# WAC 182-501-0060: WAC 182-501-0060. Health care coverage — Program benefit packages — Scope of service categories

> Washington · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0060

## Section

- **Citation:** WAC 182-501-0060
- **Heading:** WAC 182-501-0060. Health care coverage — Program benefit packages — Scope of service categories
- **Jurisdiction:** Washington
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Washington Administrative Code / Title 182 / Chapter 182-501 / Section 182-501-0060

## Text

(1) This rule provides a table that lists:
(a) The following Washington apple health programs:
(i) The alternative benefits plan (ABP) medicaid;
(ii) Categorically needy (CN) medicaid;
(iii) Medically needy (MN) medicaid; and
(iv) Medical care services (MCS) programs (includes incapacity-based and aged, blind, and disabled medical care services), as described in WAC 182-508-0005 ; and
(b) The benefit packages showing what service categories are included for each program.
(2) Within a service category included in a benefit package, some services may be covered and others noncovered.
(3) Services covered within each service category included in a benefit package:
(a) Are determined in accordance with WAC 182-501-0050 and 182-501-0055 when applicable.
(b) May be subject to limitations, restrictions, and eligibility requirements contained in agency rules.
(c) May require prior authorization (see WAC 182-501-0165 ), or expedited prior authorization when allowed by the agency.
(d) Are paid for by the agency or the agency's designee and subject to review both before and after payment is made. The agency or the client's managed care organization may deny or recover payment for such services, equipment, and supplies based on these reviews.
(4) The agency does not pay for covered services, equipment, or supplies that:
(a) Require prior authorization from the agency or the agency's designee, if prior authorization was not obtained before the service was provided;
(b) Are provided by providers who are not contracted with the agency as required under chapter 182-502 WAC;
(c) Are included in an agency or the agency's designee waiver program identified in chapter 182-515 WAC; or
(d) Are covered by a third-party payor (see WAC 182-501-0200 ), including medicare, if the third-party payor has not made a determination on the claim or has not been billed by the provider.
(5) Programs not addressed in the table:
(a) Medical assistance programs for noncitizens (see chapter 182-507 WAC); and
n an agency or the agency's designee waiver program identified in chapter 182-515 WAC; or
(d) Are covered by a third-party payor (see WAC 182-501-0200 ), including medicare, if the third-party payor has not made a determination on the claim or has not been billed by the provider.
(5) Programs not addressed in the table:
(a) Medical assistance programs for noncitizens (see chapter 182-507 WAC); and
(b) Family planning only programs (see WAC 182-532-500 through 182-532-570 );
(c) Postpartum and family planning extension (see WAC 182-523-0130 (4) and 182-505-0115 (5));
(d) Eligibility for pregnant minors (see WAC 182-505-0117 ); and
(e) Kidney disease program (see chapter 182-540 WAC).
(6) Scope of service categories. The following table lists the agency's categories of health care services.
(a) Under the ABP, CN, and MN headings, there are two columns. One addresses clients 20 years of age and younger, and the other addresses clients 21 years of age and older.
(b) The letter "Y" means a service category is included for that program. Services within each service category are subject to limitations and restrictions listed in the specific medical assistance program rules and agency issuances.
(c) The letter "N" means a service category is not included for that program.
(d) Refer to WAC 182-501-0065 for a description of each service category and for the specific program rules containing the limitations and restrictions to services
ervices within each service category are subject to limitations and restrictions listed in the specific medical assistance program rules and agency issuances.
(c) The letter "N" means a service category is not included for that program.
(d) Refer to WAC 182-501-0065 for a description of each service category and for the specific program rules containing the limitations and restrictions to services.
Service Categories ABP 20- ABP 21+ CN 1 20- CN 21+ MN 20- MN 21+ MCS Ambulance (ground and air) Y Y Y Y Y Y Y Applied behavior analysis (ABA) Y Y Y Y Y Y N Behavioral health services Y Y Y Y Y Y Y Blood/blood products/related services Y Y Y Y Y Y Y Dental services Y Y Y Y Y Y Y Diagnostic services (lab and X-ray) Y Y Y Y Y Y Y Early and periodic screening, diagnosis, and treatment (EPSDT) services Y N Y N Y N N Enteral nutrition program Y Y Y Y Y Y Y Habilitative services Y Y N N N N N Health care professional services Y Y Y Y Y Y Y Health homes Y Y Y Y N N N Hearing evaluations Y Y Y Y Y Y Y Hearing aids Y Y Y Y Y Y Y Home health services Y Y Y Y Y Y Y Home infusion therapy/parenteral nutrition program Y Y Y Y Y Y Y Hospice services Y Y Y Y Y Y N Hospital services Inpatient/outpatient Y Y Y Y Y Y Y Intermediate care facility/services for persons with intellectual disabilities Y Y Y Y Y Y Y Maternity care and delivery services Y Y Y Y Y Y Y Medical equipment, supplies, and appliances Y Y Y Y Y Y Y Medical nutrition therapy Y Y Y Y Y Y Y Nursing facility services Y Y Y Y Y Y Y Organ transplants Y Y Y Y Y Y Y Orthodontic services Y N Y N Y N N Out-of-state services Y Y Y Y Y Y N Outpatient rehabilitation services (OT, PT, ST) Y Y Y Y Y N Y Personal care services Y Y Y Y N N N Prescription drugs Y Y Y Y Y Y Y Private duty nursing Y Y Y Y Y Y N Prosthetic/orthotic devices Y Y Y Y Y Y Y Reproductive health services Y Y Y Y Y Y Y Respiratory care (oxygen) Y Y Y Y Y Y Y School-based medical services Y N Y N Y N N Vision care Exams, refractions, and fittings Y Y Y Y Y Y Y Vision hardware Frames and lenses Y N Y N Y N N
Service
Y Y Y Y N Y Personal care services Y Y Y Y N N N Prescription drugs Y Y Y Y Y Y Y Private duty nursing Y Y Y Y Y Y N Prosthetic/orthotic devices Y Y Y Y Y Y Y Reproductive health services Y Y Y Y Y Y Y Respiratory care (oxygen) Y Y Y Y Y Y Y School-based medical services Y N Y N Y N N Vision care Exams, refractions, and fittings Y Y Y Y Y Y Y Vision hardware Frames and lenses Y N Y N Y N N
Service Categories
ABP 20-
ABP 21+
CN 1 20-
CN 21+
MN 20-
MN 21+
MCS
Ambulance (ground and air)
Y
Y
Y
Y
Y
Y
Y
Applied behavior analysis (ABA)
Y
Y
Y
Y
Y
Y
N
Behavioral health services
Y
Y
Y
Y
Y
Y
Y
Blood/blood products/related services
Y
Y
Y
Y
Y
Y
Y
Dental services
Y
Y
Y
Y
Y
Y
Y
Diagnostic services (lab and X-ray)
Y
Y
Y
Y
Y
Y
Y
Early and periodic screening, diagnosis, and treatment (EPSDT) services
Y
N
Y
N
Y
N
N
Enteral nutrition program
Y
Y
Y
Y
Y
Y
Y
Habilitative services
Y
Y
N
N
N
N
N
Health care professional services
Y
Y
Y
Y
Y
Y
Y
Health homes
Y
Y
Y
Y
N
N
N
Hearing evaluations
Y
Y
Y
Y
Y
Y
Y
Hearing aids
Y
Y
Y
Y
Y
Y
Y
Home health services
Y
Y
Y
Y
Y
Y
Y
Home infusion therapy/parenteral nutrition program
Y
Y
Y
Y
Y
Y
Y
Hospice services
Y
Y
Y
Y
Y
Y
N
Hospital services Inpatient/outpatient
Y
Y
Y
Y
Y
Y
Y
Intermediate care facility/services for persons with intellectual disabilities
Y
Y
Y
Y
Y
Y
Y
Maternity care and delivery services
Y
Y
Y
Y
Y
Y
Y
Medical equipment, supplies, and appliances
Y
Y
Y
Y
Y
Y
Y
Medical nutrition therapy
Y
Y
Y
Y
Y
Y
Y
Nursing facility services
Y
Y
Y
Y
Y
Y
Y
Organ transplants
Y
Y
Y
Y
Y
Y
Y
Orthodontic services
Y
N
Y
N
Y
N
N
Out-of-state services
Y
Y
Y
Y
Y
Y
N
Outpatient rehabilitation services (OT, PT, ST)
Y
Y
Y
Y
Y
N
Y
Personal care services
Y
Y
Y
Y
N
N
N
Prescription drugs
Y
Y
Y
Y
Y
Y
Y
Private duty nursing
Y
Y
Y
Y
Y
Y
N
Prosthetic/orthotic devices
Y
Y
Y
Y
Y
Y
Y
Reproductive health services
Y
Y
Y
Y
Y
Y
Y
Respiratory care (oxygen)
Y
Y
Y
Y
Y
Y
Y
School-based medical services
Y
N
Y
N
Y
N
N
Vision care Exams, refractions, and fittings
Y
Y
Y
Y
Y
Y
Y
Vision hardware Frames and lenses
Y
N
Y
N
Y
N
N
1
Clients enroll
Y
Personal care services
Y
Y
Y
Y
N
N
N
Prescription drugs
Y
Y
Y
Y
Y
Y
Y
Private duty nursing
Y
Y
Y
Y
Y
Y
N
Prosthetic/orthotic devices
Y
Y
Y
Y
Y
Y
Y
Reproductive health services
Y
Y
Y
Y
Y
Y
Y
Respiratory care (oxygen)
Y
Y
Y
Y
Y
Y
Y
School-based medical services
Y
N
Y
N
Y
N
N
Vision care Exams, refractions, and fittings
Y
Y
Y
Y
Y
Y
Y
Vision hardware Frames and lenses
Y
N
Y
N
Y
N
N
1
Clients enrolled in the Washington apple health for kids and Washington apple health for kids with premium programs, which includes the children's health insurance program (CHIP), receive CN-scope of health care services.

