The department pays enrolled providers for covered healthcare services, equipment and supplies they provide to eligible clients.
(1) To be eligible for enrollment, a provider must:
(a) Be licensed, certified, accredited, or registered according to Washington state laws and rules; and
(b) Meet the conditions in this chapter and chapters regulating the specific type of provider, program, and/or service.
(2) To enroll, an eligible provider must sign a core provider agreement with the department and receive a unique provider number; a provider may also sign a contract to enroll. (Note: Section 13 of the core provider agreement, DSHS 09-048 (REV. 06/2002), is hereby rescinded. The department and each provider signing a core provider agreement will hold each other harmless from a legal action based on the negligent actions or omissions of either party under the terms of the agreement.)
(3) Eligible providers listed in this subsection may request enrollment. Out-of-state providers listed in this subsection are subject to conditions in chapter
388-502 WAC.
(a) Professionals:
(i) Advanced registered nurse practitioners;
(ii) Anesthesiologists;
(iii) Audiologists;
(iv) Chiropractors;
(v) Dentists;
(vi) Dental hygienists;
(vii) Denturists;
(viii) Dietitians or nutritionists;
(ix) Marriage and family therapists, only as provided in WAC
388-531-1400;
(x) Maternity case managers;
(xi) Mental health counselors, only as provided in WAC
388-531-1400;
(xii) Midwives;
(xiii) Occupational therapists;
(xiv) Ophthalmologists;
(xv) Opticians;
(xvi) Optometrists;
(xvii) Orthodontists;
(xviii) Osteopathic physicians;
(xix) Podiatric physicians;
(xx) Pharmacists;
(xxi) Physicians;
(xxii) Physical therapists;
(xxiii) Psychiatrists;
(xxiv) Psychologists;
(xxv) Registered nurse delegators;
(xxvi) Registered nurse first assistants;
(xxvii) Respiratory therapists;
(xxviii) Social workers, only as provided in WAC
388-531-1400 and
388-531-1600;
(xxix) Speech/language pathologists;
(xxx) Radiologists; and
(xxxi) Radiology technicians (technical only);
(b) Agencies, centers and facilities:
(i) Adult day health centers;
(ii) Ambulance services (ground and air);
(iii) Ambulatory surgery centers (medicare-certified);
(iv) Birthing centers (licensed by the department of health);
(v) Blood banks;
(vi) Chemical dependency treatment facilities certified by the department of social and health services (DSHS), division of alcohol and substance abuse (DASA), and contracted through either:
(A) A county under chapter
388-810 WAC; or
(B) DASA to provide chemical dependency treatment services;
(vii) Centers for the detoxification of acute alcohol or other drug intoxication conditions (certified by DASA);
(viii) Community AIDS services alternative agencies;
(ix) Community mental health centers;
(x) Early and periodic screening, diagnosis, and treatment (EPSDT) clinics;
(xi) Family planning clinics;
(xii) Federally qualified health centers (FQHC) (designated by the Centers for medicare and medicaid);
(xiii) Genetic counseling agencies;
(xiv) Health departments;
(xv) HIV/AIDS case management;
(xvi) Home health agencies;
(xvii) Hospice agencies;
(xviii) Hospitals;
(xix) Indian Health Service;
(xx) Tribal or urban Indian clinics;
(xxi) Inpatient psychiatric facilities;
(xxii) Intermediate care facilities for the mentally retarded (ICF-MR);
(xxiii) Kidney centers;
(xxiv) Laboratories (CLIA certified);
(xxv) Maternity support services agencies;
(xxvi) Neuromuscular and neurodevelopmental centers;
(xxvii) Nursing facilities (approved by DSHS aging and disability services);
(xxviii) Pharmacies;
(xxix) Private duty nursing agencies;
(xxx) Rural health clinics (medicare-certified);
(xxxi) Tribal mental health services (contracted through the DSHS mental health division); and
(xxxii) Washington state school districts and educational service districts.
(c) Suppliers of:
(i) Durable and nondurable medical equipment and supplies;
(ii) Infusion therapy equipment and supplies;
(iii) Prosthetics/orthotics;
(iv) Hearing aids; and
(v) Oxygen equipment and supplies;
(d) Contractors of:
(i) Transportation brokers;
(ii) Interpreter services agencies; and
(iii) Eyeglass and contact lens providers.
(4) Nothing in this chapter precludes the department from entering into other forms of written agreements to provide services to eligible clients.
(5) The department does not enroll licensed or unlicensed practitioners who are not specifically addressed in subsection (3) of this section. Ineligible providers include but are not limited to:
(a) Acupuncturists;
(b) Counselors, except as provided in WAC
388-531-1400;
(c) Sanipractors;
(d) Naturopaths;
(e) Homeopaths;
(f) Herbalists;
(g) Massage therapists;
(h) Social workers, except as provided in WAC
388-531-1400 and
388-531-1600; or
(i) Christian Science practitioners or theological healers.
[Statutory Authority: RCW 74.09.521. 08-12-030, § 388-502-0010, filed 5/29/08, effective 7/1/08. Statutory Authority: RCW 74.08.090, 74.09.080, 74.09.120. 03-14-106, § 388-502-0010, filed 6/30/03, effective 7/31/03. Statutory Authority: RCW 74.08.090, 74.09.500, and 74.09.530. 01-07-076, § 388-502-0010, filed 3/20/01, effective 4/20/01; 00-15-050, § 388-502-0010, filed 7/17/00, effective 8/17/00.]