Section 182-532-530. Family planning only program—Covered yearly exams.

(1) The medicaid agency covers one of the following services per client per year, as medically necessary:

(a) A cervical, vaginal, and breast cancer screening exam; or

(b) A comprehensive prevention visit for family planning. (Under a delayed pelvic protocol, the comprehensive prevention visit for family planning may be split into two visits, per client, per year.)

(2) The cervical, vaginal, and breast cancer screening exam:

(a) Must be:

(i) Provided following the guidelines of a nationally recognized protocol; and

(ii) Conducted at the time of an office visit with a primary focus and diagnosis of family planning.

(b) May be billed by a provider other than a TAKE CHARGE provider.

(3) The comprehensive prevention visit for family planning:

(a) Must be provided by one or more qualified TAKE CHARGE trained providers. (See WAC 182-532-730.)

(b) Must include:

(i) A clinical breast examination and pelvic examination that follows the guidelines of a nationally recognized protocol; and

(ii) Client-centered counseling that incorporates risk factor reduction for unintended pregnancy and anticipatory guidance about the advantages and disadvantages of all contraceptive methods.

(c) May include:

(i) A pap smear according to current, nationally recognized clinical guidelines; and

(ii) For women ages thirteen through twenty-five, routine gonorrhea and chlamydia testing and treatment.

(d) Must be documented in the client's chart with detailed information that allows for a well-informed follow-up visit.

(e) Must be billed by a TAKE CHARGE provider only.

[Statutory Authority: RCW 41.05.021, 74.09.520, 74.09.657, 74.09.659, and 74.09.800. WSR 13-16-008, § 182-532-530, filed 7/25/13, effective 9/1/13. WSR 11-14-075, recodified as § 182-532-530, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.800. WSR 08-11-031, § 388-532-530, filed 5/13/08, effective 6/13/08. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. WSR 05-24-032, § 388-532-530, filed 11/30/05, effective 12/31/05; WSR 04-05-011, § 388-532-530, filed 2/6/04, effective 3/8/04.]

RCW 41.05.021, 74.09.520, 74.09.657, 74.09.659, and 74.09.800. WSR 13-16-008, § 182-532-530, filed 7/25/13, effective 9/1/13. WSR 11-14-075, recodified as § 182-532-530, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.800. WSR 08-11-031, § 388-532-530, filed 5/13/08, effective 6/13/08. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. WSR 05-24-032, § 388-532-530, filed 11/30/05, effective 12/31/05; WSR 04-05-011, § 388-532-530, filed 2/6/04, effective 3/8/04.

Rules

182-532-730,