WAC 182-531-1710 Screening, brief intervention, and referral to treatment (SBIRT).

Revised January 1, 2026

1. The medicaid agency covers alcohol and substance misuse counseling through screening, brief intervention, and referral to treatment (SBIRT) services when delivered by, or under the supervision of, a qualified licensed physician or other qualified licensed health care professional within the scope of their practice.
2. SBIRT is a comprehensive, evidence-based public health practice designed to identify, reduce and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. SBIRT can be used to identify people who are at risk for or have some level of substance use disorder which can lead to illness, injury, or other long-term morbidity or mortality. SBIRT services are provided in a wide variety of medical and community health care settings such as primary care centers, hospital emergency rooms, trauma centers, and dental offices.
3. The following health care professionals are eligible to become qualified SBIRT providers to deliver SBIRT services or supervise qualified staff to deliver SBIRT services:
   1. Advanced registered nurse practitioners, in accordance with chapters 18.79 RCW and 246-840 WAC;
   2. Certified behavioral health support specialist, in accordance with chapters 18.227 RCW and 246-821 WAC;
   3. Dental hygienist, in accordance with chapters 18.29 RCW and 246-815 WAC;
   4. Dentist, in accordance with chapters 18.260 RCW and 246-817 WAC;
   5. Independent and advanced social worker, in accordance with chapters 18.225 RCW and 246-809 WAC;
   6. Licensed practical nurse, in accordance with chapters 18.79 RCW and 246-840 WAC;
   7. Marriage and family therapists, in accordance with chapters 18.225 RCW and 246-809 WAC;
   8. Mental health counselor, in accordance with chapters 18.225 RCW and 246-809 WAC;
   9. Mental health counselor associate, in accordance with chapters 18.225 RCW and 246-809 WAC;
   10. Psychological associate, in accordance with chapters 18.83 RCW and 246-924 WAC;
   11. Psychologist, in accordance with chapters 18.83 RCW and 246-924 WAC;
   12. Physicians, in accordance with chapters 18.71 RCW and 246-919 WAC;
   13. Physician assistants, in accordance with chapters 18.71A RCW and 246-918 WAC;
   14. Registered nurse, in accordance with chapters 18.79 RCW and 246-840 WAC; and
   15. Substance use disorder professional (SUDP), in accordance with chapters 18.205 RCW and 246-811 WAC
4. To become a qualified SBIRT provider, eligible licensed health care professionals must:
   1. Complete agency-approved SBIRT training and mail or fax the SBIRT training certificate or other proof of this training completion to the agency; or
   2. Have an addiction specialist certification and mail or fax proof of this certification to the agency.
5. The agency pays for SBIRT as follows:
   1. Screenings, which are included in the reimbursement for the evaluation and management code billed;
   2. Brief interventions, limited to four sessions per client, per provider, per calendar year; and
   3. When billed by one of the following qualified SBIRT health care professionals:
      1. Advanced registered nurse practitioner;
      2. Dental hygienist;
      3. Dentist;
      4. Independent and advanced social worker;
      5. Marriage and family therapist;
      6. Mental health counselor;
      7. Physician; and
      8. Psychologist
6. The agency evaluates a request for additional sessions in excess of the limitations or restrictions according to WAC 182-501-0169.
7. To be paid for providing alcohol and substance misuse counseling through SBIRT, providers must bill the agency using the agency's published billing instructions.

WAC 388-79A-015 Procedure for allowing guardianship fees and related costs from client participation before June 1, 2018.

Revised June 1, 2018

1. This section describes the procedure for allowing guardianship fees and related costs from client participation when:
   1. A court order was entered before June 1, 2018; and
   2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
2. The medicaid agency or the agency's designee, after receiving the court order, adjusts the client's current participation to reflect the amounts, as allowed under WAC 182-513-1380, 183-515-1509, or 183-515-1514.
3. A client's participation cannot be prospectively or retrospectively reduced to pay guardianship fees and related costs incurred:
   1. Before the client's long-term care medicaid eligibility effective date;
   2. During any time when the client was not eligible for or did not receive long-term care services; or
   3. After the client has died.
4. The fees and costs allowed by the court at the final accounting must not exceed the amounts advanced and paid to the guardian from the client's participation if:
   1. The court, at a prior accounting, allowed the guardian to receive guardianship fees and related costs from the client's participation in advance of services rendered by the guardian; and
   2. The client dies before the next accounting.

WAC 388-79A-010 Maximum guardianship fees and related costs before June 1, 2018

Revised June 1, 2018

1. This section sets the maximum guardianship fees and related costs when:
   1. The court order was entered before June 1, 2018; and
   2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
2. For court orders entered before June 1, 2018, where the order establishes or continues a legal guardianship for a client:
   1. Guardianship fees must not exceed $175 per month;
   2. Costs directly related to establishing a guardianship for a client must not exceed $700; and
   3. Costs to maintain the guardianship must not exceed $600 during any three-year period.

WAC 388-79A-005 Maximum amount of guardianship fees and related costs for a long-term care medicaid eligible client.

