is the federal aid Title XIX program of the Social Security Act under which medical care is provided to eligible persons. "Medical assistance"
for the purposes of chapters 388-500
WAC, means the various health care programs administered by the agency or the agency's designee that provide federally funded and/or state-funded health care benefits to eligible clients. "Medical assistance administration (MAA)"
is the former organization within the department of social and health services authorized to administer the federally funded and/or state-funded health care programs that are now administered by the agency, formerly the medicaid purchasing administration (MPA), of the health and recovery services administration (HRSA). "Medical care services (MCS)"
means the limited scope of care medical program financed by state funds for clients who meet the incapacity criteria defined in chapter 182-508
WAC or who are eligible for the Alcohol and Drug Addiction Treatment and Support Act (ADATSA) program. "Medical consultant"
means a physician employed or contracted by the agency or the agency's designee. "Medical facility"
means a medical institution or clinic that provides health care services. "Medical institution"
See "institution" in WAC 182-500-0050
. "Medically necessary"
is a term for describing requested service which is reasonably calculated to prevent, diagnose, correct, cure, alleviate or prevent worsening of conditions in the client that endanger life, or cause suffering or pain, or result in an illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction. There is no other equally effective, more conservative or substantially less costly course of treatment available or suitable for the client requesting the service. For the purposes of this section, "course of treatment" may include mere observation or, where appropriate, no medical treatment at all. "Medically needy (MN) or medically needy program (MNP)"
is the state- and federally funded health care program available to specific groups of persons who would be eligible as categorically needy (CN), except their monthly income is above the CN standard. Some long-term care clients with income and/or resources above the CN standard may also qualify for MN. "Medicare"
is the federal government health insurance program for certain aged or disabled persons under Titles II and XVIII of the Social Security Act. Medicare has four parts:
(1) "Part A" -
Covers medicare inpatient hospital services, post-hospital skilled nursing facility care, home health services, and hospice care.
(2) "Part B" -
The supplementary medical insurance benefit (SMIB) that covers medicare doctors' services, outpatient hospital care, outpatient physical therapy and speech pathology services, home health care, and other health services and supplies not covered under Part A of medicare.
(3) "Part C" -
Covers medicare benefits for clients enrolled in a medicare advantage plan.
(4) "Part D" -
The medicare prescription drug insurance benefit. "Medicare assignment"
means the process by which a provider agrees to provide services to a medicare beneficiary and accept medicare's payment for the services. "Medicare cost-sharing"
means out-of-pocket medical expenses related to services provided by medicare. For medical assistance clients who are enrolled in medicare, cost-sharing may include Part A and Part B premiums, co-insurance, deductibles, and copayments for medicare services. See chapter 182-517
WAC for more information.
[Statutory Authority: RCW 41.05.021, 74.09.035, and 2011 1st sp.s. c 36. 12-19-051, § 182-500-0070, filed 9/13/12, effective 10/14/12. 11-14-075, recodified as § 182-500-0070, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 2011 1st sp. sess. c 15. 11-14-053, § 388-500-0070, filed 6/29/11, effective 7/30/11.]