PDFWAC 182-532-550
Family planning only programs—Payment limitations.
(1) The medicaid agency limits payment under the family planning only programs to services that:
(a) Have a primary focus and diagnosis of family planning as determined by a qualified licensed medical practitioner; and
(b) Are medically necessary for the client to safely and effectively use, or continue to use, the client's chosen contraceptive method.
(2) The agency pays:
(a) Providers for covered family planning services using the agency's published fee schedules;
(b) For family planning pharmacy services, family planning laboratory services, and sterilization services using the agency's published fee schedules; and
(c) A dispensing fee only for contraceptive drugs purchased through the 340B program of the Public Health Service Act. (See chapter 182-530 WAC)
(3) The agency does not pay for inpatient services under the family planning only programs, except for complications arising from covered family planning services.
(4) The agency requires providers to:
(a) Meet the timely billing requirements of WAC 182-502-0150; and
(b) Seek timely reimbursement from a third party when a client has available third-party resources, as described under WAC 182-501-0200. Exceptions to this requirement are described under WAC 182-501-0200 (2) and (3) and 182-532-570.
(5) Services provided to family planning clients by federally qualified health centers (FQHCs), rural health centers (RHCs), and Indian health care providers (IHCP) do not qualify for encounter or enhanced rates.
[Statutory Authority: RCW 41.05.021, 41.05.160 and section 1115(a) of the Social Security Act. WSR 19-18-024, § 182-532-550, filed 8/28/19, effective 10/1/19. Statutory Authority: RCW 41.05.021, 74.09.520, 74.09.657, 74.09.659, and 74.09.800. WSR 13-16-008, § 182-532-550, filed 7/25/13, effective 9/1/13. WSR 11-14-075, recodified as § 182-532-550, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520, and 74.09.800. WSR 05-24-032, § 388-532-550, filed 11/30/05, effective 12/31/05; WSR 04-05-011, § 388-532-550, filed 2/6/04, effective 3/8/04.]