Wash. Admin. Code § 182-550-2551

Current through Register Vol. 24-23, December 1, 2024

Section 182-550-2551 - When the medicaid agency authorizes acute PM&R services

(1) Acute PM&R services may be authorized when all of the following are met:

(a) The client has all of the following:

(i) Extensive or complex medical needs;

(ii) Nursing needs; and

(iii) Therapy needs.

(b) The client has a new or recent significant impairment in two or more of the following areas:

(i) Mobility and strength;

(ii) Self-care/ADLs (activities of daily living);

(iii) Communication; or

(iv) Cognitive/perceptual functioning.

(c) The client has a new or recent onset of one of the following conditions:

(i) Brain injury caused by trauma or disease.

(ii) Spinal cord injury resulting in:

(A) Quadriplegia; or

(B) Paraplegia.

(iii) Extensive burns.

(iv) Bilateral limb loss.

(v) Stroke or aneurysm with resulting hemiplegia or cognitive deficits, including speech and swallowing deficits.

(vi) Multiple trauma (after the client is cleared to bear weight) with complicated orthopedic conditions and neurological deficits.

(vii) Skin flap surgery after severe pressure ulcer for a client who:

(A) Requires close observation by a surgeon; and

(B) Is ready to mobilize or be upright in a chair.

(viii) Acute inflammatory demyelinating polyneuropathy (AIDP).

(2) If the client does not meet the clinical criteria set forth in this section, the agency will evaluate the request for medical necessity according to the process in WAC 182-501-0165.

Citation of Existing Rules Affected by this Order:

WAC Numbers and descriptions	Proposed change	Reason for change
1.	WAC 296-17A-5301 (subclassification 5301-21, Word processing or secretarial services)	Include tutoring services in scopes of subclassification 5301-21.	* Tutoring services are not currently anywhere in WAC, and classifying them has not been consistent. * Classification 5301 appropriately represents the overall relative low hazard of tutoring services. * Classification 5301 allows for exposure to a business's operative hazards, and is administratively simple, since it doesn't require employers to track hours.
2.	WAC 296-17A-6108 (nursing homes)	Limit classification 6108 to facilities licensed as nursing homes and/or skilled nursing centers by DSHS.	* To provide for more consistency and equity when classifying care facilities.
3.	WAC 296-17A-6205 (clubs)	Reclassify fraternities and sororities from classification 6509 to classification 6205.	* Fraternities and sororities do not provide the personal and medical services common to other type residences found in classification 6509. * This is similar to the National Council on Compensation Insurance (NCCI) practices in other states. NCCI includes fraternities and sororities with the clubs, not otherwise classified, code. * Fraternities and sororities appear to have a lower level of hazard than the rest of classification 6509.
4.	WAC 296-17A-6509 (adult family homes, Alzheimer units, and other care facilities)	Assign classification 6509 to residences licensed by DSHS as providing care other than as hospitals, nursing homes, or skilled nursing centers.	* To provide for more consistency and equity when classifying care facilities.

Wash. Admin. Code § 182-550-2551

Amended by WSR 17-10-058, Filed 5/2/2017, effective 6/2/2017

11-14-075, recodified as §182-550-2551, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520 and 42 C.F.R. 482.56. 03-06-047, § 388-550-2551, filed 2/28/03, effective 3/31/03. Statutory Authority: RCW 74.08.090 and 74.09.520. 99-17-111, § 388-550-2551, filed 8/18/99, effective 9/18/99.