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Chapter 182-533 WAC

Last Update: 10/12/23

MATERNITY-RELATED SERVICES

WAC Sections

FIRST STEPS SERVICES FOR WOMEN AND INFANTS
HTMLPDF182-533-0300Services under First Steps.
HTMLPDF182-533-0310Maternity support services—Purpose.
HTMLPDF182-533-0315Maternity support services—Definitions.
HTMLPDF182-533-0320Maternity support services—Client eligibility.
HTMLPDF182-533-0325Maternity support services—Provider requirements.
HTMLPDF182-533-0327Maternity support services—Professional staff qualifications and interdisciplinary team.
HTMLPDF182-533-0328Maternity support services—Documentation requirements.
HTMLPDF182-533-0330Maternity support services—Covered services.
HTMLPDF182-533-0340Maternity support services—Noncovered services.
HTMLPDF182-533-0345Maternity support services—Payment.
HTMLPDF182-533-0360Infant case management—Purpose.
HTMLPDF182-533-0365Infant case management—Definitions.
HTMLPDF182-533-0370Infant case management—Client eligibility.
HTMLPDF182-533-0375Infant case management—Provider requirements.
HTMLPDF182-533-0378Infant case management—Documentation requirements.
HTMLPDF182-533-0380Infant case management—Covered services.
HTMLPDF182-533-0385Infant case management—Noncovered services.
HTMLPDF182-533-0386Infant case management—Payment.
HTMLPDF182-533-0390Childbirth education (CBE) classes.
OTHER MATERNITY AND INFANT SERVICES
HTMLPDF182-533-0400Maternity care and newborn delivery.
HTMLPDF182-533-0600Planned home births and births in birthing centers.
SUBSTANCE-USING PREGNANT PEOPLE (SUPP) SERVICES
HTMLPDF182-533-0701Substance-using pregnant people (SUPP) program—Purpose.
HTMLPDF182-533-0710Substance-using pregnant people (SUPP) program—Client eligibility.
HTMLPDF182-533-0720Substance-using pregnant people (SUPP) program—Provider requirements.
HTMLPDF182-533-0730Substance-using pregnant people (SUPP) program—Covered services.

PDF182-533-0300

Services under First Steps.

(1) Under the 1989 Maternity Care Access Act, and RCW 74.09.760 through 74.09.910, the agency established First Steps to provide access to services for eligible women and their infants.
(2) The rules for the:
(a) Maternity support services (MSS) component of First Steps are found in WAC 182-533-0310 through 182-533-0345.
(b) Infant case management (ICM) component of First Steps are found in WAC 182-533-0360 through 182-533-0386.
(c) Childbirth education (CBE) component of First Steps are found in WAC 182-533-0390.
(3) Other services under First Steps include:
(a) Medical services, including full medical coverage, prenatal care, delivery, post-pregnancy follow-up, and twelve months family planning services post-pregnancy;
(b) Ancillary services, including but not limited to, expedited medical eligibility determination; and
(c) Alcohol and drug assessment and treatment services for pregnant women available statewide and administered by the division of behavioral health and recovery (see WAC 182-533-0701).
[Statutory Authority: RCW 41.05.021 and 2011 c 5. WSR 12-01-097, § 182-533-0300, filed 12/20/11, effective 1/20/12. WSR 11-14-075, recodified as § 182-533-0300, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0300, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0300, filed 6/10/04, effective 7/11/04. Statutory Authority: RCW 74.08.090, 74.09.770, and 74.09.800. WSR 00-14-068, § 388-533-0300, filed 7/5/00, effective 8/5/00.]


PDF182-533-0310

Maternity support services—Purpose.

The purpose of maternity support services (MSS) is to:
(1) Improve and promote healthy birth outcomes. Services are delivered by an MSS interdisciplinary team to eligible pregnant and post-pregnant women and their infants.
(2) Help eligible clients to access:
(a) Prenatal care as early in the pregnancy as possible; and
(b) Health care for their infants.
[WSR 11-14-075, recodified as § 182-533-0310, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0310, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0310, filed 6/10/04, effective 7/11/04.]


PDF182-533-0315

Maternity support services—Definitions.

The following definitions and those found in WAC 182-500-0005 apply to maternity support services (MSS) and infant case management (ICM) (see WAC 182-533-0360 through 182-533-0386 for ICM rules).
"Basic health messages" - For MSS, the preventive health education messages designed to promote healthy pregnancies, healthy newborns and healthy parenting during the first year of life.
"Care coordination" - Professional collaboration and communication between the client's MSS provider and other medical and/or health and social services providers to address the individual client's needs as identified in the care plan.
"Care plan" - A written statement developed for a person that continues throughout the eligibility period and outlines any medical, social, environmental or other interventions to achieve an improved quality of life, including health and social outcomes.
"Case conference" - A formal or informal consultation used by the MSS interdisciplinary team to consult with each other and, when needed, other pertinent providers and/or the client to optimize the client's care.
"Case management" - Services to help individuals access needed medical, social, educational, and other services.
"Childbirth education (CBE)" - A component of the First Steps program to provide educational sessions offered in a group setting that prepares a pregnant woman and her support person(s) for an upcoming childbirth and healthy parenting.
"Department of health (DOH)" - The state agency that works to protect and improve the health of people in Washington state.
"First Steps" - The program created under the 1989 Maternity Care Access Act.
"Infant case management (ICM)" - A component of the First Steps program to provide parent(s) with information and assistance in accessing needed medical, social, educational, and other services that improve the welfare of infants.
"Infant case management (ICM) screening" - A brief in-person evaluation provided by a qualified person, under WAC 182-533-0375, to determine whether an infant and the infant's parent(s) have a specific risk factor(s).
"Linking" - Assistance to clients for identifying and using community resources to address specific medical, social and educational needs.
"Maternity cycle" - An eligibility period for maternity support services that begins during pregnancy and continues to the end of the month in which the sixtieth-day post-pregnancy occurs.
"Maternity support services (MSS)" - A component of the First Steps program to provide screening, assessment, basic health messages, education, counseling, case management, care coordination, and other interventions delivered by an MSS interdisciplinary team during the maternity cycle.
"Maternity support services (MSS) interdisciplinary team" - A provider's group of qualified staff consisting of at least a community health nurse, a certified registered dietitian, a behavioral health specialist, and, at the discretion of the provider, a community health worker. Based upon individual client need, each team member provides maternity support services and consultation. (See WAC 182-533-0327(3).)
"Medicaid agency" - The health care authority.
"Parent(s)" - A person who resides with an infant, provides the infant's day-to-day care, and meets the legal description under WAC 182-533-0370 (1)(c).
"Risk factors" - The biopsychosocial factors that could lead to poor birth outcomes, infant morbidity, and/or infant mortality.
"Screening" - A method for systematically identifying and documenting risk factors and client need.
"Washington apple health (WAH)" - The public health insurance programs for eligible Washington residents. Washington apple health is the name used in Washington state for medicaid, the children's health insurance program (CHIP), and state-only funded health care programs. (See WAC 182-500-0120.)
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0315, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0315, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0315, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0315, filed 6/10/04, effective 7/11/04.]


