Section 182-551-2130 - Noncovered services(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.Wash. Admin. Code § 182-551-2130
Amended by WSR 16-03-035, Filed 1/12/2016, effective 2/12/2016Amended by WSR 18-24-023, Filed 11/27/2018, effective 1/1/2019Amended by WSR 22-05-048, Filed 2/9/2022, effective 3/12/2022Amended by WSR 23-24-026, Filed 11/29/2023, effective 1/1/202411-14-075, 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.