Section 182-543-2000 - Eligible providers and provider requirements(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:(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.Wash. Admin. Code § 182-543-2000
Amended by WSR 14-08-035, filed 3/25/14, effective 4/25/2014Amended by WSR 17-15-073, Filed 7/14/2017, effective 8/14/2017Amended by WSR 18-24-021, Filed 11/27/2018, effective 1/1/2019Amended by WSR 21-23-044, Filed 11/9/2021, effective 12/10/2021Statutory 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.