PDF182-533-0320

Maternity support services—Client eligibility.

(1) To receive maternity support services (MSS), a client must:
(a) Be covered under the alternative benefit plan, categorically needy, medically needy, or state-funded medical programs under Washington apple health; and
(b) Be within the eligibility period of a maternity cycle as defined in WAC 182-533-0315.
(2) Clients who do not agree with an eligibility decision for MSS have a right to a fair hearing under chapter 182-526 WAC.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-12-060, § 182-533-0320, filed 5/26/16, effective 6/26/16; WSR 15-12-075, § 182-533-0320, filed 5/29/15, effective 7/1/15. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0320, filed 4/16/14, effective 5/17/14. Statutory Authority: RCW 41.05.021 and 2011 c 5. WSR 12-01-097, § 182-533-0320, filed 12/20/11, effective 1/20/12. WSR 11-14-075, recodified as § 182-533-0320, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0320, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0320, filed 6/10/04, effective 7/11/04.]


PDF182-533-0325

Maternity support services—Provider requirements.

Maternity support service providers may include community clinics, federally qualified health centers, local health departments, hospitals, nonprofit organizations, and private clinics.
(1) To be paid for providing maternity support services (MSS) and infant case management (ICM) services to eligible clients, a provider must:
(a) Be enrolled as an eligible provider with the medicaid agency (see WAC 182-502-0010).
(b) Be currently approved as an MSS/ICM provider by the medicaid agency.
(c) Meet the requirements in this chapter, chapter 182-502 WAC and the medicaid agency's current billing instructions.
(d) Ensure that professional staff providing services:
(i) Meet the minimum regulatory and educational qualifications for the scope of services provided under WAC 182-533-0327; and
(ii) Follow the requirements in this chapter and the medicaid agency's current billing instructions.
(e) Screen each client for risk factors using the agency's designated MSS screening tool, located on the agency's website under forms. Agency approval is required for a provider to use an alternate MSS screening tool.
(f) Screen clients for ICM eligibility.
(g) Conduct case conferences under WAC 182-533-0327(2).
(h) Develop and implement an individualized care plan for each client.
(i) Initiate and participate in care coordination activities throughout the maternity cycle with at least MSS interdisciplinary team members, the client's prenatal care provider, and the Women, Infants, and Children (WIC) Nutrition Program.
(j) Comply with Section 1902 (a)(23) of the Social Security Act regarding the client's freedom to choose a provider.
(k) Comply with Section 1915 (g)(1) of the Social Security Act regarding the client's voluntary receipt of services.
(2) MSS providers may provide services in any of the following locations:
(a) A provider's office or clinic.
(b) The client's residence.
(c) An alternate site that is not the client's residence. (The reason for using an alternate site for visitation instead of the home must be documented in the client's record.)
(3) An individual or service organization that has a written contractual agreement with a qualified MSS provider also may provide MSS and ICM services to eligible clients. The provider must:
(a) Keep a copy of the written subcontractor agreement on file;
(b) Ensure that an individual or service organization staff member providing MSS/ICM services (the subcontractor) meets the minimum regulatory and educational qualifications required of an MSS/ICM provider;
(c) Ensure that the subcontractor provides MSS/ICM services under the requirements of this chapter;
(d) Maintain professional, financial, and administrative responsibility for the subcontractor;
(e) Bill for services using the provider's national provider identifier and MSS/ICM taxonomy; and
(f) Reimburse the subcontractor for MSS/ICM services provided under the written agreement.
(4) Providers must obtain agency approval of all MSS/ICM outreach-related materials, including websites and publications, prior to making those materials available to clients.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-12-060, § 182-533-0325, filed 5/26/16, effective 6/26/16; WSR 15-12-075, § 182-533-0325, filed 5/29/15, effective 7/1/15. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0325, filed 4/16/14, effective 5/17/14. Statutory Authority: RCW 41.05.021 and 2011 c 5. WSR 12-01-097, § 182-533-0325, filed 12/20/11, effective 1/20/12. WSR 11-14-075, recodified as § 182-533-0325, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0325, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0325, filed 6/10/04, effective 7/11/04.]


PDF182-533-0327

Maternity support services—Professional staff qualifications and interdisciplinary team.

