WAC 182-543-2000 Eligible providers and provider requirements.

WAC 182-543-2000 Eligible providers and provider requirements.

Effective May 1, 2025

1. The medicaid agency pays on a fee-for-service basis, providers (including providers who supply medical equipment and supplies in an outpatient clinical setting), pharmacies, and suppliers, for medical equipment, medical supplies, complex rehabilitation technology (CRT), and related repair services.
   1. Providers pharmacies, and suppliers (including out-of-state providers, pharmacies, and suppliers) must:
      1. Be enrolled with medicare as a pharmacy, supplier of medical equipment, medical supplies, and related repair services, or as a CRT supplier (CRT suppliers must also comply with the requirements in WAC 182-543-4400); and
      2. Possess a national provider identifier (NPI) for a pharmacy, supplier of medical equipment, medical supplies, and related repair services, or CRT supplier.
   2. Prosthetics and orthotics providers, and occupational therapists providing orthotics, must meet the licensing regulations of the state in which they practice.
2. Providers and suppliers of medical equipment and supplies must:
   1. Meet the general provider requirements in chapter 182-502 WAC, except when the client is dual-eligible, medicare is the primary payer, and the agency is being billed only for one or more of the co-pay, coinsurance, or deductible;
   2. Have the proper business license and be certified, licensed and bonded if required, to perform the services billed to the agency;
   3. Have a valid prescription, which is referred to as a standard written order (SWO), for the medical equipment or supplies. A SWO is a written order communicated by the treating provider to the supplier that:
      1. 1. Is written by an authorized practitioner as defined in WAC 182-551-2010 and meets the face-to-face encounter requirements described in WAC 182-551-2040;
            1. Client's full name;
            2. Order date, which is the date the order was written or electronically signed by the treating practitioner;
            3. General item description, which may be either a general description (for example, wheelchair or hospital bed), a HCPCS code, a HCPCS code narrative, or a brand name or model number;
               1. For equipment, in addition to the base item description, the SWO may include all concurrently ordered options, accessories, or additional features that are separately billed or require an upgraded code (list each separately);
               2. For supplies, in addition to the base item description, the order/prescription may include all concurrently ordered supplies that are separately billed (list each separately);
            4. If applicable, the length of time the item is required; and 
            5. The name, NPI, and signature of the treating practitioner, practitioner credentials, and the signature date.
   4. Provide instructions for use of equipment;
   5. Provide only new equipment to clients, which include full manufacturer and dealer warranties. See WAC 182-543-2250(3);
   6. Provide documentation of proof of delivery, upon agency request (see WAC 182-543-2200); and
   7. Bill the agency using only the allowed procedure codes listed in the agency's published billing guides.