PDFWAC 182-551-2030
Skilled services—Requirements.
(1) The medicaid agency covers home health skilled services provided to eligible clients, subject to the provisions in this section and other applicable published WAC.
(2) Home health skilled services provided to eligible clients must:
(a) Meet the definition of "acute care" in WAC 182-551-2010;
(b) Provide for the treatment of an illness, injury, or disability;
(c) Be medically necessary as defined in WAC 182-500-0070 and the process outlined in WAC 182-501-0165;
(d) Be reasonable, based on the community standard of care, in amount, duration, and frequency;
(e) Meet face-to-face requirements described in WAC 182-551-2040;
(f) Be provided under a plan of care (POC), as defined in WAC 182-551-2010 and described in WAC 182-551-2210. Any statement in the POC must be supported by documentation in the client's medical records;
(g) Be used to prevent placement in a more restrictive setting;
(h) Be provided in any setting where normal life activities take place; and
(i) The client's medical records must justify the medical reason or reasons that the services should be provided where the client's normal life activities take place instead of at an ordering physician's office, clinic, or other outpatient setting.
(3) Clients in residential facilities contracted with the state and paid by other programs, such as home and community programs to provide skilled nursing services, are eligible for skilled nursing services
only on a short-term, temporary basis while authorization of these services is pending with the other state programs. Prior authorization is required.
[Statutory Authority: RCW 41.05.021, 41.05.160, and P.L. 114-255. WSR 23-24-026, § 182-551-2030, filed 11/29/23, effective 1/1/24. Statutory Authority: RCW 41.05.021, 41.05.160 and 42 C.F.R. Section 440.70. WSR 18-24-023, § 182-551-2030, filed 11/27/18, effective 1/1/19. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-03-035, § 182-551-2030, filed 1/12/16, effective 2/12/16. WSR 11-14-075, recodified as § 182-551-2030, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, chapter 74.09 RCW, and 2009 c 326. WSR 10-10-087, § 388-551-2030, filed 5/3/10, effective 6/3/10. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.530, and 74.09.500. WSR 02-15-082, § 388-551-2030, filed 7/15/02, effective 8/15/02.]