Section 182-552-0001. Respiratory care—General.

(1) The respiratory care described in this chapter is considered part of the agency's durable medical equipment (DME) benefit. This chapter applies to:

(a) Medicaid clients who require respiratory care in their homes, community residential settings, and skilled nursing facilities;

(b) Providers who supply respiratory care to medicaid clients; and

(c) Licensed health care professionals whose scope of practice allows for the provision of respiratory care.

(2) The medicaid agency covers the respiratory care listed in this chapter according to the limitations and requirements in this chapter.

(3) The medicaid agency pays for respiratory care for medicaid clients when it is:

(a) Covered;

(b) Within the scope of the eligible client's medical care program;

(c) Medically necessary, as defined under chapter 182-500 WAC;

(d) Prescribed by a physician, advanced registered nurse practitioner (ARNP), or physician assistant certified (PAC) within the scope of his or her licensure;

(e) Authorized, as required within this chapter, chapters 182-501 and 182-502 WAC, and the agency's published medicaid provider guides and provider notices;

(f) Billed according to this chapter, chapters 182-501 and 182-502 WAC, and the agency's published medicaid provider guides and provider notices; and

(g) Provided and used within accepted medical or respiratory care community standards of practice.

(4) The agency does not require prior authorization for requests for covered respiratory care for medicaid clients that meets the clinical criteria set forth in this chapter.

(5) The agency requires prior authorization for covered respiratory care for medicaid clients when the clinical criteria set forth in this chapter are not met, including the criteria associated with the expedited prior authorization process.

(a) The medicaid agency evaluates requests requiring prior authorization on a case-by-case basis to determine whether they are medically necessary, according to the process found in WAC 182-501-0165.

(b) Refer to WAC 182-552-1300, 182-552-1325, 182-552-1350, and 182-552-1375 for specific details regarding authorization.

[Statutory Authority: RCW 41.05.021. WSR 12-14-022, § 182-552-0001, filed 6/25/12, effective 8/1/12.]

RCW 41.05.021. WSR 12-14-022, § 182-552-0001, filed 6/25/12, effective 8/1/12.

Rules

182-500,182-501,182-502,182-501,182-502,