implementation and Enforcement: Jean Gowen, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-2005.
A school district fiscal impact statement is not required under RCW 28A.305.135.
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.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rules do not disproportionately impact small businesses.
August 24, 2018
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 15-18-065, filed 8/27/15, effective 9/27/15)
WAC 182-550-6300Outpatient nutritional counseling.
(((1) The medicaid agency will cover nutritional counseling services only for eligible medicaid clients age twenty and under referred during an early and periodic screening, diagnosis and treatment screening to a certified dietitian.
(2) Except for children under the children's medical program, the agency will not cover nutritional counseling for clients under the medically indigent and other state-only funded programs.
(3) The agency will pay for nutritional counseling for the following conditions:
(a) Inadequate or excessive growth, such as failure to thrive, undesired weight loss, underweight, major change in weight-to-height percentile, and obesity;
(b) Inadequate dietary intake, such as formula intolerance, food allergy, limited variety of foods, limited food resources, and poor appetite;
(c) Infant feeding problems, such as poor suck/swallow reflex, breast-feeding difficulties, lack of developmental feeding progress, inappropriate kinds or amounts of feeding offered, and limited caregiver knowledge or skills;
(d) Chronic disease requiring nutritional intervention, such as congenital heart disease, pulmonary disease, renal disease, cystic fibrosis, metabolic disorder, and gastrointestinal disease;
(e) Medical conditions requiring nutritional intervention, such as iron-deficiency anemia, familial hyperlipidemia, and pregnancy;
(f) Developmental disability, such as increasing the risk of altered energy and nutrient needs, oral-motor or behavioral feeding difficulties, medication-nutrient interaction, and tube feedings; or
(g) Psycho-social factors, such as behavior suggesting eating disorders.
(4) The agency will pay for maximum of twenty sessions, in any combination, of assessment/evaluation and/or nutritional counseling in a calendar year.
(5) The agency will require each assessment/evaluation or nutritional counseling session be for a period of twenty-five to thirty minutes of direct interaction with a client and/or the client's caregiver.
(6) The agency will pay the provider for a maximum of two sessions per day per client.))See chapter 182-555 WAC for medical nutrition therapy.
Chapter 182-555 WAC
WAC 182-555-0100General.
The medical nutrition therapy program ensures that clients have access to medically necessary outpatient medical nutrition therapy and associated follow-ups.
WAC 182-555-0200Definitions.
The following definitions and those found in chapter 182-500 WAC apply to this chapter:
"Enteral nutrition" - See WAC 182-554-200.
"Medical nutrition therapy" - Means an interaction between the registered dietitian (RD) and the client or client's guardian for the purpose of evaluating and making recommendations regarding the client's nutritional status.
"Nutrition assessment" - Means the collection and documentation of information such as food or nutrition-related history; biochemical data, medical tests and procedures; anthropometric measurements, nutrition-focused physical findings and client history.
"Nutrition care process" - Means a systematic approach to providing high-quality nutrition care. Provides a framework for the registered dietitian to individualize care, taking into account the client's needs and values and evidence available to make decisions.
"Nutrition-related diagnosis" - Means a diagnosis within the scope of practice for an RD to diagnose and treat as defined by the Academy of Nutrition and Dietetics.
"Registered dietitian" - Means a dietitian who is registered with the Academy of Nutrition and Dietetics and who is certified by the Washington state department of health (DOH).
WAC 182-555-0300Eligibility.
The medicaid agency covers medical nutrition therapy for clients who are:
(1) Age twenty and younger; and
(2) Referred to a registered dietitian for medical nutrition therapy by a physician, physician assistant (PA), or an advanced registered nurse practitioner (ARNP).
WAC 182-555-0400Provider requirements.
Medical nutrition therapy services must be delivered by a registered dietitian (RD) who:
(1) Has a current core provider agreement with the medicaid agency; and
(2) Has a national provider identifier (NPI).
WAC 182-555-0500Covered services.
(1) The medicaid agency covers medically necessary medical nutrition therapy when related to a nutrition-related diagnosis for eligible clients, as described under WAC 182-555-0300.
(2) The agency covers medical nutrition therapy, nutrition assessment, and counseling for conditions that are within the scope of practice for a registered dietitian (RD) to evaluate and treat.
WAC 182-555-0600Documentation requirements.
In addition to the health care record requirements found in WAC 182-502-0020, the medical nutrition therapy provider must maintain the following documentation in the client's file:
(1) Referral from the provider, as described under WAC 182-555-0300;
(2) The medical nutrition therapy provider assessment following the nutrition care process:
(a) Nutrition assessment;
(b) Nutrition diagnosis, including the problem, etiology, signs, and symptoms (PES) statement;
(c) Nutrition intervention;
(d) Nutrition monitoring and evaluation.
(3) Any correspondence with the referring provider;
(4) Information on associated medical conditions; and
(5) Information concerning the medical need.