Section 182-552-0200 - Respiratory care-Provider requirements(1) To receive payment for respiratory care equipment and supplies under this chapter, a provider must: (a) Meet the general provider requirements in chapter 182-502 WAC;(b) Obtain prior authorization from the medicaid agency, if required, before delivery to the client and before billing the agency;(c) Keep initial and subsequent prescriptions according to the requirements within this chapter;(d) Provide instructions to the client and/or caregiver on the safe and proper use of equipment provided;(e) Have a licensed health care professional whose scope of practice allows for the provision of respiratory care. The licensed health care professional must also: (i) Check equipment and ensure equipment settings continue to meet the client's needs; and(ii) Communicate with the client's authorized prescriber if there are any concerns or recommendations.(f) Verify that the client has a valid prescription. (i) To be valid, a prescription must:(A) Be written, and signed and dated by a physician, advanced registered nurse practitioner (ARNP), or physician's assistant certified (PAC); and(B) State the specific items or services requested, including the quantity, frequency, and duration/length of need. Prescriptions that only state"as needed" or "PRN" are not sufficient; and(C) For an initial prescription, not be older than three months from the date the prescriber signed the prescription; or(D) For subsequent prescriptions, not be older than one year from the date the initial prescription was signed. (See WAC 182-552-0800 for exceptions.)(2) The medicaid agency does not pay for respiratory care equipment and/or supplies furnished to the agency's clients when:(a) The authorized prescriber who provides medical justification to the agency for the item provided to the client is an employee of, has a contract with, or has any financial relationship with the provider of the item; or(b) The authorized prescriber who performs a client evaluation is an employee of, has a contract with, or has any financial relationship with a provider of respiratory care equipment, supplies, and related items.Wash. Admin. Code § 182-552-0200
Amended by WSR 23-14-064, Filed 6/28/2023, effective 8/1/2023Statutory Authority: RCW 41.05.021. 12-14-022, §182-552-0200, filed 6/25/12, effective 8/1/12.