The medicaid agency does not pay for an inpatient or outpatient hospital service, treatment, equipment, drug, or supply that is not listed or referred to as a covered service in this chapter. The following list of noncovered items and services is not intended to be all-inclusive. Noncovered items and services include, but are not limited to:

1. (1) Personal care items such as, but not limited to, slippers, toothbrush, comb, hair dryer, and make-up;
2. (2) Telephone/telegraph services or television/radio rentals;
3. (3) Medical photographic or audio/videotape records;
4. (4) Crisis counseling;
5. (5) Psychiatric day care;
6. (6) Ancillary services, such as respiratory and physical therapy, performed by regular nursing staff assigned to the floor or unit;
7. (7) Standby personnel and travel time;
8. (8) Routine hospital medical supplies and equipment such as bed scales;
9. (9) Handling fees and portable X-ray charges;
10. (10) Room and equipment charges ("rental charges") for use periods concurrent with another room or similar equipment for the same client;
11. (11) Cafeteria charges; and
12. (12) Services and supplies provided to nonpatients, such as meals and "father packs."

[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-18-065, § 182-550-1600, filed 8/27/15, effective 9/27/15. WSR 11-14-075, recodified as § 182-550-1600, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-14-018, § 388-550-1600, filed 6/22/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-1600, filed 12/18/97, effective 1/18/98.]