Section 182-533-0345. Maternity support services—Payment.

The medicaid agency pays for the covered maternity support services (MSS) described in WAC 182-533-0330, subject to the requirements in this section:

(1) MSS are:

(a) Provided to a client who meets the eligibility requirements in WAC 182-533-0320.

(b) Provided to a client during a face-to-face encounter on an individual basis or in a group setting. If provided in a group setting, the group must consist of at least three but no more than twelve clients.

(c) Provided by a provider that meets the criteria in WAC 182-533-0325. When provided in a group setting, services may not be provided by a community health worker.

(d) Provided according to the agency's maternity support services (MSS)/infant case management (ICM) provider guide.

(e) Documented in the client's record or chart.

(f) Billed using:

(i) The eligible client's agency-assigned client identification number;

(ii) The appropriate procedure codes, modifiers, and allowed number of units identified in the agency's MSS/ICM provider guide; and

(iii) The provider's national provider identifier and MSS/ICM taxonomy.

(2) The agency:

(a) Reimburses providers for MSS-covered services using the agency's published fee schedule.

(b) Pays MSS-covered services in units of time with one unit being equal to fifteen minutes of one-to-one service delivered face-to-face.

(c) Pays MSS-covered services in units of time with one unit being more than or equal to sixty minutes for group services delivered face-to-face.

(3) The provider may request authorization for a limitation extension under WAC 182-501-0169 to exceed the number of allowed MSS units of service.

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-12-075, § 182-533-0345, filed 5/29/15, effective 7/1/15. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0345, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0345, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0345, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0345, filed 6/10/04, effective 7/11/04.]

RCW 41.05.021 and 41.05.160. WSR 15-12-075, § 182-533-0345, filed 5/29/15, effective 7/1/15. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0345, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0345, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0345, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0345, filed 6/10/04, effective 7/11/04.

Rules

182-533-0330,182-533-0320,182-533-0325,182-501-0169,