HEALTH CARE AUTHORITY
[Filed June 24, 2022, 9:23 a.m., effective August 1, 2022]
Effective Date of Rule: August 1, 2022.
Purpose: The agency is amending WAC 182-537-0600 to remove subsection (6), which requires participating school districts to provide local funding. The legislature changed the funding formula for school-based health services by removing the financial contribution requirement for school districts.
Citation of Rules Affected by this Order: Amending WAC 182-537-0600.
Adopted under notice filed as WSR 22-11-005 on May 5, 2022.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: June 24, 2022.
AMENDATORY SECTION(Amending WSR 20-14-062, filed 6/26/20, effective 7/27/20)
WAC 182-537-0600School district requirements for billing and payment.
To receive payment from the medicaid agency for providing school-based health care services (SBHS) to eligible children, a school district must:
(1) Enroll as a billing provider in ProviderOne and have a current, signed core provider agreement (CPA) with the agency.
(2) Have a current, signed, and executed SBHS contract with the agency.
(3) Meet the applicable requirements in chapter 182-502 WAC.
(4) Comply with the applicable requirements in the agency's current, published ProviderOne billing and resource guide.
(5) Bill according to the agency's current SBHS billing guide and the SBHS fee schedule.
(6) ((Comply with the intergovernmental transfer (IGT) process. The school district must provide its local match to the agency within one hundred twenty days of the invoice date.
(a) If local match is not received within one hundred twenty days of the invoice date, the agency will deny claims.
(b) School districts may resubmit denied claims within twenty-four months from the date of service under WAC 182-502-0150.
(7))) Provide only early intervention or health care-related services identified through a current individualized education program (IEP) or individualized family service plan (IFSP).
(((8)))(7) Use only licensed health care providers or nonlicensed people practicing under the supervision of a licensed provider under WAC 182-537-0350.
(((9)))(8) Enroll licensed health care providers as servicing providers under the school district's ProviderOne account, and ensure providers have their own national provider identifier (NPI) number.
(((10)))(9) Meet documentation requirements described in WAC 182-537-0700.