Section 182-551-1860. Concurrent care for hospice clients twenty years of age and younger.

(1) In accordance with Section 2302 of the Patient Protection and Affordable Care Act of 2010 and Section 1814(a)(7) of the Social Security Act, hospice palliative services are available to clients twenty years of age and younger without forgoing curative services which the client is entitled to under Title XIX Medicaid and Title XXI Children's Health Insurance Program (CHIP) for treatment of the terminal condition.

(2) Unless otherwise specified within this section, curative treatment including related services and medications requested for clients twenty years of age and younger are subject to the medicaid agency's specific program rules governing those services or medications.

(3) The following services aimed at achieving a disease-free state are included under the curative care benefit:

(a) Radiation;

(b) Chemotherapy;

(c) Diagnostics, including laboratory and imaging;

(d) Licensed health care professional services;

(e) Inpatient and outpatient hospital care;

(f) Surgery;

(g) Medication;

(h) Equipment and related supplies; and

(i) Ancillary services, such as medical transportation.

(4) The following are not included under the curative care benefit:

(a) Hospice covered services as described in WAC 182-551-1210;

(b) Services related to symptom management such as:

(I) Radiation;

(II) Chemotherapy;

(III) Surgery;

(IV) Medication; and

(V) Equipment and related supplies; and

(c) Ancillary services, such as medical transportation.

(5) Health care professionals must request prior authorization from the agency in accordance with WAC 182-501-0163 for enrollment in a concurrent care plan. Prior authorization requests are subject to medical necessity review under WAC 182-501-0165.

(6) If the curative treatment includes noncovered services in accordance with WAC 182-501-0070, the provider must request an exception to rule in accordance with WAC 182-501-0160.

(7) If the medicaid agency denies a request for a covered service, refer to WAC 182-502-0160, Billing a client, for when a client may be responsible to pay for a covered service.

[Statutory Authority: RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. WSR 12-09-079, § 182-551-1860, filed 4/17/12, effective 5/18/12.]

RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. WSR 12-09-079, § 182-551-1860, filed 4/17/12, effective 5/18/12.

Rules

182-551-1210,182-501-0163,182-501-0165,182-501-0070,182-501-0160,182-502-0160,