(1) MSS providers must use qualified professionals, as specified in this section.
(a) Behavioral health specialists who are currently credentialed, certified, or licensed in Washington by the department of health under chapters 246-809, 246-810, 246-811, and 246-924 WAC as one of the following:
(i) Licensed mental health counselor.
(ii) Licensed independent clinical social worker.
(iii) Licensed social worker.
(iv) Licensed marriage and family therapist.
(v) Licensed psychologist.
(vi) Associate mental health counselor.
(vii) Associate independent clinical social worker.
(viii) Associate social worker.
(ix) Associate marriage and family therapist.
(x) Certified counselor.
(xi) Certified substance use disorder professional.
(b) Certified dietitians who are currently registered with the commission on dietetic registration and certified by the Washington state department of health under chapter 246-822 WAC.
(c) Community health nurses who are currently licensed as registered nurses in the state of Washington by the department of health under chapter 246-840 WAC.
(d) Community health workers (CHWs) who have a high school diploma or the equivalent and:
(i) Have a minimum of one year of health care and/or social services experience.
(ii) Carry out all activities under the direction and supervision of a professional member or supervisor of the MSS interdisciplinary team.
(iii) Complete a training plan developed by their provider.
(2) The provider's qualified staff must participate in an MSS interdisciplinary team consisting of at least a community health nurse, a certified registered dietitian, a behavioral health specialist, and, at the discretion of the provider, a community health worker.
(a) The interdisciplinary team must work together to address risk factors identified in a client's care plan.
(b) Each qualified staff member acting within her/his area of expertise must address the variety of client needs identified during the maternity cycle.
(c) An MSS interdisciplinary team case conference is required at least once prenatally for clients who are entering MSS during pregnancy, and are eligible for the maximum level of service. Using clinical judgment and the client's risk factors, the provider may decide which interdisciplinary team members to include in case conferencing.
(3) All Indian health programs, tribes, and any MSS provider within a county with fewer than fifty-five medicaid births per year are required to have at least one MSS interdisciplinary team member, as described in subsection (1) of this section:
(a) A behavioral health specialist;
(b) A registered dietitian; or
(c) A community health nurse.
[Statutory Authority: RCW 41.05.021, 41.05.160, and 18.205.020. WSR 21-06-042, § 182-533-0327, filed 2/24/21, effective 3/27/21. Statutory Authority: RCW 41.05.021, 41.05.160. WSR 16-12-060, § 182-533-0327, filed 5/26/16, effective 6/26/16. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0327, filed 4/16/14, effective 5/17/14.]


PDF182-533-0328

Maternity support services—Documentation requirements.

Providers must fulfill the documentation requirements under WAC 182-502-0020 and the medicaid agency's current billing instructions including:
(1) Required supervision records for community health workers;
(2) Continued education verification and renewal of credentials for professional staff;
(3) Subcontracting documents, as specified under WAC 182-533-0325(3); and
(4) Client records, which include consent forms and documentation for screening, assessments, care plans, case conferences, case management, and care coordination for each client.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0328, filed 4/16/14, effective 5/17/14.]


PDF182-533-0330

Maternity support services—Covered services.

(1) The medicaid agency must cover these maternity support services (MSS) provided by an MSS interdisciplinary team:
(a) In-person screening(s) for risk factors related to pregnancy and birth outcomes;
(b) Brief assessment when indicated;
(c) Brief counseling;
(d) Education that relates to improving pregnancy and parenting outcomes;
(e) Interventions for risk factors identified on the care plan;
(f) Basic health messages;
(g) Case management services;
(h) Care coordination;
(i) Infant case management (ICM) screening.
(2) The medicaid agency must determine the maximum number of units of services allowed per client when directed by the legislature to achieve targeted expenditure levels for payment of maternity support services for any specific biennium. (The maximum number of MSS units allowed per client is published in the agency's current billing instructions.)
(3) The medicaid agency must pay for covered maternity support services according to WAC 182-533-0345.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0330, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0330, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0330, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0330, filed 6/10/04, effective 7/11/04.]


PDF182-533-0340

Maternity support services—Noncovered services.

(1) The medicaid agency must cover only those services listed in WAC 182-533-0330.
(2) The medicaid agency must evaluate a request for any noncovered service under the provisions of WAC 182-501-0160.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0340, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0340, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0340, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 06-24-036, § 388-533-0340, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0340, filed 6/10/04, effective 7/11/04.]


PDF182-533-0345

Maternity support services—Payment.

The medicaid agency pays for the covered maternity support services (MSS) described in WAC 182-533-0330, subject to the requirements in this section:
(1) MSS are:
(a) Provided to a client who meets the eligibility requirements in WAC 182-533-0320.
(b) Provided to a client during a face-to-face encounter on an individual basis or in a group setting. If provided in a group setting, the group must consist of at least three but no more than twelve clients.
(c) Provided by a provider that meets the criteria in WAC 182-533-0325. When provided in a group setting, services may not be provided by a community health worker.
(d) Provided according to the agency's maternity support services (MSS)/infant case management (ICM) provider guide.
(e) Documented in the client's record or chart.
(f) Billed using:
(i) The eligible client's agency-assigned client identification number;
(ii) The appropriate procedure codes, modifiers, and allowed number of units identified in the agency's MSS/ICM provider guide; and
(iii) The provider's national provider identifier and MSS/ICM taxonomy.
(2) The agency:
(a) Reimburses providers for MSS-covered services using the agency's published fee schedule.
(b) Pays MSS-covered services in units of time with one unit being equal to fifteen minutes of one-to-one service delivered face-to-face.
(c) Pays MSS-covered services in units of time with one unit being more than or equal to sixty minutes for group services delivered face-to-face.
(3) The provider may request authorization for a limitation extension under WAC 182-501-0169 to exceed the number of allowed MSS units of service.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-12-075, § 182-533-0345, filed 5/29/15, effective 7/1/15. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0345, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0345, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-011, § 388-533-0345, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0345, filed 6/10/04, effective 7/11/04.]


