Date of Adoption: September 25, 2001.

     Purpose: The department is adopting rules to reflect long-standing operational policy regarding the services covered by DSHS/MAA and delivered in neurodevelopmental centers. Client eligibility, provider requirements and service limitations are being adopted in rule.

     Statutory Authority for Adoption: RCW 74.09.080.

     Other Authority: RCW 74.09.520 and 74.09.530.

      Adopted under notice filed as WSR 01-16-138 on July 31, 2001.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

September 25, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (a) Neurodevelopmental centers that may be reimbursed as such by the medical assistance administration (MAA);

     (b) Clients who may receive covered services at a neurodevelopmental center; and

     (c) Covered services that may be provided at and reimbursed to a neurodevelopmental center.

     (2) In order to provide and be reimbursed for the services listed in subsection (4) of this section, MAA requires a neurodevelopmental center provider to do all of the following:

     (a) Be contracted with the department of health (DOH) as a neurodevelopmental center;

     (b) Provide documentation of the DOH contract to MAA;

     (c) Sign a core provider agreement with MAA; and

     (d) Receive a neurodevelopmental center provider number from MAA.

     (3) Clients who are twenty years of age or younger and who meet the following eligibility criteria may receive covered services from neurodevelopmental centers:

     (a) For occupational therapy, refer to WAC 388-545-300(2);

     (b) For physical therapy, refer to WAC 388-545-500(2);

     (c) For speech therapy and audiology services, refer to WAC 388-545-700(2); and

     (d) For early and periodic screening, diagnosis and treatment (EPSDT) screening by physicians, refer to WAC 388-529-0200.

     (4) MAA reimburses neurodevelopmental centers for providing the following services to clients who meet the requirements in subsection (3) of this section:

     (a) Occupational therapy services as described in WAC 388-545-300;

     (b) Physical therapy services as described in WAC 388-545-500;

     (c) Speech therapy and audiology services as described in WAC 388-545-700; and

     (d) Specific pediatric evaluations and team conferences that are:

     (i) Attended by the center's medical director; and

     (ii) Identified as payable in MAA's billing instructions.

     (5) In order to be reimbursed, neurodevelopmental centers must meet MAA's billing requirements in WAC 388-502-0020, 388-502-0100 and 388-502-0150.

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