WAC 182-550-2301. Hospital and medical criteria requirements for bariatric surgery

(1) The medicaid agency pays a hospital for bariatric surgery and bariatric surgery-related services only when the surgery is provided in an inpatient hospital setting and only when: (a) The client: (i) Qualifies for bariatric surgery by successfully completing all requirements under WAC 182-531-1600 ; and (ii) Continues to meet the criteria to qualify for bariatric surgery under WAC 182-531-1600 up to the actual surgery date. (b) The hospital: (i) Is accredited by the metabolic and bariatric surgery accreditation and quality improvement program (MBSAQIP); and (ii) Receives prior authorization from the agency before performing a bariatric surgery for a Washington apple health client. (2) See WAC 182-531-1600 (13) for requirements for surgeons who perform bariatric surgery. (3) Authorization does not guarantee payment. Authorization for bariatric surgery and bariatric surgery-related services is valid only if: (a) The client is eligible on the date of admission and date of service; and (b) The hospital and professional providers meet the criteria in this section and other applicable WAC to perform bariatric surgery or to provide bariatric surgery-related services.