WAC 182-533-0345. 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 an 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 12 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 15 minutes of one-to-one service delivered in-person or through telemedicine according to WAC 182-501-0300 . (c) Pays MSS-covered services in units of time with one unit being more than or equal to 60 minutes for group services delivered face-to-face. (d) Pays for one initial MSS screening, when provided by an MSS provider listed in WAC 182-533-0327 (1)(a) through (c), with the unit being more than or equal to 60 minutes and delivered in-person or through telemedicine. (e) Pays for one postpartum MSS registered nurse visit, that takes place in the client's home or a homeless shelter within four weeks after the pregnancy ends, with the unit being more than or equal to 90 minutes and delivered in-person. (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.