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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 182. Health Care Authority |
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Chapter 182-543. Durable medical equipment and related supplies, complex rehabilitation technology, prosthetics, orthotics, medical supplies and related services. |
Section 182-543-7200. Limitation extension (LE).
Latest version.
- (1) The medicaid agency limits the amount, frequency, or duration of certain covered medical supplies and equipment (MSE), durable medical equipment (DME), and related supplies, prosthetics, orthotics, medical supplies, and related services, and reimburses up to the stated limit without requiring prior authorization.(2) Certain covered items have limitations on quantity and frequency. These limits are designed to avoid the need for prior authorization for items normally considered medically necessary and for quantities sufficient for a thirty-day supply for one client.(3) The agency requires a provider to request prior authorization for a limitation extension (LE) in order to exceed the stated limits for nondurable medical equipment and medical supplies. All requests for prior authorization must be accompanied by a completed General Information for Authorization form (HCA 13-835) in addition to any program specific forms as required within this chapter. Agency forms are available online at http://www.hca.wa.gov/medicaid/forms/Pages/index.aspx.(4) The agency evaluates such requests for LE under the provisions of WAC 182-501-0169.[Statutory Authority: RCW 41.05.021 and 2013 c 178. WSR 14-08-035, § 182-543-7200, filed 3/25/14, effective 4/25/14. WSR 11-14-075, recodified as § 182-543-7200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.04.050. WSR 11-14-052, § 388-543-7200, filed 6/29/11, effective 8/1/11.]
Rules
182-501-0169,