WAC 182-532-530 Family planning only program—Covered yearly exams

Effective September 1, 2013

  1. The medicaid agency covers one of the following services per client per year, as medically necessary:
    1. A cervical, vaginal, and breast cancer screening exam; or
    2. A comprehensive prevention visit for family planning. (Under a delayed pelvic protocol, the comprehensive prevention visit for family planning may be split into two visits, per client, per year.)
  2. The cervical, vaginal, and breast cancer screening exam:
    1. Must be:
      1. Provided following the guidelines of a nationally recognized protocol; and
      2. Conducted at the time of an office visit with a primary focus and diagnosis of family planning.
    2. May be billed by a provider other than a TAKE CHARGE provider.
  3. The comprehensive prevention visit for family planning:
    1. Must be provided by one or more qualified TAKE CHARGE trained providers. (See WAC 182-532-730.)
    2. Must include:
      1. A clinical breast examination and pelvic examination that follows the guidelines of a nationally recognized protocol; and
      2. Client-centered counseling that incorporates risk factor reduction for unintended pregnancy and anticipatory guidance about the advantages and disadvantages of all contraceptive methods.
    3. May include:
      1. A pap smear according to current, nationally recognized clinical guidelines; and
      2. For women ages thirteen through twenty-five, routine gonorrhea and chlamydia testing and treatment.
    4. Must be documented in the client's chart with detailed information that allows for a well-informed follow-up visit.
    5. Must be billed by a TAKE CHARGE provider only.

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.