WAC 182-501-0065

Effective July 1, 2011

WAC 182-501-0065 Healthcare coverage -- Description of covered categories of service. (Emergency rule effective 8/17/12.)

This rule provides a brief description of the medical, dental, mental health, and substance abuse service categories listed in the table in WAC 182-501-0060. The description of services under each category is not intended to be all inclusive.

     (1) For categorically needy (CN), medically needy (MN), and medical care services (MCS), refer to the WAC citations listed in the following descriptions for specific details regarding each service category. 

     (2) The following service categories are subject to the exclusions, limitations, restrictions, and eligibility requirements contained in agency rules:

     (a) Adult day health -- A supervised daytime program providing skilled nursing and rehabilitative therapy service in addition to the core services of adult day care.  Adult day health services are for adults with medical or disabling conditions that require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician or ARNP.  (WAC 388-71-0706388-71-0710388-71-0712388-71-0714388-71-0720388-71-0722388-71-0726, and 388-71-0758 )

    (b) Ambulance -- Emergency medical transportation and ambulance transportation for nonemergency medical needs. (WAC 182-546-0001 through 182-546-4000)

     (c) Blood processing/administration -- Blood and/or blood derivatives, including synthetic factors, plasma expanders, and their administration. (WAC 182-550-1400 and 182-550-1500)

     (d) Dental services -- Diagnosis and treatment of dental problems including emergency treatment and preventive care. (Chapters 182-535 and 182-535A WAC)

     (e) Detoxification -- Inpatient treatment performed by a certified detoxification center or in an inpatient hospital setting. (WAC 388-800-0020 through 388-800-0035; and 182-550-1100 )     

     (f) Diagnostic services -- Clinical testing and imaging services. (WAC 182-531-0100182-550-1400 and 182-550-1500

     (g)  Healthcare professional services -- Office visits, emergency oral health, emergency room, nursing facility, home-based, and hospital-based care; surgery, anesthesia, pathology, radiology, and laboratory services; obstetric services; kidney dialysis and renal disease services; osteopathic care, podiatry services, physiatry, and pulmonary/respiratory services; and allergen immunotherapy. (Chapter 182-531 WAC)

     (h) Hearing evaluations -- Audiology; diagnostic evaluations; hearing exams and testing. (WAC 182-531-0100 and 182-531-0375 )

     (i)  Hearing aids -- (chapter 182-547 WAC )

     (j) Home health services -- Intermittent, short-term skilled nursing care, physical therapy, speech therapy, home infusion therapy, and health aide services, provided in the home. (WAC 182-551-2000 through 182-551-2220)

     (k) Hospice services -- Physician services, skilled nursing care, medical social services, counseling services for client and family, drugs, medications (including biologicals), medical equipment and supplies needed for palliative care, home health aide, homemaker, personal care services, medical transportation, respite care, and brief inpatient care. This benefit also includes services rendered in a hospice care center and pediatric palliative care services. (WAC 182-551-1210 through 182-551-1850)
     (l) Hospital services -- Inpatient/outpatient -- Emergency room; hospital room and board (includes nursing care); inpatient services, supplies, equipment, and prescription drugs; surgery, anesthesia; diagnostic testing, laboratory work, blood/blood derivatives; radiation and imaging treatment and diagnostic services; and outpatient or day surgery, and obstetrical services. (Chapter 182-550 WAC)

     (m) Intermediate care facility/services for mentally retarded -- Habilitative training, health-related care, supervision, and residential care. (Chapter 388-835 WAC)

     (n) Maternity care and delivery services -- Community health nurse visits, nutrition visits, behavioral health visits, midwife services, maternity and infant case management services, family planning services and community health worker visits. (WAC 182-533-0300)

     (o) Medical equipment, durable (DME) -- Wheelchairs, hospital beds, respiratory equipment; prosthetic and orthotic devices; casts, splints, crutches, trusses, and braces. (Chapter 182-543 WAC)

     (p) Medical equipment, nondurable (MSE) -- Antiseptics, germicides, bandages, dressings, tape, blood monitoring/testing supplies, braces, belts, supporting devices, decubitus care products, ostomy supplies, pregnancy test kits, syringes, needles, and urological supplies. (Chapter 182-543 WAC)

     (q) Medical nutrition services -- Enteral and parenteral nutrition, including supplies. (Chapters 182-553 and 182-554 WAC)

     (r) Mental health services -- Crisis mental health services are available to state residents through the regional support networks (RSNs). 

(i)  Inpatient care -- Voluntary and involuntary admissions for psychiatric services (WAC 182-550-2600)

(ii)  Outpatient (community mental health) services -- Nonemergency, nonurgent counseling. (WAC 182-531-1400388-865-0215, and 388-865-0230)

(iii)  Psychiatric visits.  (WAC 182-531-1400388-865-0230 )

(iv)  Medication management.  (WAC 182-531-1400

     (s) Nursing facility services -- Nursing, therapies, dietary, and daily care services. (Chapter 388-97 WAC)

     (t) Organ transplants -- Solid organs, e.g., heart, kidney, liver, lung, pancreas, and small bowel; bone marrow and peripheral stem cell; skin grafts; and corneal transplants. (WAC 182-550-1900  and 182-556-0400)

     (u) Out-of-state services -- See WAC 182-502-0120 for payment of services out-of-state.    

     (v) Oxygen/respiratory services -- Oxygen, oxygen equipment and supplies; oxygen and respiratory therapy, equipment, and supplies. (Chapter 182-552 WAC)

     (w) Personal care services -- Assistance with activities of daily living (e.g., bathing, dressing, eating, managing medications) and routine household chores (e.g., meal preparation, housework, essential shopping, transportation to medical services). (WAC 388-106-0010388-106-0200388-106-0300388-106-0400388-106-0500388-106-0700, and 388-106-0745 )

     (x) Prescription drugs -- Outpatient drugs (including in nursing facilities), both generic and brand name; drug devices and supplies; some over-the-counter drugs; oral, topical, injectable drugs; vaccines, immunizations, and biologicals; and family planning drugs, devices, and supplies. (WAC 182-530-2000) Additional coverage for medications and prescriptions is addressed in specific program WAC sections.

     (y) Private duty nursing -- Continuous skilled nursing services provided in the home, including client assessment, administration of treatment, and monitoring of medical equipment and client care for clients seventeen years of age and under. (WAC 182-551-3000.)For benefits for clients eighteen years of age and older, see WAC 388-106-1000 through388-106-1055.

     (z) Prosthetic/orthotic devices -- Artificial limbs and other external body parts; devices that prevent, support, or correct a physical deformity or malfunction. (WAC 182-543-1100)

     (aa) Psychological evaluation -- Complete diagnostic history, examination, and assessment, including the testing of cognitive process, visual motor responses, and abstract abilities. (WAC 388-865-0610)

     (bb)  Reproductive health services -- Gynecological exams; contraceptives, drugs, and supplies, including prescriptions; sterilization; screening and treatment of sexually transmitted diseases; and educational services. (WAC 182-532-530)

     (cc)  Substance abuse services -- Chemical dependency assessment, case management services, and treatment services. (WAC 182-533-0701 through 182-533-0730182-556-0100 and 182-556-0400; and 388-800-0020)

     (dd) Therapy -- Occupational/physical/speech -- Evaluations, assessments, and treatment. (Chapter 182-545 WAC)

     (ee) Vision care -- Eye exams, refractions, fittings, visual field testing, vision therapy, ocular prosthetics, and surgery. (WAC 182-531-1000 )

     (ff)  Vision hardware --  Frames and lenses.  (Chapter 182-544 WAC)

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.