PDF182-533-0360

Infant case management—Purpose.

The purpose of infant case management (ICM) is to improve the welfare of infants by providing their parent(s) with information and assistance to access needed medical, social, educational, and other services.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0360, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0360, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-010, § 388-533-0360, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0360, filed 6/10/04, effective 7/11/04.]


PDF182-533-0365

Infant case management—Definitions.

The definitions in WAC 182-533-0315 also apply to infant case management (ICM).
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0365, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0365, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-010, § 388-533-0365, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0365, filed 6/10/04, effective 7/11/04.]


PDF182-533-0370

Infant case management—Client eligibility.

(1) To be eligible to receive infant case management (ICM), an infant must meet all the following criteria:
(a) Be covered under categorically needy, medically needy, or state-funded medical programs under Washington apple health.
(b) Meet the age requirement for ICM, which is the day after the maternity cycle (defined in WAC 182-533-0315) ends, through the last day of the month of the infant's first birthday.
(c) Reside with at least one parent who provides the infant's day-to-day care and is:
(i) The infant's natural or adoptive parent(s);
(ii) A person other than a foster parent who has been granted legal custody of the infant; or
(iii) A person who is legally obligated to support the infant.
(d) Have a parent(s) who needs assistance in accessing medical, social, educational and/or other services to meet the infant's basic health and safety needs.
(e) Not be receiving any case management services funded through Title XIX medicaid that duplicate ICM services.
(2) Clients who meet the eligibility criteria and are enrolled in a medicaid agency-contracted managed care organization (MCO) are eligible for ICM services outside their plan.
(3) Clients who do not agree with an eligibility decision by the medicaid agency for ICM have a right to a fair hearing under chapter 182-526 WAC.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-06-026, § 182-533-0370, filed 2/28/19, effective 4/1/19. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0370, filed 4/16/14, effective 5/17/14. Statutory Authority: RCW 41.05.021 and 2011 c 5. WSR 12-01-097, § 182-533-0370, filed 12/20/11, effective 1/20/12. WSR 11-14-075, recodified as § 182-533-0370, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-010, § 388-533-0370, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0370, filed 6/10/04, effective 7/11/04.]


PDF182-533-0375

Infant case management—Provider requirements.

(1) Infant case management (ICM) services may be provided only by a qualified infant case manager who is employed by a provider meeting the requirements in WAC 182-533-0325.
(2) The infant case manager must meet at least one of the following qualifications under (a), (b), or (c) of this subsection:
(a) Be a current member of the maternity support services (MSS) interdisciplinary team under WAC 182-533-0327 (1)(a), (b), or (c).
(b) Have a bachelor of arts, bachelor of science, or higher degree in a social service-related field, such as social work, behavioral sciences, psychology, child development, or mental health, plus at least one year of full-time experience working in one or more of the following areas:
(i) Community services;
(ii) Social services;
(iii) Public health services;
(iv) Crisis intervention;
(v) Outreach and referral programs; or
(vi) Other related fields.
(c) Have an associate of arts degree, or an associate's degree in a social service-related field, such as social work, behavioral sciences, psychology, child development, or mental health, plus at least two years of full-time experience working in one or more of the following areas:
(i) Community services;
(ii) Social services;
(iii) Public health services;
(iv) Crisis intervention;
(v) Outreach and referral programs;
(vi) Other related fields.
(3) The medicaid agency requires any staff person qualifying under subsection (2)(c) of this section to be under the supervision of a clinical staff person meeting the criteria in subsection (2)(a) or (b) of this section. Clinical supervision may include face-to-face meetings and/or chart reviews.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-12-060, § 182-533-0375, filed 5/26/16, effective 6/26/16. Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0375, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0375, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-010, § 388-533-0375, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0375, filed 6/10/04, effective 7/11/04.]


PDF182-533-0378

Infant case management—Documentation requirements.

Providers must fulfill the documentation requirements under WAC 182-502-0020 and the medicaid agency's current billing instructions including:
(1) Required supervision records for infant case managers;
(2) Continued education verification and renewal of credentials for professional staff; and
(3) Client records that include consent forms and documentation for screening, assessments, care plans, case management, and care coordination for each client.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0378, filed 4/16/14, effective 5/17/14.]


PDF182-533-0380

Infant case management—Covered services.

(1) The medicaid agency must cover infant case management (ICM) services subject to the restrictions and limitations in this section and other applicable WAC.
Covered services include:
(a) An initial in-person screening for ICM services, which includes an assessment of risk factors and the development of an individualized care plan;
(b) Case management services and care coordination;
(c) Referral and linking the infant and parent(s) to other services or resources;
(d) Advocacy for the infant and parent(s); and
(e) Follow-up contact(s) with the parent(s) to ensure the care plan continues to meet the needs of the infant and parent(s).
(2) The medicaid agency may determine the maximum number of units allowed per client when directed by the legislature to achieve targeted expenditure levels for payment in any specific biennium. (The maximum number of ICM units allowed per client is published in the agency's current billing instructions.)
(3) The medicaid agency must pay for covered ICM services according to WAC 182-533-0386.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0380, filed 4/16/14, effective 5/17/14. Statutory Authority: RCW 41.05.021 and 2011 c 5. WSR 12-01-097, § 182-533-0380, filed 12/20/11, effective 1/20/12. WSR 11-14-075, recodified as § 182-533-0380, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-010, § 388-533-0380, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0380, filed 6/10/04, effective 7/11/04.]


