WAC 388-551-2130   Noncovered home health services.  (1) The Health and Recovery Services Administration (HRSA) does not cover the following home health services under the home health program, unless otherwise specified:

     (a) Chronic long-term care skilled nursing visits or specialized therapy visits for a medically stable client when a long-term care skilled nursing plan or specialized therapy plan is in place through the department of social and health services' aging and disability services administration (ADSA).

     (i) HRSA considers requests for interim chronic long-term care skilled nursing services or specialized therapy services for a client while the client is waiting for ADSA to implement a long-term care skilled nursing plan or specialized therapy plan; and

     (ii) On a case-by-case basis, HRSA may authorize long-term care skilled nursing visits or specialized therapy visits for a client for a limited time until a long-term care skilled nursing plan or specialized therapy plan is in place. Any services authorized are subject to the restrictions and limitations in this section and other applicable published WACs.

     (b) Social work services.

     (c) Psychiatric skilled nursing services.

     (d) Pre- and postnatal skilled nursing services, except as listed under WAC 388-551-2100 (2)(e).

     (e) Well-baby follow-up care.

     (f) Services performed in hospitals, correctional facilities, skilled nursing facilities, or a residential facility with skilled nursing services available.

     (g) Home health aide services that are not provided in conjunction with skilled nursing or specialized therapy services.

     (h) Health care for a medically stable client (e.g., one who does not have an acute episode, a disease exacerbation, or treatment change).

     (i) Home health specialized therapies and home health aide visits for clients in the following programs:

     (i) CNP - emergency medical only; and

     (ii) LCP-MNP - emergency medical only.

     (j) Skilled nursing visits for a client when a home health agency cannot safely meet the medical needs of that client within home health services program limitations (e.g., for a client to receive infusion therapy services, the caregiver must be willing and capable of managing the client's care).

     (k) More than one of the same type of specialized therapy and/or home health aide visit per day.

     (l) HRSA does not reimburse for duplicate services for any specialized therapy for the same client when both providers are performing the same or similar procedure(s).

     (m) Home health visits made without a written physician's order, unless the verbal order is:

     (i) Documented prior to the visit; and

     (ii) The document is signed by the physician within forty-five days of the order being given.

     (2) HRSA does not cover additional administrative costs billed above the visit rate (these costs are included in the visit rate and will not be paid separately).

     (3) HRSA evaluates a request for any service that is listed as noncovered under the provisions of WAC 388-501-0160.



[Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 06-24-036, § 388-551-2130, filed 11/30/06, effective 1/1/07. Statutory Authority: RCW 74.08.090, 74.09.520, 74.09.530, and 74.09.500. 02-15-082, § 388-551-2130, filed 7/15/02, effective 8/15/02. Statutory Authority: RCW 74.08.090 and 74.09.530. 99-16-069, § 388-551-2130, filed 8/2/99, effective 9/2/99.]