Current through Register Vol. 24-18, September 15, 2024
Maternity support service providers may include community
clinics, federally qualified health centers, local health departments,
hospitals, nonprofit organizations, and private clinics.
(1) To be paid for providing maternity
support services (MSS) and infant case management (ICM) services to eligible
clients, a provider must:
(a) Be enrolled as
an eligible provider with the medicaid agency (see WAC
182-502-0010) .
(b) Be currently approved as an MSS/ICM
provider by the medicaid agency.
(c) Meet the requirements in this chapter,
chapter 182-502 WAC and the medicaid agency's current billing
instructions.
(d) Ensure that
professional staff providing services:
(i)
Meet the minimum regulatory and educational qualifications for the scope of
services provided under WAC
182-533-0327; and
(ii) Follow the requirements in this chapter
and the medicaid agency's current billing instructions.
(e) Screen each client for risk factors using
the agency's designated MSS screening tool, located on the agency's web site
under forms. Agency approval is required for a provider to use an alternate MSS
screening tool.
(f) Screen clients
for ICM eligibility.
(g) Conduct
case conferences under WAC
182-533-0327(2).
(h) Develop and implement an individualized
care plan for each client.
(i)
Initiate and participate in care coordination activities throughout the
maternity cycle with at least MSS interdisciplinary team members, the client's
prenatal care provider, and the Women, Infants, and Children (WIC) Nutrition
Program.
(j) Comply with Section
1902(a)(23) of the Social Security Act regarding the client's freedom to choose
a provider.
(k) Comply with Section
1915(g)(1) of the Social Security Act regarding the client's voluntary receipt
of services.
(2) MSS
providers may provide services in any of the following locations:
(a) A provider's office or clinic.
(b) The client's residence.
(c) An alternate site that is not the
client's residence. (The reason for using an alternate site for visitation
instead of the home must be documented in the client's record.)
(3) An individual or service
organization that has a written contractual agreement with a qualified MSS
provider also may provide MSS and ICM services to eligible clients. The
provider must:
(a) Keep a copy of the written
subcontractor agreement on file;
(b) Ensure that an individual or service
organization staff member providing MSS/ICM services (the subcontractor) meets
the minimum regulatory and educational qualifications required of an MSS/ICM
provider;
(c) Ensure that the
subcontractor provides MSS/ICM services under the requirements of this chapter;
(d) Maintain professional,
financial, and administrative responsibility for the subcontractor;
(e) Bill for services using the provider's
national provider identifier and MSS/ICM taxonomy; and
(f) Reimburse the subcontractor for MSS/ICM
services provided under the written agreement.
(4) Providers must obtain agency approval of
all MSS/ICM outreach-related materials, including web sites and publications,
prior to making those materials available to clients.
Statutory Authority:
RCW
41.05.021 and 2011 c 5. 12-01-097,
§182-533-0325, filed 12/20/11, effective 1/20/12. 11-14-075, recodified as
§182-533-0325, filed 6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.09.760 through
74.09.910, and 2009 c 564 §
1109. 10-12-011, § 388-533-0325, filed 5/21/10, effective 6/21/10.
Statutory Authority:
RCW
74.08.090,
74.09.760 through
74.09.910. 04-13-049, §
388-533-0325, filed 6/10/04, effective
7/11/04.