PDF182-533-0385

Infant case management—Noncovered services.

(1) The medicaid agency must cover only those services that are listed in WAC 182-533-0380.
(2) The medicaid agency must evaluate a request for any noncovered service under the provisions of WAC 182-501-0160.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0385, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0385, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-010, § 388-533-0385, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. WSR 06-24-036, § 388-533-0385, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0385, filed 6/10/04, effective 7/11/04.]


PDF182-533-0386

Infant case management—Payment.

(1) The medicaid agency must pay for the covered infant case management (ICM) services described in WAC 182-533-0380 on a fee-for-service basis subject to the following requirements.
ICM services must be:
(a) Provided to a client who meets the eligibility requirements in WAC 182-533-0370.
(b) Provided by a person who meets the criteria established in WAC 182-533-0375.
(c) Provided according to the agency's current billing instructions.
(d) Documented in the infant's and/or the parent's record or chart.
(e) Billed using:
(i) The eligible infant's medicaid agency-assigned client identification number;
(ii) The appropriate procedure codes and modifiers identified in the agency's current billing instructions; and
(iii) The medicaid agency-assigned MSS/ICM provider number.
(2) The medicaid agency:
(a) Must pay ICM services in units of time, with one unit being equal to fifteen minutes of one-to-one service delivered face-to-face.
(b) When directed by the legislature to achieve targeted expenditure levels for payment of maternity support services for any specific biennium, may determine the maximum number of units allowed per client.
(c) Must publish the maximum number of units allowed per client in the agency's current billing instructions.
(3) The provider may request authorization for a limitation extension to exceed the number of allowed ICM units of service under WAC 182-501-0169.
(4) For a client enrolled in a managed care plan who is eligible to receive ICM, the medicaid agency must pay ICM services delivered outside the plan on a fee-for-service basis as described in this section.
[Statutory Authority: RCW 41.05.021. WSR 14-09-061, § 182-533-0386, filed 4/16/14, effective 5/17/14. WSR 11-14-075, recodified as § 182-533-0386, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910, and 2009 c 564 § 1109. WSR 10-12-010, § 388-533-0386, filed 5/21/10, effective 6/21/10. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0386, filed 6/10/04, effective 7/11/04.]


PDF182-533-0390

Childbirth education (CBE) classes.

(1) Purpose. The purpose of childbirth education (CBE) classes is to help prepare the client and the client's support person(s):
(a) For the physiological, emotional, and psychological changes experienced during and after pregnancy;
(b) To develop self-advocacy skills;
(c) To increase knowledge about and access to local community resources;
(d) To improve parenting skills; and
(e) To improve the likelihood of positive birth outcomes.
(2) Definitions. The definitions in chapter 182-500 WAC, medical assistance definitions, and WAC 182-533-0315, maternity support services definitions, also apply to this section.
(3) Client eligibility. To be eligible for CBE classes, a client must be:
(a) Pregnant; and
(b) Covered under one of the medical assistance programs described in WAC 182-533-0320 (1)(a)(i) and (iv).
(4) Provider requirements. To be paid for providing CBE classes to eligible clients, an approved instructor must:
(a) Have a core provider agreement on file with the agency;
(b) Ensure that individuals providing CBE classes or following up during or after the completion of online classes have credentials and/or certification as outlined in the agency's current published billing instructions;
(c) Deliver CBE classes:
(i) In a series of group sessions; or
(ii) Through online classes approved by the agency; and
(d) Provide curriculum containing topics outlined in the agency's CBE curriculum checklist found in the agency's current published billing instructions. Topics include, but are not limited to:
(i) Pregnancy;
(ii) Labor and birth;
(iii) Newborns; and
(iv) Family adjustment.
(5) Documentation. Providers must:
(a) Follow the health care record requirements found in WAC 182-502-0020; and
(b) Maintain the following additional documentation:
(i) An original or electronically signed copy of each client's Freedom of Choice form and Consent for Services form;
(ii) A client sign-in sheet or log-in verification for each class; and
(iii) Names and ProviderOne Client ID numbers of eligible clients attending CBE classes and the date(s) they participated in each CBE class.
(6) Coverage.
(a) The agency covers one CBE class series per client, per pregnancy. In order for the provider to be reimbursed:
(i) The client must attend at least one CBE session or agency-approved online CBE class; and
(ii) The provider must follow up with clients participating in online classes through a telemedicine, including audio-only, visit or an in-person visit. If the client does not appear for the follow up visit, the provider must attempt to connect with the client one more time before billing the agency.
(b) CBE classes must include a minimum of six hours of instruction and are subject to the restrictions and limitations in this section and other applicable WAC.
(7) Payment. The agency pays for the CBE classes described in subsection (6) of this section on a fee-for-service basis subject to the following:
(a) CBE must:
(i) Include all classes, core materials, publications, and educational materials provided throughout the class series. Clients must receive the same materials as are offered to other attendees; and
(ii) Be billed according to the agency's current published billing instructions.
(b) The provider must accept the agency's fee as payment in full for classes provided to a client in accordance with 42 C.F.R. § 447.15.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 23-21-069, § 182-533-0390, filed 10/12/23, effective 11/12/23; WSR 19-06-026, § 182-533-0390, filed 2/28/19, effective 4/1/19. Statutory Authority: RCW 41.05.021 and 2011 c 5. WSR 12-01-097, § 182-533-0390, filed 12/20/11, effective 1/20/12. WSR 11-14-075, recodified as § 182-533-0390, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.910. WSR 04-13-049, § 388-533-0390, filed 6/10/04, effective 7/11/04.]


