WAC 388-501-0065
Healthcare coverage -- Description of
covered categories of service. This rule provides a brief
description of the medical, dental, mental health, and
substance abuse service categories listed in the table in WAC 388-501-0060. The description of services under each category
is not intended to be all inclusive.
(1) For categorically needy (CN), medically needy (MN),
and medical care services (MCS), refer to the WAC citations
listed in the following descriptions for specific details
regarding each service category. For Alien Emergency Medical
(AEM) services, refer to WAC 388-438-0110.
(2) The following service categories are subject to the
exclusions, limitations, and eligibility requirements
contained in department rules:
(a) Adult day health -- Skilled nursing services,
counseling, therapy (physical, occupational, speech, or
audiology), personal care services, social services, general
therapeutic activities, health education, nutritional meals
and snacks, supervision, and protection. [WAC 388-71-0702
through 388-71-0776]
(b) Ambulance -- Emergency medical transportation and
ambulance transportation for nonemergency medical needs. [WAC 388-546-0001 through 388-546-4000]
(c) Blood processing/administration -- Blood and/or blood
derivatives, including synthetic factors, plasma expanders,
and their administration. [WAC 388-550-1400 and 388-550-1500]
(d) Dental services -- Diagnosis and treatment of dental
problems including emergency treatment and preventive care.
[Chapters 388-535 and 388-535A WAC]
(e) Detoxification -- Inpatient treatment performed by a
certified detoxification center or in an inpatient hospital
setting. [WAC 388-800-0020 through 388-800-0035; and
388-550-1100]
(f) Diagnostic services -- Clinical testing and imaging
services. [WAC 388-531-0100; 388-550-1400 and 388-550-1500]
(g) Family planning services -- Gynecological exams;
contraceptives, drugs, and supplies, including prescriptions;
sterilization; screening and treatment of sexually transmitted
diseases; and educational services. [WAC 388-532-530]
(h) Healthcare professional services -- Office visits,
emergency room, nursing facility, home-based, and
hospital-based care; surgery, anesthesia, pathology,
radiology, and laboratory services; obstetric services; kidney
dialysis and renal disease services; osteopathic care,
podiatry services, physiatry, and pulmonary/respiratory
services; and allergen immunotherapy. [Chapter 388-531 WAC]
(i) Hearing care -- Audiology; diagnostic evaluations;
hearing exams and testing; and hearing aids. [WAC 388-544-1200 and 388-544-1300; 388-545-700; and 388-531-0100]
(j) Home health services -- Intermittent, short-term
skilled nursing care, physical therapy, speech therapy, home
infusion therapy, and health aide services, provided in the
home. [WAC 388-551-2000 through 388-551-2220]
(k) Hospice services -- Physician services, skilled nursing
care, medical social services, counseling services for client
and family, drugs, medications (including biologicals),
medical equipment and supplies needed for palliative care,
home health aide, homemaker, personal care services, medical
transportation, respite care, and brief inpatient care. This
benefit also includes services rendered in a hospice care
center and pediatric palliative care services. [WAC 388-551-1210 through 388-551-1850]
(l) Hospital services -- Inpatient/outpatient -- Emergency
room; hospital room and board (includes nursing care);
inpatient services, supplies, equipment, and prescription
drugs; surgery, anesthesia; diagnostic testing, laboratory
work, blood/blood derivatives; radiation and imaging treatment
and diagnostic services; and outpatient or day surgery, and
obstetrical services. [Chapter 388-550 WAC]
(m) Intermediate care facility/services for mentally
retarded -- Habilitative training, health-related care,
supervision, and residential care. [Chapter 388-835 WAC]
(n) Maternity care and delivery services -- Community
health nurse visits, nutrition visits, behavioral health
visits, midwife services, maternity and infant case management
services, and community health worker visits. [WAC 388-533-0330]
(o) Medical equipment, durable (DME) -- Wheelchairs,
hospital beds, respiratory equipment; prosthetic and orthotic
devices; casts, splints, crutches, trusses, and braces. [WAC 388-543-1100]
(p) Medical equipment, nondurable (MSE) -- Antiseptics,
germicides, bandages, dressings, tape, blood
monitoring/testing supplies, braces, belts, supporting
devices, decubitus care products, ostomy supplies, pregnancy
test kits, syringes, needles, transcutaneous electrical nerve
stimulators (TENS) supplies, and urological supplies. [WAC 388-543-2800]
(q) Medical nutrition services -- Enteral and parenteral
nutrition, including supplies. [Chapters 388-553 and 388-554
WAC]
(r) Mental health services -- Inpatient and outpatient
psychiatric services and community mental health services.
[Chapter 388-865 WAC]
(s) Nursing facility services -- Nursing, therapies,
dietary, and daily care services. [Chapter 388-97 WAC]
(t) Organ transplants -- Solid organs, e.g., heart, kidney,
liver, lung, pancreas, and small bowel; bone marrow and
peripheral stem cell; skin grafts; and corneal transplants. [WAC 388-550-1900 and 388-550-2000, and 388-556-0400]
(u) Out-of-state services -- Emergency services; prior
authorized care. Services provided in bordering cities are
treated as if they were provided in state. [WAC 388-501-0175
and 388-501-0180; 388-531-1100; and 388-556-0500]
(v) Oxygen/respiratory services -- Oxygen, oxygen equipment
and supplies; oxygen and respiratory therapy, equipment, and
supplies. [Chapter 388-552 WAC]
(w) Personal care services -- Assistance with activities of
daily living (e.g., bathing, dressing, eating, managing
medications) and routine household chores (e.g., meal
preparation, housework, essential shopping, transportation to
medical services). [WAC 388-106-0010, [388-106-]0300,
[388-106-]0400, [388-106-]0500, [388-106-]0600,
[388-106-]0700, [388-106-]0720 and [388-106-]0900]
(x) Prescription drugs -- Outpatient drugs (including in
nursing facilities), both generic and brand name; drug devices
and supplies; some over-the-counter drugs; oral, topical,
injectable drugs; vaccines, immunizations, and biologicals;
and family planning drugs, devices, and supplies. [WAC 388-530-1100] Additional coverage for medications and
prescriptions is addressed in specific program WAC sections.
(y) Private duty nursing -- Continuous skilled nursing
services provided in the home, including client assessment,
administration of treatment, and monitoring of medical
equipment and client care for clients seventeen years of age
and under. [WAC 388-551-3000.] For benefits for clients
eighteen years of age and older, see WAC 388-106-1000 through388-106-1055
.
(z) Prosthetic/orthotic devices -- Artificial limbs and
other external body parts; devices that prevent, support, or
correct a physical deformity or malfunction. [WAC 388-543-1100]
(aa) School medical services -- Medical services provided
in schools to children with disabilities under the Individuals
with Disabilities Education Act (IDEA). [Chapter 388-537 WAC]
(bb) Substance abuse services -- Chemical dependency
assessment, case management services, and treatment services.
[WAC 388-533-0701 through 388-533-0730; 388-556-0100 and
388-556-0400; and 388-800-0020]
(cc) Therapy -- Occupational/physical/speech -- Evaluations,
assessments, and treatment. [WAC 388-545-300, 388-545-500,
and 388-545-700]
(dd) Vision care -- Eye exams, refractions, frames, lenses,
ocular prosthetics, and surgery. [WAC 388-544-0250 through388-544-0550
]
[Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530,
and 74.09.700. 06-24-036, § 388-501-0065, filed 11/30/06,
effective 1/1/07.]
NOTES:
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.