Apple Health (Medicaid) Provider Alert
The Health Care Authority (HCA) has revised the voluntary services attestation section of the Authorization of Secure Ambulance Transportation to/from Behavioral Health Services (HCA 42-0003) form. Effective immediately, HCA no longer requires an assessment conducted by a designated crisis responder (DCR) to be performed for individuals seeking voluntary behavioral health (BH) services.
What does this mean for providers?
For the purposes of continuity of care, the HCA 42-0003 form has been revised as follows:
- If an individual is assessed by an emergency department (ED) physician/attending physician, and is determined to meet the criteria for voluntary services, the physician would be the medical professional signing the voluntary attestation section of the form.
- If an individual is assessed by an ED physician/attending physician, and is determined not to meet the criteria for voluntary services, the physician would contact a DCR to initiate the process for involuntary services pursuant to Chapter 71.05 and 71.34 RCW. The DCR would be the medical professional signing the DCR attestation section of the form.
Amended Form The revised HCA 42-0003 form can be found on the agency’s Forms and Publications website.
Who do I contact if I have questions?
For more information, contact Shauna James, Ambulance Program Manager.
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