1. (1) The medicaid agency pays for the covered community health worker (CHW) services described in this chapter when they are:

   1. (a) Initiated and recommended by a physician or other licensed practitioner of the healing arts, as specified in 42 C.F.R. 440.130;
   2. (b) Provided and billed according to the agency's community health worker (CHW) services billing guide; and
   3. (c) Documented in the client's record or chart per WAC 182-562-0900.
2. (2) The agency pays providers for covered services provided to eligible clients using the agency's published fee schedule.
3. (3) The agency uses the appropriate payment methodology found in WAC 182-531-1850 for community health worker services.
4. (4) For children age 20 and younger, providers must follow the rules for the early periodic screening, diagnosis, and treatment (EPSDT) program. See chapter 182-534 WAC. EPSDT is defined under WAC 182-500-0030.

[Statutory Authority: RCW 41.05.021, 41.05.160, and 2024 c 376 s 211(43). WSR 25-06-056, s 182-562-1000, filed 2/28/25, effective 7/1/25.]