Section 182-533-0386. Infant case management—Payment.

(1) The medicaid agency must pay for the covered infant case management (ICM) services described in WAC 182-533-0380 on a fee-for-service basis subject to the following requirements.

ICM services must be:

(a) Provided to a client who meets the eligibility requirements in WAC 182-533-0370.

(b) Provided by a person who meets the criteria established in WAC 182-533-0375.

(c) Provided according to the agency's current billing instructions.

(d) Documented in the infant's and/or the parent's record or chart.

(e) Billed using:

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

(ii) The appropriate procedure codes and modifiers identified in the agency's current billing instructions; and

(iii) The medicaid agency-assigned MSS/ICM provider number.

(2) The medicaid agency:

(a) Must pay ICM services in units of time, with one unit being equal to fifteen minutes of one-to-one service delivered face-to-face.

(b) When directed by the legislature to achieve targeted expenditure levels for payment of maternity support services for any specific biennium, may determine the maximum number of units allowed per client.

(c) Must publish the maximum number of units allowed per client in the agency's current billing instructions.

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

(4) For a client enrolled in a managed care plan who is eligible to receive ICM, the medicaid agency must pay ICM services delivered outside the plan on a fee-for-service basis as described in this section.

[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0386, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0386, 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 10-12-010, § 388-533-0386, 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, § 388-533-0386, filed 6/10/04, effective 7/11/04.]

RCW 41.05.021. WSR 14-09-061, § 182-533-0386, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0386, 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 10-12-010, § 388-533-0386, 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, § 388-533-0386, filed 6/10/04, effective 7/11/04.

Rules

182-533-0380,182-533-0370,182-533-0375,182-501-0169,