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WSR 12-21-111 Washington State Register, Issue 12-21 the process found in WAC ((388-501-0165)) 182-501-0165; ((and (e))) (f) Authorized, as required within this chapter; (((f))) (g) Billed according to WAC ((388-502-0150)) 182-502-0150 and ((388-502-0160)) 182-502-0160; and (((g))) (h) Billed according to the requirements of this chapter. (3) Coverage determinations for the ((department)) agency are made by the ((department's)) agency's pharmacists or medical consultants in accordance with applicable federal law. The ((department's)) agency's determination may include consultation with the drug use review (DUR) board. (((4) The department may not reimburse for prescriptions written by health care practitioners whose application for a core provider agreement (CPA) has been denied, or whose CPA has been terminated. (5) The department may not reimburse for prescriptions written by non-CPA health care practitioners who do not have a current core provider agreement with the department when the department determines there is a potential danger to the client's health and/or safety.)) AMENDATORY SECTION (Amending WSR 12-18-062, filed 8/31/12, effective 10/1/12) WAC 182-531-0100 Scope of coverage for physicianrelated and health care professional services—General and administrative. (1) The medicaid agency covers health care services, equipment, and supplies listed in this chapter, according to agency rules and subject to the limitations and requirements in this chapter, when they are: (a) Within the scope of an eligible client's medical assistance program. Refer to WAC 182-501-0060 and 182-501- 0065; and (b) Medically necessary as defined in WAC 182-500- 0070. (2) The agency evaluates a request for a service that is in a covered category under the provisions of WAC 182-501- 0065. (3) The agency evaluates requests for covered services that are subject to limitations or other restrictions and approves such services beyond those limitations or restrictions as described in WAC 182-501-0169. (4) The agency covers the following physician-related services and health care professional services, subject to the conditions in subsections (1), (2), and (3) of this section: (a) Allergen immunotherapy services; (b) Anesthesia services; (c) Dialysis and end stage renal disease services (refer to chapter 182-540 WAC); (d) Emergency physician services; (e) ENT (ear, nose, and throat) related services; (f) Early and periodic screening, diagnosis, and treatment (EPSDT) services (refer to WAC 182-534-0100); (g) Reproductive health services (refer to chapter 182- 532 WAC); (h) Hospital inpatient services (refer to chapter 182-550 WAC); (i) Maternity care, delivery, and newborn care services (refer to chapter 182-533 WAC); <strong>Proposed</strong> [ 126 ] (j) Office visits; (k) Vision-related services (refer to chapter 182-544 WAC for vision hardware for clients twenty years of age and younger); (l) Osteopathic treatment services; (m) Pathology and laboratory services; (n) Physiatry and other rehabilitation services (refer to chapter 182-550 WAC); (o) Foot care and podiatry services (refer to WAC 182- 531-1300); (p) Primary care services; (q) Psychiatric services, provided by a psychiatrist; (r) Psychotherapy services for children as provided in WAC 182-531-1400; (s) Pulmonary and respiratory services; (t) Radiology services; (u) Surgical services; (v) Cosmetic, reconstructive, or plastic surgery, and related services and supplies to correct physiological defects from birth, illness, or physical trauma, or for mastectomy reconstruction for post cancer treatment; (w) Oral health care services for emergency conditions for clients twenty-one years of age and older, except for clients of the division of developmental disabilities (refer to WAC 182-531-1025); and (x) Other outpatient physician services. (5) The agency covers physical examinations for medical assistance clients only when the physical examination is one or more of the following: (a) A screening exam covered by the EPSDT program (see WAC 182-534-0100); (b) An annual exam for clients of the division of developmental disabilities; or (c) A screening pap smear, mammogram, or prostate exam. (6) By providing covered services to a client eligible for a medical assistance program, a provider who ((has signed an agreement with the agency)) meets the requirements in WAC 182-502-0005(3) accepts the agency's rules and fees ((as outlined in the agreement,)) which includes federal and state law and regulations, billing instructions, and agency issuances. (7) Outpatient drugs are not subject to the rules in this chapter. For rules about outpatient drugs see chapter 182-530 WAC. WSR 12-21-111 PROPOSED RULES HEALTH CARE AUTHORITY (Medicaid Program) [Filed October 23, 2012, 1:37 p.m.] Original Notice. Preproposal statement of inquiry was filed as WSR 12- 07-075. Title of Rule and Other Identifying Information: Amends WAC 182-507-0110 Alien medical programs, 182- 507-0115 Alien emergency medical program (AEM), and
182-507-0120 Alien medical for dialysis and cancer treatment. Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, 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 http://maa.dshs.wa.gov/pdf/CherryStreet DirectionsNMap.pdf or directions can be obtained by calling (360) 725-1000), on November 27, 2012, at 10:00 a.m. Date of Intended Adoption: Not sooner than November 28, 2012. Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail arc@hca.wa.gov, fax (360) 586-9727, by 5:00 p.m. on November 27, 2012. Assistance for Persons with Disabilities: Contact Kelly Richters by November 19, 2012, TTY (800) 848-5429 or (360) 725-1307 or e-mail kelly.richters@hca.wa.gov. Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The HCA is changing the titles of these rules to clarify the rules' content, removing reference to "state-only" funding from WAC 182- 507-0120, changing references to the "department" to the "agency," and correcting cross-references. Statutory Authority for Adoption: RCW 41.05.021. Rule is not necessitated by federal law, federal or state court decision. Name of Proponent: HCA, governmental. Name of Agency Personnel Responsible for Drafting: Jason R. P. Crabbe, P.O. Box 45504, Olympia, WA 98504- 5504, (360) 725-1346; Implementation and Enforcement: Dody McAlpine, P.O. Box 45504, Olympia, WA 98504- 5534, (360) 725-9964. No small business economic impact statement has been prepared under chapter 19.85 RCW. The HCA has analyzed the proposed new and amended rules and determines they will not have an adverse economic impact on small businesses. The preparation of a comprehensive small business economic impact statement therefore is not required. 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. October 23, 2012 Kevin M. Sullivan Rules Coordinator AMENDATORY SECTION (Amending WSR 12-13-056, filed 6/15/12, effective 7/1/12) WAC 182-507-0110 Alien medical programs. (1) To qualify for an alien medical program (AMP) a person must: (a) Be ineligible for medicaid or other ((DSHS)) medicaid agency medical program due to the citizenship/alien status requirements described in WAC 388-424-0010; (b) Meet the requirements described in WAC ((388-438- 0115, 388-438-0120, or 388-438-0125)) 182-507-0115, 182- 507-0120, or 182-507-0125; and Washington State Register, Issue 12-21 WSR 12-21-111 (c) Meet categorical eligibility criteria for one of the following programs, except for the Social Security number or citizenship/alien status requirements: (i) WAC 388-475-0050, for an SSI-related person; (ii) WAC ((388-505-0220)) 182-505-0240, for family medical programs; (iii) WAC ((388-505-0210)) 182-505-0210, for a child under the age of nineteen; (iv) WAC ((388-462-0015)) 182-505-0115, for a pregnant woman; (v) WAC 388-462-0020, for the breast and cervical cancer treatment program for women; or (vi) WAC ((388-523-0100)) 182-523-0100, for medical extensions. (2) AMP medically needy (MN) coverage is available for children, adults age sixty-five or over, or persons who meet SSI disability criteria. See WAC 388-519-0100 for MN eligibility and 388-519-0110 for spending down excess income under the MN program. (3) The ((department)) agency or its designee does not consider a person's date of arrival in the United States when determining eligibility for AMP. (4) The ((department)) agency or its designee does not consider a sponsor's income and resources when determining eligibility for AMP, unless the sponsor makes the income or resources available. (5) A person is not eligible for AMP if that person entered the state specifically to obtain medical care. (6) A person who the ((department)) agency or its designee determines is eligible for AMP may be eligible for retroactive coverage as described in WAC 388-416-0015. (7) Once the ((department)) agency or its designee determines financial and categorical eligibility for AMP, the ((department)) agency or its designee then determines whether a person meets the requirements described in WAC ((388-438-0115, 388-438-0120, or 388-438-0125)) 182-507- 0115, 182-507-0120, or 182-507-0125. AMENDATORY SECTION (Amending WSR 12-13-056, filed 6/15/12, effective 7/1/12) WAC 182-507-0115 Alien emergency medical program (AEM). (1) A person nineteen years of age or older who is not pregnant and meets the eligibility criteria under WAC ((388-438-0110)) 182-507-0110 is eligible for the alien emergency medical program's scope of covered services described in this section if the person meets (a) and (b) ((below,)) or (c) ((below)) of this subsection: (a) The ((department's health and recovery services administration)) medicaid agency determines that the primary condition requiring treatment meets the definition of an emergency medical condition as defined in WAC ((388-500- 0005)) 182-500-0030, and the condition is confirmed through review of clinical records; and (b) The person's qualifying emergency medical condition is treated in one of the following hospital settings: (i) Inpatient; (ii) Outpatient surgery; (iii) Emergency room services, which must include an evaluation and management (E&M) visit by a physician; or [ 127 ] <strong>Proposed</strong>
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WSR 12-21-011 WITHDRAWAL OF PROPOSE
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todial parent when DCS seeks to enf
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AMENDATORY SECTION (Amending WSR 07
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Type of Licensee Tax Payment Requir
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66.24.140, or out-of-state holder o
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WAC 478-276-140. The request shall
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going shall apply only to that inst
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Rule is not necessitated by federal
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A cost-benefit analysis is not requ
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COMMUNITY RESIDENTIAL DAILY RATES F
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•• Safety-related activities in
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Assistance for Persons with Disabil
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• Medical Examiners' Handbook. ((
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vider account number to perform IME
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standard for Emergency and Standby
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((Notes to Tables 010-1 and 010-2.
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(((24))) "Electrical equipment" inc
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(c) "Service-entrance conductors, u
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Any outlets eliminated by such wind
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Washington State Register, Issue 12
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Notes to drawings E-101, E-102, and
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in accordance with 250.28 (D)(1) ba
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(c) Raceways and cables are secured
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(c) In an area in which a transform
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((STRICKEN GRAPHIC ((STRICKEN GRAPH
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cal nonmetallic tubing (when instal
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tic offices or clinics, outpatient
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(i) The date of the measurements. (
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(b) The installation of greater tha
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(b) Normal department inspection fo
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(i) Yard pole, pedestal, or other m
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(iii) Installing electrician's cert
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(iv) Journeyman or specialty electr
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(e) Failing to ensure that all elec
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Regardless of the number of stories
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(C) Any plumbing work regulated und
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AMENDATORY SECTION (Amending WSR 08
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Page 103 and 104: (20) The laboratory must develop an
Page 105 and 106: (39) The certification mark may be
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Page 117 and 118: (e) What records must the employer
Page 119 and 120: NEW SECTION WAC 296-17A-6625 Classi
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Page 155 and 156: tral. The proposed rule also adds s
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6. Energy and natural resources a.
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1. How would the proposal be likely
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chapter and specifying conditions u
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on the same date, the institution s
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(1) The technical college shall sub
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(2) The director or designee will a
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equire commerce to provide a cost-b
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annual report required by U.S. Depa
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