PDF182-533-0400

Maternity care and newborn delivery.

(1) The following definitions and abbreviations and those found in chapter 182-500 WAC apply to this chapter.
(a) "Birthing center" means a specialized facility licensed as a childbirth center by the department of health (DOH) under chapter 246-349 WAC.
(b) "Bundled services" means services integral to the major procedure that are included in the fee for the major procedure. Under this chapter, certain services which are customarily bundled must be billed separately (unbundled) when the services are provided by different providers.
(c) "Facility fee" means the portion of the medicaid agency's payment for the hospital or birthing center charges. This does not include the agency's payment for the professional fee.
(d) "Global fee" means the fee the agency pays for total obstetrical care. Total obstetrical care includes all bundled antepartum care, delivery services and postpartum care.
(e) "High-risk" pregnancy means any pregnancy that poses a significant risk of a poor birth outcome.
(f) "Professional fee" means the portion of the agency's payment for services that rely on the provider's professional skill or training, or the part of the reimbursement that recognizes the provider's cognitive skill. (See WAC 182-531-1850 for reimbursement methodology.)
(2) The agency covers full scope medical maternity care and newborn delivery services for fee-for-service and managed care clients under WAC 182-501-0060.
(3) The agency does not provide maternity care and delivery services to clients who are eligible for:
(a) Family planning only programs (a pregnant client under these programs should be referred to the Washington healthplanfinder via www.wahealthplanfinder.org for eligibility review); or
(b) Any other program not listed in this section.
(4) The agency requires providers of maternity care and newborn delivery services to meet all the following requirements:
(a) Providers must be currently licensed:
(i) By the state of Washington's department of health (DOH), or department of licensing, or both; or
(ii) According to the laws and rules of any other state, if exempt under federal law.
(b) Providers must have a signed core provider agreement with the agency;
(c) Providers must be practicing within the scope of their licensure; and
(d) Providers must have valid certifications from the appropriate federal or state agency, if such is required to provide these services (e.g., federally qualified health centers (FQHCs), laboratories certified through the Clinical Laboratory Improvement Amendment (CLIA)).
(5) The agency covers total obstetrical care services (paid under a global fee). Total obstetrical care includes all the following:
(a) Routine antepartum care that begins in any trimester of a pregnancy;
(b) Delivery (intrapartum care and birth) services; and
(c) Postpartum care. This includes family planning counseling.
(6) When an eligible client receives all the services listed in subsection (5) of this section from one provider, the agency pays that provider a global obstetrical fee.
(7) When an eligible client receives services from more than one provider, the agency pays each provider for the services furnished. The separate services that the agency pays appear in subsection (5) of this section.
(8) The agency pays for antepartum care services in one of the following two ways:
(a) Under a global fee; or
(b) Under antepartum care fees.
(9) The agency's fees for antepartum care include all the following:
(a) Completing an initial and any subsequent patient history;
(b) Completing all physical examinations;
(c) Recording and tracking the client's weight and blood pressure;
(d) Recording fetal heart tones;
(e) Performing a routine chemical urinalysis (including all urine dipstick tests); and
(f) Providing maternity counseling.
(10) The agency covers certain antepartum services in addition to the bundled services listed in subsection (9) of this section as follows:
(a) The agency pays for either of the following, but not both:
(i) An enhanced prenatal management fee (a fee for medically necessary increased prenatal monitoring). The agency provides a list of diagnoses, or conditions, or both, that the agency identifies as justification for more frequent monitoring visits; or
(ii) A prenatal management fee for "high-risk" maternity clients. This fee is payable to either a physician or a certified nurse midwife.
(b) The agency pays for both of the following:
(i) Necessary prenatal laboratory tests except routine chemical urinalysis, including all urine dipstick tests, as described in subsection (9)(e) of this section; and
(ii) Treatment of medical problems that are not related to the pregnancy. The agency pays these fees to physicians or advanced registered nurse practitioners (ARNP).
(11) The agency covers high-risk pregnancies. The agency considers a pregnant client to have a high-risk pregnancy when the client:
(a) Has any high-risk medical condition (whether or not it is related to the pregnancy); or
(b) Has a diagnosis of multiple births.
(12) The agency covers delivery services for clients with high-risk pregnancies, described in subsection (11) of this section, when the delivery services are provided in a hospital.
(13) The agency pays a facility fee for delivery services in the following settings:
(a) Inpatient hospital; or
(b) Birthing centers.
(14) The agency pays a professional fee for delivery services in the following settings:
(a) Hospitals, to a provider who meets the criteria in subsection (4) of this section and who has privileges in the hospital;
(b) Planned home births and birthing centers.
(15) The agency covers hospital delivery services for an eligible client as defined in subsection (2) of this section. The agency's bundled payment for the professional fee for hospital delivery services include:
(a) The admissions history and physical examination; and
(b) The management of uncomplicated labor (intrapartum care); and
(c) The vaginal delivery of the newborn (with or without episiotomy or forceps); or
(d) Cesarean delivery of the newborn.
(16) The agency pays only a labor management fee to a provider who begins intrapartum care and unanticipated medical complications prevent that provider from following through with the birthing services.
(17) In addition to the agency's payment for professional services in subsection (15) of this section, the agency may pay separately for services provided by any of the following professional staff:
(a) A stand-by physician in cases of high risk delivery, or newborn resuscitation, or both;
(b) A physician assistant or registered nurse "first assist" when delivery is by cesarean section;
(c) A physician, ARNP, or licensed midwife for newborn examination as the delivery setting allows; and
(d) An obstetrician, or gynecologist specialist, or both, for external cephalic version and consultation.
(18) In addition to the professional delivery services fee in subsection (15) or the global/total fees (i.e., those that include the hospital delivery services) in subsections (5) and (6) of this section, the agency allows additional fees for any of the following:
(a) High-risk vaginal delivery;
(b) Multiple vaginal births. The agency's typical payment covers delivery of the first child. For each subsequent child, the agency pays at fifty percent of the provider's usual and customary charge, up to the agency's maximum allowable fee; or
(c) High-risk cesarean section delivery.
(19) The agency does not pay separately for any of the following:
(a) More than one child delivered by cesarean section during a surgery. The agency's cesarean section surgery fee covers one or multiple surgical births;
(b) Postoperative care for cesarean section births. This is included in the surgical fee. Postoperative care is not the same as, or part of, postpartum care.
(20) The agency pays for an early delivery, including induction or cesarean section, before thirty-nine weeks of gestation only if medically necessary. The agency considers an early delivery to be medically necessary:
(a) If the mother or fetus has a diagnosis listed in the Joint Commission's current table of Conditions Possibly Justifying Elective Delivery Prior to 39 Weeks Gestation; or
(b) If the provider documents a clinical situation that supports medical necessity.
(21) The agency will only pay for antepartum and postpartum professional services for an early elective delivery as defined in WAC 182-500-0030.
(22) The hospital will receive no payment for an early elective delivery as defined in WAC 182-500-0030.
(23) In addition to the services listed in subsection (10) of this section, the agency covers counseling for tobacco/nicotine cessation for eligible clients who are pregnant or in the postpartum period as defined in 42 C.F.R. 435.170. See WAC 182-531-1720.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-22-017, § 182-533-0400, filed 10/25/19, effective 11/25/19; WSR 15-24-021, § 182-533-0400, filed 11/19/15, effective 1/1/16. WSR 11-14-075, recodified as § 182-533-0400, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-014, § 388-533-0400, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.760, and 74.09.770. WSR 05-01-065, § 388-533-0400, filed 12/8/04, effective 1/8/05; WSR 02-07-043, § 388-533-0400, filed 3/13/02, effective 4/13/02. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.800. WSR 00-23-052, § 388-533-0400, filed 11/13/00, effective 12/14/00.]


