WSR 17-12-082 PERMANENT RULES HEALTH CARE AUTHORITY
(Washington Apple Health)
[Filed June 5, 2017, 10:06 a.m., effective July 6, 2017] Effective Date of Rule: Thirty-one days after filing.
Purpose: The agency amended this rule to align the language with the federal rules in 42 U.S.C. 1396d (o)(1)(C) for hospice concurrent care. The amended language states that a client age twenty and younger may voluntarily elect hospice care without waiving any rights to services that the client is entitled to under Title XIX medicaid and Title XXI children's health insurance program (CHIP) that are related to the treatment of the client's condition for which a diagnosis of terminal illness has been made. The agency also removed the prior authorization requirement for enrollment in a concurrent care plan.
Citation of Existing Rules Affected by this Order: Amending WAC 182-551-1860.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160, Section 2302 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. 1396d (o)(1)(C).
Adopted under notice filed as WSR 17-08-031 on March 28, 2017.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: June 5, 2017.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 12-09-079, filed 4/17/12, effective 5/18/12)
WAC 182-551-1860 Concurrent care for hospice clients age twenty ((years of age)) and younger.
(1) In accordance with ((Section 2302 of the Patient Protection and Affordable Care Act of 2010 and Section 1814(a)(7) of the Social Security Act, hospice palliative services are available to)) 42 U.S.C. 1396d (o)(1)(C), a client((s)) age twenty ((years of age)) and younger ((without forgoing curative services which)) may voluntarily elect hospice care without waiving any rights to services that the client is entitled to under Title XIX Medicaid and Title XXI Children's Health Insurance Program (CHIP) ((for treatment of the terminal condition)) that are related to the treatment of the client's condition for which a diagnosis of terminal illness has been made.
(2) ((Unless otherwise specified within this section, curative treatment including)) The related services in subsection (1) of this section and medications requested for clients age twenty ((years of age)) and younger are subject to the medicaid agency's specific program rules governing those services or medications.
(3) ((The following services aimed at achieving a disease-free state are included under the curative care benefit:
(a) Radiation;
(b) Chemotherapy;
(c) Diagnostics, including laboratory and imaging;
(d) Licensed health care professional services;
(e) Inpatient and outpatient hospital care;
(f) Surgery;
(g) Medication;
(h) Equipment and related supplies; and
(i) Ancillary services, such as medical transportation.
(4) The following are not included under the curative care benefit:
(a) Hospice covered services as described in WAC 182-551-1210;
(b) Services related to symptom management such as:
(I) Radiation;
(II) Chemotherapy;
(III) Surgery;
(IV) Medication; and
(V) Equipment and related supplies; and
(c) Ancillary services, such as medical transportation.
(5) Health care professionals must request prior authorization from the agency in accordance with WAC 182-501-0163 for enrollment in a concurrent care plan. Prior authorization requests are subject to medical necessity review under WAC 182-501-0165.
(6))) If the ((curative treatment)) services in this section include((s)) noncovered services ((in accordance with)) listed in WAC 182-501-0070, the provider must request an exception to rule ((in accordance with)) under WAC 182-501-0160.
(((7))) (4) If the medicaid agency denies a request for a covered service, refer to WAC 182-502-0160, billing a client, for when a client may be responsible to pay for a covered service.
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