WAC 388-832-0165. What are excess medical costs?

(1) Excess medical costs are medical expenses for which you are responsible after your private insurance and medicaid benefits have been exhausted. (2) The developmental disabilities administration (DDA) may pay excess medical costs for a: (a) Dental insurance premium; (b) Dental service; (c) Health insurance premium; (d) Medical service; (e) Prescription medication; (f) Psychiatric service; and (g) Skilled nursing service. (3) DDA may pay for excess medical costs directly to: (a) A DDA-contracted provider; (b) Your family member who has an individual and family services contract with DDA; or (c) The department-contracted nurse who has provided skilled nursing services. (4) The following limits apply to excess medical costs: (a) The service must be of direct medical or remedial benefit to you and deemed medically necessary by your health care professional; (b) Therapies included under WAC 388-832-0170 must not be paid under excess medical costs. (c) Medical and dental premiums are excluded for family members other than the DDA-eligible client. (d) Prior approval by your regional administrator or designee is required. (e) Reimbursement will not occur unless DDA receives receipts as required under WAC 388-832-0136 .