PDF182-533-0600

Planned home births and births in birthing centers.

(1) Client eligibility. The medicaid agency covers planned home births and births in birthing centers for clients who choose to give birth at home or in an agency-approved birthing center and:
(a) Are eligible for the alternative benefit package under WAC 182-501-0060, categorically needy or medically needy scope of care under WAC 182-533-0400(2);
(b) Have an agency-approved medical provider who has accepted responsibility for the planned home birth or birth in birthing center under this section;
(c) Are expected to deliver the child vaginally and without complication (i.e., with a low risk of adverse birth outcome); and
(d) Pass the agency's risk screening criteria. The agency provides these risk-screening criteria to qualified medical services providers.
(2) Qualified providers. Only the following provider types may be reimbursed for planned home births and births in birthing centers:
(a) Physicians licensed under chapters 18.57 or 18.71 RCW;
(b) Nurse midwives licensed under chapter 18.79 RCW; and
(c) Midwives licensed under chapter 18.50 RCW.
(3) Birthing center requirements.
(a) Each participating birthing center must:
(i) Be licensed as a childbirth center by the department of health (DOH) under chapter 246-329 WAC;
(ii) Be specifically approved by the agency to provide birthing center services;
(iii) Have a valid core provider agreement with the agency; and
(iv) Maintain standards of care required by DOH for licensure.
(b) The agency suspends or terminates the core provider agreement of a birthing center if it fails to maintain DOH standards cited in (a) of this subsection.
(4) Home birth or birthing center providers. Home birth or birthing center providers must:
(a) Obtain from the client a signed consent form in advance of the birth;
(b) Follow the agency's risk screening criteria and consult with, or refer the client or newborn to, a physician or hospital when medically appropriate;
(c) Have current, written, and appropriate plans for consultation, emergency transfer and transport of a client or newborn to a hospital;
(d) Make appropriate referral of the newborn for pediatric care and medically necessary follow-up care;
(e) Inform parents of required prophylactic eye ointment and newborn screening tests for heritable or metabolic disorders, and congenital heart defects, and send the newborn's blood sample to the DOH for testing. Parents may refuse these services for religious reasons under RCW 70.83.020. The provider must obtain the signature from the parent(s) on:
(i) The reverse side of the screening card to document refusal of screenings for heritable or metabolic disorders; and
(ii) A waiver form to document refusal of prophylactic eye ointment or a screening for congenital heart defects;
(f) Inform parents of the benefits and risks of Vitamin K injections for newborns; and
(g) Have evidence of current cardiopulmonary resuscitation (CPR) training for:
(i) Adult CPR; and
(ii) Neonatal resuscitation.
(5) Planned home birth providers. Planned home birth providers must:
(a) Provide medically necessary equipment, supplies, and medications for each client;
(b) Have arrangements for twenty-four hour per day coverage;
(c) Have documentation of contact with local area emergency medical services to determine the level of response capability in the area; and
(d) Participate in a formal, state-sanctioned, quality assurance improvement program or professional liability review process.
(6) Limitations. The agency does not cover planned home births or births in birthing centers for women identified with any of the following conditions:
(a) Previous cesarean section;
(b) Current alcohol or drug addiction or abuse;
(c) Significant hematological disorders or coagulopathies;
(d) History of deep venous thrombosis or pulmonary embolism;
(e) Cardiovascular disease causing functional impairment;
(f) Chronic hypertension;
(g) Significant endocrine disorders including preexisting diabetes (type I or type II);
(h) Hepatic disorders including uncontrolled intrahepatic cholestasis of pregnancy or abnormal liver function tests;
(i) Isoimmunization, including evidence of Rh sensitization or platelet sensitization;
(j) Neurologic disorders or active seizure disorders;
(k) Pulmonary disease;
(l) Renal disease;
(m) Collagen-vascular diseases;
(n) Current severe psychiatric illness;
(o) Cancer affecting the female reproductive system;
(p) Multiple gestation;
(q) Breech presentation in labor with delivery not imminent; or
(r) Other significant deviations from normal as assessed by the provider.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 20-02-068, § 182-533-0600, filed 12/26/19, effective 1/26/20. Statutory Authority: RCW 41.05.021, 41.05.160, 70.83.020, 2015 c 37, and WAC 246-100-202. WSR 15-19-122, § 182-533-0600, filed 9/21/15, effective 10/22/15. WSR 11-14-075, recodified as § 182-533-0600, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.760, and 74.09.770. WSR 05-01-065, § 388-533-0600, filed 12/8/04, effective 1/8/05. Statutory Authority: RCW 74.08.090, 74.09.760 through 74.09.800. WSR 00-23-052, § 388-533-0600, filed 11/13/00, effective 12/14/00.]


