Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid
agency does not cover the following home health services under the home health
program:
(a) Chronic long-term care skilled
nursing visits or specialized therapy visits for a medically stable client when
a long-term care skilled nursing plan or specialized therapy plan is in place
through the department of social and health services' aging and long-term
support administration (ALTSA).
(i) Prior to
ALTSA implementing a long-term care skilled nursing plan or specialized therapy
plan, the medicaid agency may consider a short-term authorization of these
services as an exception to rule (ETR); and
(ii) Any services authorized are subject to
the provisions in this section and other applicable WAC.
(b) Social work services that are not
"medical social services" as defined in WAC
182-551-2010 or listed as covered
in WAC 182-551-2115.
(c) Psychiatric skilled nursing
services.
(d) Prenatal and
postpartum skilled nursing services, except as listed under WAC
182-551-2100.
(e) Well-baby follow-up care.
(f) Services performed in hospitals,
correctional facilities, skilled nursing facilities, or a residential facility
with skilled nursing services available.
(g) Health care for a medically stable
client.
(h) Home health specialized
therapies and home health aide visits for AEM clients in the following
programs:
(i) Categorically needy - Emergency
medical only; and
(ii) Medically
needy - Emergency medical only.
(2) The medicaid agency evaluates a request
for home health services that are listed as noncovered:
(a) For a person age 21 and older, under WAC
182-501-0160;
(b) For a person age 20 and younger, under
the early and periodic screening diagnosis and treatment (EPSDT) provisions in
chapter 182-534 WAC; and
(c) For a
person age 19 or older that is under emergency related services only, under WAC
182-507-0120.
11-14-075, recodified as §182-551-2130, filed
6/30/11, effective 7/1/11. Statutory Authority:
RCW
74.08.090, chapter 74.09 RCW, and 2009 c 326.
10-10-087, § 388-551-2130, filed 5/3/10, effective 6/3/10. Statutory
Authority:
RCW
74.04.050,
74.08.090,
74.09.530, and
74.09.700. 06-24-036, §
388-551-2130, filed 11/30/06, effective 1/1/07. Statutory Authority:
RCW
74.08.090,
74.09.520,
74.09.530, and
74.09.500. 02-15-082, §
388-551-2130, filed 7/15/02, effective 8/15/02. Statutory Authority:
RCW
74.08.090 and
74.09.530. 99-16-069, §
388-551-2130, filed 8/2/99, effective
9/2/99.