## Nearby sections

- [WAC 182-501-0050 WAC 182-501-0050. Health care general coverage](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0050.md)
- [WAC 182-501-0055 WAC 182-501-0055. Health care coverage — How the agency determines coverage of services for its health care programs using health technology assessments](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0055.md)
- [WAC 182-501-0060 WAC 182-501-0060. Health care coverage — Program benefit packages — Scope of service categories](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0060.md)
- [WAC 182-501-0065 WAC 182-501-0065. Health care coverage — Description of service categories](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0065.md)
- [WAC 182-501-0070 WAC 182-501-0070. Health care coverage — Noncovered services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0070.md)
- [WAC 182-501-0100 WAC 182-501-0100. Subrogation](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0100.md)
- [WAC 182-501-0125 WAC 182-501-0125. Advance directives](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0125.md)
- [WAC 182-501-0135 WAC 182-501-0135. Patient review and coordination (PRC)](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0135.md)
- [WAC 182-501-0160 WAC 182-501-0160. Exception to rule—Request for a noncovered health care service](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0160.md)
- [WAC 182-501-0163 WAC 182-501-0163. Health care coverage — Process for submitting a valid request for authorization](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0163.md)
- [WAC 182-501-0165 WAC 182-501-0165. Medical and dental coverage — Fee-for-service (FFS) prior authorization — Determination process for payment](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0165.md)
- [WAC 182-501-0169 WAC 182-501-0169. Health care coverage — Limitation extension](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0169.md)
- [WAC 182-501-0175 WAC 182-501-0175. Medical care provided in bordering cities](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0175.md)
- [WAC 182-501-0180 WAC 182-501-0180. Health care services provided outside the state of Washington — General provisions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0180.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_501_0060. Check the current official text before relying on it. Not legal advice.