PDF182-533-0701

Substance-using pregnant people (SUPP) program—Purpose.

The substance-using pregnant people (SUPP) program provides immediate access to medical care in a hospital setting to substance-using or substance-dependent pregnant people and their fetuses. The purpose of the immediate access to medical care is to reduce harm to and improve birth outcomes for birthing parents and their fetuses by preventing obstetric and prenatal complications related to substance use disorder.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 22-17-168, § 182-533-0701, filed 8/24/22, effective 9/24/22. WSR 11-14-075, recodified as § 182-533-0701, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.800. WSR 04-11-008, § 388-533-701 (codified as WAC 388-533-0701), filed 5/5/04, effective 6/5/04.]


PDF182-533-0710

Substance-using pregnant people (SUPP) program—Client eligibility.

(1) To be eligible for the substance-using pregnant people (SUPP) program, a person must be:
(a) Pregnant; and
(b) Eligible for medicaid.
(2) A client eligible under subsection (1) of this section who is enrolled in an agency-contracted managed care plan is eligible for SUPP services outside their plan. SUPP services and reimbursement are delivered outside a managed care plan and are subject to fee-for-services rules.
(3) A client receiving withdrawal management services or secure withdrawal management services through the agency is not eligible for the SUPP program.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 22-17-168, § 182-533-0710, filed 8/24/22, effective 9/24/22; WSR 15-14-038, § 182-533-0710, filed 6/24/15, effective 7/25/15. WSR 11-14-075, recodified as § 182-533-0710, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.800. WSR 05-08-061, § 388-533-0710, filed 3/31/05, effective 5/1/05; WSR 04-11-008, § 388-533-710 (codified as WAC 388-533-0710), filed 5/5/04, effective 6/5/04.]


PDF182-533-0720

Substance-using pregnant people (SUPP) program—Provider requirements.

(1) The agency pays only those providers who:
(a) Have been approved by the agency to provide substance-using pregnant people (SUPP) program services;
(b) Have been licensed and certified as a behavioral health agency by the department of health (DOH) under chapter 246-341 WAC;
(c) Meet the department of health hospital licensing regulations in chapter 246-320 WAC; and
(d) Meet the general provider requirements in chapter 182-502 WAC.
(2) Providers must:
(a) Report any changes in their certification, level of care, or program operations to the agency SUPP program manager;
(b) Have written policies and procedures that include a working statement describing the purpose and methods of treatment for substance-using or substance-dependent pregnant people;
(c) Provide guidelines and resources for current medical treatment methods by specific substance type;
(d) Have linkages with state and community providers to ensure a working knowledge exists of current medical and substance use disorder resources; and
(e) Ensure that an assessment for substance use disorders of the client has been completed:
(i) By a substance use disorder professional under chapter 246-811 WAC;
(ii) Using the latest criteria of the American Society of Addiction Medicine (ASAM); and
(iii) No earlier than six months before, and no later than five days after, the client's admission to the SUPP program.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 22-17-168, § 182-533-0720, filed 8/24/22, effective 9/24/22; WSR 15-14-038, § 182-533-0720, filed 6/24/15, effective 7/25/15. WSR 11-14-075, recodified as § 182-533-0720, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.800. WSR 05-08-061, § 388-533-0720, filed 3/31/05, effective 5/1/05; WSR 04-11-008, § 388-533-720 (codified as WAC 388-533-0720), filed 5/5/04, effective 6/5/04.]


PDF182-533-0730

Substance-using pregnant people (SUPP) program—Covered services.

(1) The agency pays for the following covered services for a pregnant client and their fetus under the substance-using pregnant people (SUPP) program:
(a) Primary acute withdrawal management and medical stabilization;
(b) Secondary subacute withdrawal management and medical stabilization; and
(c) Rehabilitation treatment and services as determined by the provider.
(2) The maximum length of treatment per inpatient stay that the agency will pay for is 26 days, unless additional days have been preauthorized by the agency (SUPP) program manager.
(3) If a client's pregnancy ends before inpatient treatment is completed, a provider may continue treatment through the 26th day.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 22-17-168, § 182-533-0730, filed 8/24/22, effective 9/24/22; WSR 15-14-038, § 182-533-0730, filed 6/24/15, effective 7/25/15. WSR 11-14-075, recodified as § 182-533-0730, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.800. WSR 05-08-061, § 388-533-0730, filed 3/31/05, effective 5/1/05; WSR 04-11-008, § 388-533-730 (codified as WAC 388-533-0730), filed 5/5/04, effective 6/5/04.]