Current through Register Vol. 24-18, September 15, 2024
The medicaid agency pays for the covered maternity support
services (MSS) described in WAC
182-533-0330, subject to the
requirements in this section:
(1) MSS
are:
(a) Provided to a client who meets the
eligibility requirements in WAC
182-533-0320.
(b) Provided to a client during a
face-to-face encounter on an individual basis or in a group setting. If
provided in a group setting, the group must consist of at least three but no
more than twelve clients.
(c)
Provided by a provider that meets the criteria in WAC
182-533-0325. When provided in a
group setting, services may not be provided by a community health
worker.
(d) Provided according to
the agency's maternity support services (MSS)/infant case management (ICM)
provider guide.
(e) Documented in
the client's record or chart.
(f)Billed using:
(i) The eligible client's agency-assigned
client identification number;
(ii)
The appropriate procedure codes, modifiers, and allowed number of units
identified in the agency's MSS/ICM provider guide; and
(iii) The provider's national provider
identifier and MSS/ICM taxonomy.
(2) The agency:
(a) Reimburses providers for MSS-covered
services using the agency's published fee schedule.
(b) Pays MSS-covered services in units of
time with one unit being equal to fifteen minutes of one-to-one service
delivered face-to-face.
(c) Pays
MSS-covered services in units of time with one unit being more than or equal to
sixty minutes for group services delivered face-to-face.
(3) The provider may request authorization
for a limitation extension under WAC
182-501-0169 to exceed the number
of allowed MSS units of service.
11-14-075, recodified as §182-533-0345, 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, § 388-533-0345, filed 5/21/10, effective 6/21/10.
Statutory Authority:
RCW
74.08.090,
74.09.760 through
74.09.910. 04-13-049, §
388-533-0345, filed 6/10/04, effective
7/11/04.
