Apple Health (Medicaid) forms related to Medical Equipment and Supplies and Outpatient Rehabilitation

Washington State Health Care Authority sent this bulletin at 06/17/2024 11:04 AM PDT

June 17, 2024

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Apple Health (Medicaid) Provider Alert

Attention providers: Apple Health (Medicaid) client forms required for certain Medical Equipment and Supplies and Outpatient Rehabilitation Extension Requests are available for use.

Prior Authorization and equipment proof of delivery requirements

HCA has updated Apple Health (Medicaid) client forms related to Medical Equipment and Supplies and Outpatient Rehabilitation. Forms can be found at Forms and publications | Washington State Health Care Authority. The following forms have been updated and are available for use:

HCA Prescription / Standard Written Order Form 13-794
Outpatient Rehabilitation Limitation Extension Request Form 13-786
Hospital Bed Evaluation Form 13-747
Bathroom Equipment Form 13-872
Speech & Language Pathologist Evaluation for Speech Generating Device Form 13-0127

Billing Guide and Fee Schedule

HCA will revise the Medical Equipment & Supplies Billing Guide to reflect this change. See HCA’s Provider billing guides and fee schedules, under Medical Equipment & Supplies effective July 1, 2024.

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Apple Health (Medicaid) forms related to Medical Equipment and Supplies and Outpatient Rehabilitation

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination