WAC 182-501-0180 through
182-501-0184
describe the health care services available to a Washington apple health client
on a fee-for-service basis or to a client enrolled in a managed care
organization (MCO) (defined in WAC
182-538-050) .
(1) Subject to the requirements, exceptions,
and limitations in this section, WAC
182-501-0182,
and
182-501-0184,
the medicaid agency covers emergency and nonemergency out-of-state health care
services provided to eligible Washington apple health recipients when the
services are:
(a) Within the scope of the
client's or enrollee's health care program as specified under chapter
182-501
WAC or other program rules;
(b)
Allowed to be provided outside the state of Washington by specific program WAC;
and
(2) The agency does not cover
services provided outside the state of Washington under the Involuntary
Treatment Act (chapter 71.05 RCW, including designated bordering
cities.
(3) When the agency pays
for covered health care services furnished to an eligible Washington apple
health client or enrollee outside the state of Washington, its payment is
payment in full according to
42 C.F.R.
447.15. No additional payment may be sought
from the client (see WAC
182-502-0160
).
(4) The agency determines
coverage for transportation services provided out of state, including ambulance
services, according to chapter
182-546 WAC.
(5) With the exception of designated
bordering cities (see WAC
182-501-0175
), if the client or enrollee travels out of state expressly to obtain health
care, the service must be prior authorized by the agency. See WAC
182-501-0182
for requirements related to out-of-state nonemergency treatment and WAC
182-501-0165
for the agency's medical necessity determination process.
(6) The agency does not cover health care
services provided outside the United States and U.S. territories, except in
British Columbia, Canada. See WAC
182-501-0184
for limitations on coverage of, and payment for, health care provided to
Washington apple health clients or enroll-ees in British Columbia,
Canada.
(7) See WAC
182-502-0120
for provider requirements for payment of health care provided outside the state
of Washington.
Notes
Wash. Admin.
Code §
182-501-0180
Amended by
WSR
15-15-053, Filed 7/9/2015, effective
8/9/2015
Amended by
WSR
20-23-064, Filed 11/16/2020, effective
12/17/2020
11-14-075, recodified as §182-501-0180, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090,
74.04.057 and
74.09.510. 11-14-054, §
388-501-0180, filed 6/29/11, effective 7/30/11. Statutory Authority:
RCW
74.04.050,
74.04.057,
74.08.090,
74.09.500, and
74.09.035. 08-08-064, §
388-501-0180, filed 3/31/08, effective 5/1/08. Statutory Authority:
RCW
74.04.050,
74.08.090,
74.09.530, and
74.09.700. 06-24-036, §
388-501-0180, filed 11/30/06, effective 1/1/07. Statutory Authority:
RCW
74.08.090 and
74.09.035. 01-01-011, §
388-501-0180, filed 12/6/00, effective 1/6/01. Statutory Authority:
RCW
74.08.090. 94-10-065 (Order 3732), §
388-501-0180, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-82-135
and 388-92-015.
