1. (1) The medicaid agency requires prior authorization for Level 1 and Level 2 long term acute care (LTAC) inpatient stays. The prior authorization process includes all the following:

   1. (a) For an initial 30-day stay:

      1. (i) The client must:

         1. (A) Be eligible under one of the programs listed in WAC 182-550-2575; and
         2. (B) Require Level 1 or Level 2 LTAC services as defined in WAC 182-550-1050.

      2. (ii) The LTAC provider of services must:

         1. (A) Before admitting the client to the LTAC hospital, submit a request for prior authorization to the agency as published in the agency's LTAC billing instructions;
         2. (B) Include sufficient medical information to justify the requested initial stay;
         3. (C) Obtain prior authorization from the agency's medical director or designee, when accepting the client from the transferring hospital; and
         4. (D) Meet all the requirements in WAC 182-550-2580.
   2. (b) For any extension of stay, the criteria in (a) of this subsection must be met, and the LTAC provider of services must submit a request for the extension of stay to the agency with sufficient medical justification.
2. (2) The agency authorizes Level 1 or Level 2 LTAC services for initial stays or extensions of stay based on the client's circumstances and the medical justification received.

3. (3) A client who does not agree with a decision regarding a length of stay has a right to an administrative hearing under chapter 182-526 WAC. After receiving a request for an administrative hearing, the agency may request additional information from the client and the facility, or both. After the agency reviews the available information, the result may be:

   1. (a) A reversal of the initial agency decision;
   2. (b) Resolution of the client's issue(s); or
   3. (c) An administrative hearing conducted according to chapter 182-526 WAC.

4. (4) The agency may authorize an administrative day rate payment, and pharmaceuticals, for a client who meets one or more of the following. The client:

   1. (a) Does not meet the requirements for Level 1 or Level 2 LTAC services;
   2. (b) Is waiting for placement in another hospital or other facility; or
   3. (c) If appropriate, is waiting to be discharged to the client's residence.

[Statutory Authority: RCW 41.05.021, 41.05.160, 74.09.520, and 2025 c 367. WSR 26-01-069, s 182-550-2590, filed 12/12/25, effective 1/12/26. Statutory Authority: RCW 35.05.353 (1)(c), 41.05.021, and 41.05.160. WSR 25-10-099, s 182-550-2590, filed 5/7/25, effective 6/7/25. Statutory Authority: RCW 41.05.021, 41.05.160, and 74.09.520(13). WSR 23-21-063, § 182-550-2590, filed 10/12/23, effective 1/1/24. Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-18-026, § 182-550-2590, filed 8/28/19, effective 9/28/19; WSR 15-18-065, § 182-550-2590, filed 8/27/15, effective 9/27/15. WSR 11-14-075, recodified as § 182-550-2590, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 08-21-039, § 388-550-2590, filed 10/8/08, effective 11/8/08; WSR 07-11-129, § 388-550-2590, filed 5/22/07, effective 8/1/07. Statutory Authority: RCW 74.08.090. WSR 02-14-162, § 388-550-2590, filed 7/3/02, effective 8/3/02.]