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Family planning only program—Covered yearly exams.
(1) The medicaid agency covers one of the following services per client per year, as medically necessary:
(a) A cervical, vaginal, and breast cancer screening exam; or
(b) A comprehensive prevention visit for family planning. (Under a delayed pelvic protocol, the comprehensive prevention visit for family planning may be split into two visits, per client, per year.)
(2) The cervical, vaginal, and breast cancer screening exam:
(a) Must be:
(i) Provided following the guidelines of a nationally recognized protocol; and
(ii) Conducted at the time of an office visit with a primary focus and diagnosis of family planning.
(b) May be billed by a provider other than a TAKE CHARGE provider.
(3) The comprehensive prevention visit for family planning:
(a) Must be provided by one or more qualified TAKE CHARGE trained providers. (See WAC 182-532-730.)
(b) Must include:
(i) A clinical breast examination and pelvic examination that follows the guidelines of a nationally recognized protocol; and
(ii) Client-centered counseling that incorporates risk factor reduction for unintended pregnancy and anticipatory guidance about the advantages and disadvantages of all contraceptive methods.
(c) May include:
(i) A pap smear according to current, nationally recognized clinical guidelines; and
(ii) For women ages thirteen through twenty-five, routine gonorrhea and chlamydia testing and treatment.
(d) Must be documented in the client's chart with detailed information that allows for a well-informed follow-up visit.
(e) Must be billed by a TAKE CHARGE provider only.
[Statutory Authority: RCW 41.05.021
, and 74.09.800
. WSR 13-16-008, § 182-532-530, filed 7/25/13, effective 9/1/13. WSR 11-14-075, recodified as § 182-532-530, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
. WSR 08-11-031, § 388-532-530, filed 5/13/08, effective 6/13/08. Statutory Authority: RCW 74.08.090
, and 74.09.800
. WSR 05-24-032, § 388-532-530, filed 11/30/05, effective 12/31/05; WSR 04-05-011, § 388-532-530, filed 2/6/04, effective 3/8/04.]