WAC 182-500-0010 Medical assistance definitions -- A.

Effective November 25, 2023

"Administrative renewal" means the agency uses electronically available income and resources data sources to verify and recertify a person's Washington apple health benefits for a subsequent certification period. A case is administratively renewed when the person's self-attested income and resources are reasonably compatible (as defined in WAC 182-500-0095 ) with the information available to the agency from the electronic data sources and the person meets citizenship, immigration, Social Security number, and age requirements.

"After-pregnancy coverage (APC)" means full-scope Washington apple health (medicaid) health care coverage for people up to 12 months after the month their pregnancy ends under WAC 182-505-0115 .

"Agency" or "medicaid agency" means the Washington state health care authority (HCA).

"Agency's designee" means any entity expressly designated by the agency to act on its behalf.

"Allowable costs" are the documented costs as reported after any cost adjustment, cost disallowances, reclassifications, or reclassifications to nonallowable costs which are necessary, ordinary and related to the outpatient care of medical care clients or not expressly declared nonallowable by applicable statutes or regulations. Costs are ordinary if they are of the nature and magnitude which prudent and cost-conscious management would pay.

"Alternative benefits plan" means the range of health care services included within the scope of service categories described in WAC 182-501-0060 available to persons eligible to receive health care coverage under the Washington apple health modified adjusted gross income (MAGI)-based adult coverage described in WAC 182-505-0250 .

"Ancillary services" means additional services ordered by the provider to support the core treatment provided to the patient. These services may include, but are not limited to, laboratory services, radiology services, drugs, physical therapy, occupational therapy, and speech therapy.

"Apple health for kids" is the umbrella term for health care coverage for certain groups of children that is funded by the state and federal governments under Title XIX medicaid programs, Title XXI Children's Health Insurance Program, or solely through state funds (including the program formerly known as the children's health program). Funding for any given child depends on the program for which the child is determined to be eligible. Apple health for kids programs are included in the array of health care programs available through Washington apple health (WAH).

"Attested income" or "attested resources" means a self-declared statement of a person's income or resources made under penalty of perjury to be true. (See also "self-attestation.")

"Authorization" means the agency's or the agency's designee's determination that criteria are met, as one of the preconditions to the agency's or the agency's designee's decision to provide payment for a specific service or device. (See also "expedited prior authorization" and "prior authorization.")

"Authorized representative" is defined under WAC 182-503-0130 .

This is a reprint of the official rule as published by the Office of the Code Reviser . If there are previous versions of this rule, they can be found using the Legislative Search page .

In addition to the individual's representative and advocates, some facilities or case managers need to be indicated on the AREP screen for correct payment and billing.

Hospice outside of a nursing facility or Hospice Care Center when an individual is receiving Hospice outside of a medical institution and not on a DDA or HCS Waiver. The Department of Health website has additional information about Hospice Care Centers including the Hospice Care Center addresses.

New Freedom-King and Pierce Co.

Program of All-inclusive Care for the Elderly (PACE) - King Co. on the AREP screen indicate: Providence Elder Place Attn: PEP Biller PO Box 389672 Seattle WA 98138-9672

The DSHS Office of Financial Recovery PO Box 9768 Olympia WA 98507 must be on the AREP screen if the client is residing in one of the following state owned facilities: Fircrest School Shoreline, Washington (DDA Residential Habilitation Centers-RHC) Lakeland Village Medical Lake, Washington (DDA RHC) Rainier School Buckley, Washington (DDA RHC) Yakima Valley School Selah, Washington (DDA RHC Eastern State Hospital, (Institution for the Mental Disease-IMD) Western State Hospital, (IMD) Child Study and Treatment Center (IMD)

It is important to update or remove the information on the AREP screen if the individual changes services. (Example: DDA individual at RHC discharges home to a DDA Waiver).