182-501-0175  <<  182-501-0180 >>   182-501-0182

WAC 182-501-0180

Agency filings affecting this section

Health care services provided outside the state of Washington—General provisions.

WAC 388-501-0180 through 388-501-0184 apply only to services payable on a fee-for-service basis for Washington state medical assistance clients.
(1) Subject to the exceptions and limitations in this section, WAC 388-501-0182 and 388-501-0184, the department covers emergency and nonemergency out-of-state health care services provided to eligible Washington state medical assistance clients when the services are:
(a) Within the scope of the client's health care program as specified under chapter 388-501 WAC;
(b) Allowed to be provided outside the state of Washington by specific program WAC; and
(c) Medically necessary as defined in WAC 388-500-0005.
(2) The department does not cover services provided outside the state of Washington under the Involuntary Treatment Act (chapter 71.05 RCW and chapter 388-865 WAC), including designated bordering cities.
(3) When the department pays for covered health care services furnished to an eligible Washington state medical assistance client outside the state of Washington, its payment is payment in full according to 42 C.F.R. 447.15.
(4) The department determines coverage for transportation services provided out of state, including ambulance services, according to chapter 388-546 WAC.
(5) With the exception of designated bordering cities (see WAC 388-501-0175), if the client travels out of state expressly to obtain health care, the service(s) must be prior authorized by the department. See WAC 388-501-0182 for requirements related to out-of-state nonemergency treatment and WAC 388-501-0165 for the department's medical necessity determination process.
(6) The department does not cover health care services provided outside the United States and U.S. territories, with the exception of British Columbia, Canada. See WAC 388-501-0184 for limitations on coverage of, and payment for, health care provided to medical assistance clients in British Columbia, Canada.
(7) See WAC 388-502-0120 for provider requirements for payment of health care provided outside the state of Washington.
[WSR 11-14-075, recodified as § 182-501-0180, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.04.057 and 74.09.510. WSR 11-14-054, § 388-501-0180, filed 6/29/11, effective 7/30/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 74.09.035. WSR 08-08-064, § 388-501-0180, filed 3/31/08, effective 5/1/08. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 06-24-036, § 388-501-0180, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.08.090 and 74.09.035. WSR 01-01-011, § 388-501-0180, filed 12/6/00, effective 1/6/01. Statutory Authority: RCW 74.08.090. WSR 94-10-065 (Order 3732), § 388-501-0180, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-82-135 and 388-92-015.]