Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid agency pays qualified
providers for medical equipment and repairs on a fee-for-service basis as
follows:
(a) Providers who are enrolled with
medicare for medical equipment and related repair services;
(b) Qualified complex rehabilitation
technology (CRT) suppliers who are enrolled with medicare;
(c) Medical equipment dealers and pharmacies
who are enrolled with medicare, and have a national provider identifier (NPI)
for medical supplies;
(d)
Prosthetics and orthotics providers who are licensed by the Washington state
department of health in prosthetics and orthotics. Medical equipment dealers
and pharmacies that do not require state licensure to provide selected
prosthetics and orthotics may be paid for those selected prosthetics and
orthotics only as long as the medical equipment dealers and pharmacies meet the
medicare enrollment requirement;
(e) Occupational therapists providing
orthotics who are licensed by the Washington state department of health in
occupational therapy;
(f)
Physicians who provide medical equipment in the office; and
(g) Out-of-state prosthetics and orthotics
providers who meet their state regulations.
(2) Providers and suppliers of medical
equipment must:
(a) Meet the general provider
requirements in chapter 182-502 WAC;
(b) Have the proper business license and be
certified, licensed and bonded if required, to perform the services billed to
the agency;
(c) Have a valid
prescription for the medical equipment.
(i)
To be valid, a prescription must:
(A) Be
written on the agency's Prescription Form (HCA 13-794). The agency's electronic
forms are available online at
https://www.hca.wa.gov/billers-providers/forms-and-publications;
(B) Be written by an authorized practitioner
as defined in WAC
182-551-2010 and meet
the face-to-face encounter requirements described in WAC
182-551-2040;
(C) Be written, signed (including the
prescriber's credentials), and dated by the prescriber on the same day and
before delivery of the medical equipment. Prescriptions must not be
back-dated;
(D) Be no older than
one year from the date the pre-scriber signs the prescription; and
(E) State the specific item or service
requested, diagnosis, estimated length of need (weeks, months, or years), and
quantity.
(ii) For
dual-eligible clients when medicare is the primary payer and the agency is
being billed for only the copay, only the deductible, or both, subsection
(2)(a) of this section does not apply.
(d) Provide instructions for use of
equipment;
(e) Provide only new
equipment to clients, which include full manufacturer and dealer warranties.
See WAC
182-543-2250(3);
(f) Provide documentation of proof of
delivery, upon agency request (see WAC
182-543-2200);
and
(g) Bill the agency using only
the allowed procedure codes listed in the agency's published medical equipment
billing guide.
Statutory Authority:
RCW
41.05.021 and Affordable Care Act (ACA) - 76
Fed. Reg. 5862, 42 C.F.R. Parts 405, 424, 447, 455, 457, and 498. 12-15-015,
§182-543-2000, filed 7/10/12, effective 9/1/12. 11-14-075, recodified as
§182-543-2000, filed 6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090 and
74.04.050. 11-14-052, §
388-543-2000, filed 6/29/11, effective 8/1/11; 07-17-062, § 388-543-2000,
filed 8/13/07, effective 9/13/07. Statutory Authority:
RCW
74.08.090,
74.09.530. 01-01-078, §
388-543-2000, filed 12/13/00, effective
1/13/01.
