(1) To receive maternity support services (MSS), a client must:
(a) Be covered under one of the following medical assistance programs:
(i) Categorically needy (CN);
(ii) Children's health care as described in WAC
388-505-0210;
(iii) Medically needy program (MNP); or
(iv) A pregnancy medical program as described in WAC
388-462-0015.
(b) Be within the eligibility period of a maternity cycle as defined in WAC
182-533-0315; and
(c) Meet any other eligibility criteria as determined by the agency and published in the agency's current billing instructions and/or numbered memoranda.
(2) Clients who meet the eligibility criteria in this section may receive:
(a) An in-person screening by a provider who meets the criteria established in WAC
182-533-0325. Clients are screened for risk factors related to issues that may impact their birth outcomes.
(b) Up to the maximum number of MSS units of service allowed per client as determined by the agency and published in the agency's current billing instructions and/or numbered memoranda. The agency may determine the maximum number of units allowed per client when directed by the legislature to achieve targeted expenditure levels for payment of maternity support services for any specific biennium.
(3) Clients meeting the eligibility criteria in this section who are enrolled in an agency-contracted managed care organization (MCO), are eligible for MSS outside their plan.
(4) See chapter
182-534 WAC for clients eligible for coverage under the early periodic screening, diagnosis and treatment (EPSDT) program.
(5) Clients receiving MSS before March 1, 2011, are subject to the transition plan as determined and published by the agency in numbered memoranda.
(6) Clients who do not agree with an agency decision regarding eligibility for MSS have a right to a fair hearing under chapter
388-02 WAC.
[Statutory Authority: RCW 41.05.021 and 2011 c 5. 12-01-097, § 182-533-0320, filed 12/20/11, effective 1/20/12. 11-14-075, recodified as § 182-533-0320, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through74.09.910 , and 2009 c 564 § 1109. 10-12-011, § 388-533-0320, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. 04-13-049, § 388-533-0320, filed 6/10/04, effective 7/11/04.]