Revised March 8, 2019

1. As mandated by RCW 43.20B.460 and in accordance with RCW 11.92.180, the maximum amount of guardianship fees and related costs must not exceed the limits of this section when the person under guardianship is:
   1. A medicaid eligible client, residing in:
      1. A medical institution, as defined under WAC 182-500-0050;
      2. An alternate living facility (ALF), as defined under WAC 182-513-1100; or
      3. An at-home setting; and
   2. Required under chapter 182-513 WAC or chapter 182-515 WAC to participate towards the cost of long-term care.
2. The maximum amount of guardianship fees and related costs must not exceed the limits of WAC 388-79A-010​ when:
   1. The most recent court order establishing or continuing a guardianship was entered before June 1, 2018; and
   2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
3. For all other clients not described under subsection (2) of this section, the maximum amount of guardianship fees and related costs must not exceed the limits under WAC 182-513-1530.

WAC 388-79A-001 Definitions.

Revised June 1, 2018

The following definitions apply to this chapter:

1. "Client" means a person who is eligible for and is receiving Medicaid-funded long-term care.
2. "Guardianship fees" or "fees" means necessary fees charged by a guardian for services rendered on behalf of a client.
3. "Participate" or "participation" means the amount a client must pay each month toward the cost of long-term care services received each month. It is the amount remaining after the post-eligibility process under:
   1. WAC 182-513-1380 for a client residing in a medical institution, as defined under WAC 182-500-0050;
   2. WAC 182-515-1509 for a client receiving home and community services (HCS) waivered services in an alternate living facility (ALF), as defined under WAC 182-513-1100, or in an at-home setting; or
   3. WAC 182-515-1514 for a client receiving Developmental Disabilities Community Services (DDCS) waivered services in an ALF, as defined under WAC 182-513-1100, or in an at-home setting.
4. "Related costs" or "costs" means necessary costs paid by the guardian, including attorney fees.

WAC 182-513-1530 Maximum guardianship fee and related cost de­ductions allowed from a client's participation or room and board on or after June 1, 2018.

Revised March 1, 2025

1. General information.
   1. This section sets the maximum guardianship or conservatorship fee and related cost deductions when:
      1. A court order was entered on or after June 1, 2018; or
      2. The client under guardianship or conservatorship began receiving medicaid-fun­ded long-term services and supports on or after June 1, 2018.
   2. This section only applies to a client who is:
      1. Eligible for and receives institutional services under this chap­ter or home and community-based waiver services under chapter 182-515 WAC, and who is required to pay participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Eligible for long-term services and supports under this chapter or chapter 182-515 WAC, and who is required to pay only room and board.
   3. All requirements of this section remain in full force whether or not the agency appears at a guardianship or conservatorship proceeding.
   4. In this section, the agency does not delegate any authority in determining eligibility or post-eligibility for medicaid clients.
      1. Under the authority granted by chapter 11.130 RCW, the agency does not deduct more than the amounts allowed by this section from partici­pation or room and board.
      2. The eligibility rules under Title 182 WAC remain in full force and effect.
   5. The agency does not reduce a client's participation or room and board under this section for guardianship or conservatorship fees or related costs accumulated during any month that a client was not required to pay:
      1. Participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Room and board under this chapter or chapter 182-515 WAC.
   6. If the client has another fiduciary, payee, or other princi­pal-agency relationship and the agent is allowed compensation, any monthly guardianship or conservatorship fee approved under this section is reduced by the agent's compensation.
2. Maximum guardianship fee and related cost deductions.
   1. The maximum guardianship or conservatorship fee and related cost deductions un­der this section include all guardianship or conservatorship services provided to the client, regardless of the number of guardians or conservators appointed to a client during a period of time, or whether the client has multiple guardians appointed at the same time.
   2. Maximum guardianship or conservatorship fees and related cost deductions are as follows:
      1. The total deduction for costs directly related to establish­ing a guardianship or conservatorship for a client cannot exceed $1,850;
      2. The total deduction for all guardianship and conservatorship-related costs cannot exceed $1,200 during any three-year period; and
      3. The amount of the monthly deduction for all guardianship and conservatorship fees cannot exceed $235 per month.
3. For people under subsection (1)(b)(i) of this section – Par­ticipation deductions.
   1. After receiving the court order, the agency or its designee adjusts the client's current participation to reflect the deductions under WAC 182-513-1380, 182-515-1509, or 182-515-1514.
   2. The amounts of the participation deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.
   3. For clients who pay room and board in addition to participa­tion, if the client's amount of participation is insufficient to allow for the amounts under subsection (2) of this section, then, regardless of any provision of this chapter or chapter 182-515 WAC, the client's room and board will be adjusted to allow the amounts under subsection (2) of this section.
4. For people under subsection (1)(b)(ii) of this section - Room and board deductions.
   1. The agency adjusts the client's room and board after receiv­ing the court order, regardless of any provision of this chapter or chapter 182-515 WAC.
   2. The amounts of the room and board deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.