WAC 246-130-020   What early intervention program services are available?  Services to treat HIV are available from the department, based on available funding, to eligible clients as described in this section.

     (1) The department decides what specific medical, laboratory, dental, prescription medication and insurance services to cover after actively consulting with its steering committee and considering:

     (a) Support of the steering committee;

     (b) FDA approval for prescription medications;

     (c) Standard of care recognized by the medical community;

     (d) Effectiveness in treatment for HIV, complications of HIV, side effects of current treatments for HIV or support for HIV treatment adherence; and

     (e) Relative cost of services.

     (2) The early intervention program services described in this section are available to all clients, unless they receive those services from other sources. Specific services of this section are available for a client only when medically necessary to treat HIV and associated diseases, complications of treating HIV, or support for HIV treatment adherence.

     (3) Specific covered medical, laboratory, and dental services are listed in the department's "schedule of services."

     (4) Prescription drugs covered are listed in the department's "early intervention drug formulary."

     (5) HIV insurance program includes:

     (a) Premium payment or assistance as authorized in RCW 43.70.670;

     (b) Deductible payment up to a limit determined by the early intervention program within a twelve-month period; and

     (c) Co-pay payment for third-party insurance as follows:

     (i) The percentage of prescription medication costs covered by the department and not covered by third-party insurers; and

     (ii) Fixed dollar co-pay required by a client's third-party insurance plan for prescription medication covered by the early intervention program.

     (6) Medicare premium assistance will pay premiums, copayment and deductibles for early intervention program clients on medicare who request assistance for the prescription drug program.

     (7) The department may also coordinate other services to treat HIV and AIDS. These are available as funding and contracting permit. For example, as of July 1, 2000, the department may pay toward the spend-down for medically needy (MN) clients who are also early intervention program clients.

     (8) The early intervention program will provide written notification to clients, providers, and the steering committee at least thirty days in advance of any reduction in service or payments.

     (9) You may contact the department per WAC 246-130-090 to make comments on service coverage or to receive information.



[Statutory Authority: RCW 43.70.670. 05-23-100, § 246-130-020, filed 11/17/05, effective 12/18/05. Statutory Authority: RCW 43.70.040 and 43.70.120. 00-19-117, § 246-130-020, filed 9/20/00, effective 10/21/00; 95-23-018, § 246-130-020, filed 11/7/95, effective 12/8/95. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-130-020, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.70.120. 90-17-087 (Order 071), § 248-168-020, filed 8/17/90, effective 9/17/90. Statutory Authority: RCW 43.20A.550. 87-22-012 (Order 2549), § 248-168-020, filed 10/26/87.]