This rule provides a brief description of the medical, dental, mental health, and substance abuse service categories listed in the table in WAC
388-501-0060. The description of services under each category is not intended to be all inclusive.
(1) For categorically needy (CN), medically needy (MN), and medical care services (MCS), refer to the WAC citations listed in the following descriptions for specific details regarding each service category. For Alien Emergency Medical (AEM) services, refer to WAC
388-438-0110.
(2) The following service categories are subject to the exclusions, limitations, and eligibility requirements contained in department rules:
(a)
Adult day health - Skilled nursing services, counseling, therapy (physical, occupational, speech, or audiology), personal care services, social services, general therapeutic activities, health education, nutritional meals and snacks, supervision, and protection. [WAC
388-71-0702 through
388-71-0776]
(b)
Ambulance - Emergency medical transportation and ambulance transportation for nonemergency medical needs. [WAC
388-546-0001 through
388-546-4000]
(c)
Blood processing/administration - Blood and/or blood derivatives, including synthetic factors, plasma expanders, and their administration. [WAC
388-550-1400 and
388-550-1500]
(d)
Dental services - Diagnosis and treatment of dental problems including emergency treatment and preventive care. [Chapters
388-535 and
388-535A WAC]
(e)
Detoxification - Inpatient treatment performed by a certified detoxification center or in an inpatient hospital setting. [WAC
388-800-0020 through
388-800-0035; and 388-550-1100]
(f)
Diagnostic services - Clinical testing and imaging services. [WAC
388-531-0100; 388-550-1400 and 388-550-1500]
(g)
Family planning services - Gynecological exams; contraceptives, drugs, and supplies, including prescriptions; sterilization; screening and treatment of sexually transmitted diseases; and educational services. [WAC
388-532-530]
(h)
Health care professional services - Office visits, emergency room, nursing facility, home-based, and hospital-based care; surgery, anesthesia, pathology, radiology, and laboratory services; obstetric services; kidney dialysis and renal disease services; osteopathic care, podiatry services, physiatry, and pulmonary/respiratory services; and allergen immunotherapy. [Chapter
388-531 WAC]
(i)
Hearing care - Audiology; diagnostic evaluations; hearing exams and testing; and hearing aids. [WAC
388-544-1200 and
388-544-1300; 388-545-700; and 388-531-0100]
(j)
Home health services - Intermittent, short-term skilled nursing care, physical therapy, speech therapy, home infusion therapy, and health aide services, provided in the home. [WAC
388-551-2000 through
388-551-2220]
(k)
Hospice services - Physician services, skilled nursing care, medical social services, counseling services for client and family, drugs, medications (including biologicals), medical equipment and supplies needed for palliative care, home health aide, homemaker, personal care services, medical transportation, respite care, and brief inpatient care. This benefit also includes services rendered in a hospice care center and pediatric palliative care services. [WAC
388-551-1210 through
388-551-1850]
(l)
Hospital services - Inpatient/outpatient - Emergency room; hospital room and board (includes nursing care); inpatient services, supplies, equipment, and prescription drugs; surgery, anesthesia; diagnostic testing, laboratory work, blood/blood derivatives; radiation and imaging treatment and diagnostic services; and outpatient or day surgery, and obstetrical services. [Chapter
388-550 WAC]
(m)
Intermediate care facility/services for mentally retarded - Habilitative training, health-related care, supervision, and residential care. [Chapter
388-835 WAC]
(n)
Maternity care and delivery services - Community health nurse visits, nutrition visits, behavioral health visits, midwife services, maternity and infant case management services, and community health worker visits. [WAC
388-533-0330]
(o)
Medical equipment, durable (DME) - Wheelchairs, hospital beds, respiratory equipment; prosthetic and orthotic devices; casts, splints, crutches, trusses, and braces. [WAC
388-543-1100]
(p)
Medical equipment, nondurable (MSE) - Antiseptics, germicides, bandages, dressings, tape, blood monitoring/testing supplies, braces, belts, supporting devices, decubitus care products, ostomy supplies, pregnancy test kits, syringes, needles, transcutaneous electrical nerve stimulators (TENS) supplies, and urological supplies. [WAC
388-543-2800]
(q)
Medical nutrition services - Enteral and parenteral nutrition, including supplies. [Chapters
388-553 and
388-554 WAC]
(r)
Mental health services - Inpatient and outpatient psychiatric services and community mental health services. [Chapter
388-865 WAC]
(s)
Nursing facility services - Nursing, therapies, dietary, and daily care services. [Chapter
388-97 WAC]
(t)
Organ transplants - Solid organs, e.g., heart, kidney, liver, lung, pancreas, and small bowel; bone marrow and peripheral stem cell; skin grafts; and corneal transplants. [WAC
388-550-1900 and
388-550-2000, and
388-556-0400]
(u)
Out-of-state services - Emergency services; prior authorized care. Services provided in bordering cities are treated as if they were provided in state. [WAC
388-501-0175 and
388-501-0180; 388-531-1100; and 388-556-0500]
(v)
Oxygen/respiratory services - Oxygen, oxygen equipment and supplies; oxygen and respiratory therapy, equipment, and supplies. [Chapter
388-552 WAC]
(w)
Personal care services - Assistance with activities of daily living (e.g., bathing, dressing, eating, managing medications) and routine household chores (e.g., meal preparation, housework, essential shopping, transportation to medical services). [WAC
388-106-0010, [388-106-]0300, [388-106-]0400, [388-106-]0500, [388-106-]0600, [388-106-]0700, [388-106-]0720 and [388-106-]0900]
(x)
Prescription drugs - Outpatient drugs (including in nursing facilities), both generic and brand name; drug devices and supplies; some over-the-counter drugs; oral, topical, injectable drugs; vaccines, immunizations, and biologicals; and family planning drugs, devices, and supplies. [WAC
388-530-1100] Additional coverage for medications and prescriptions is addressed in specific program WAC sections.
(y)
Private duty nursing - Continuous skilled nursing services provided in the home, including client assessment, administration of treatment, and monitoring of medical equipment and client care for clients seventeen years of age and under. [WAC
388-551-3000.] For benefits for clients eighteen years of age and older, see WAC
388-106-1000 through
388-106-1055 .
(z)
Prosthetic/orthotic devices - Artificial limbs and other external body parts; devices that prevent, support, or correct a physical deformity or malfunction. [WAC
388-543-1100]
(aa)
School medical services - Medical services provided in schools to children with disabilities under the Individuals with Disabilities Education Act (IDEA). [Chapter
388-537 WAC]
(bb)
Substance abuse services - Chemical dependency assessment, case management services, and treatment services. [WAC
388-533-0701 through
388-533-0730; 388-556-0100 and 388-556-0400; and 388-800-0020]
(cc)
Therapy - Occupational/physical/speech -- Evaluations, assessments, and treatment. [WAC
388-545-300,
388-545-500, and
388-545-700]
(dd)
Vision care - Eye exams, refractions, frames, lenses, ocular prosthetics, and surgery. [WAC
388-544-0250 through
388-544-0550]
[11-14-075, recodified as § 182-501-0065, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 06-24-036, § 388-501-0065, filed 11/30/06, effective 1/1/07.]
Notes:
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.