# WAC 182-550-1100: WAC 182-550-1100. Hospital care — General > Washington · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1100 ## Section - **Citation:** WAC 182-550-1100 - **Heading:** WAC 182-550-1100. Hospital care — General - **Jurisdiction:** Washington - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Washington Administrative Code / Title 182 / Chapter 182-550 / Section 182-550-1100 ## Text (1) The medicaid agency: (a) Pays for an eligible Washington apple health client's admission to a hospital only when the client's attending physician orders admission and when the admission and treatment provided: (i) Are covered under WAC 182-501-0050 , 182-501-0060 and 182-501-0065 ; (ii) Are medically necessary as defined in WAC 182-500-0070 ; (iii) Are determined according to WAC 182-501-0165 when prior authorization is required; (iv) Are authorized when required under this chapter; and (v) Meet applicable state and federal requirements. (b) For hospital admissions, defines "attending physician" as the client's primary care provider, or the primary provider of care to the client at the time of admission. (2) Medical record documentation of hospital services must meet the requirements in WAC 182-502-0020 . (3) The agency pays for a hospital covered service provided to an eligible apple health client enrolled in an agency-contracted managed care organization (MCO) plan, under the fee-for-service program if the service is excluded from the MCO's capitation contract with the agency and meets prior authorization requirements. (See WAC 182-550-2600 for inpatient psychiatric services.) (4) The agency pays up to 26 days of inpatient hospital care for hospital-based withdrawal management, medical stabilization, and drug treatment for chemical dependent pregnant clients eligible under the substance-using pregnant people (SUPP) program. See WAC 182-533-0701 through 182-533-0730 . (5) The agency pays for inpatient hospital withdrawal management of acute alcohol or other drug intoxication when the services are provided to an eligible client: (a) In a withdrawal management unit in a hospital that has a withdrawal management provider agreement with the agency to perform these services and the services are approved by the division of behavioral health and recovery (DBHR) within the health care authority (HCA); or (b) In an acute hospital and all the following criteria are met: ication when the services are provided to an eligible client: (a) In a withdrawal management unit in a hospital that has a withdrawal management provider agreement with the agency to perform these services and the services are approved by the division of behavioral health and recovery (DBHR) within the health care authority (HCA); or (b) In an acute hospital and all the following criteria are met: (i) The hospital does not have a withdrawal management specific provider agreement with DBHR; (ii) The hospital provides the care in a medical unit; (iii) Nonhospital-based withdrawal management is not medically appropriate for the client; (iv) The client does not require medically necessary inpatient psychiatric care and it is determined that an approval from the agency or the agency's designee as an inpatient stay is not indicated; (v) The client's stay qualifies as an inpatient stay; (vi) The client is not participating in the agency's substance-using pregnant people (SUPP) program; and (vii) The client's principal diagnosis meets the agency's medical inpatient withdrawal management criteria listed in the agency's published billing instructions. (6) The agency covers medically necessary dental-related services provided to an eligible client in a hospital-based dental clinic when the services: (a) Are provided under chapter 182-535 WAC; and (b) Are billed on the American Dental Association (ADA) or health care financing administration (HCFA) claim form. (7) The agency pays a hospital for covered dental-related services, including oral and maxillofacial surgeries, that are provided in the hospital's operating room, when: (a) The covered dental-related services are medically necessary and provided under chapter 182-535 WAC; (b) The covered dental-related services are billed on a UB claim form; and (c) At least one of the following is true: im form. (7) The agency pays a hospital for covered dental-related services, including oral and maxillofacial surgeries, that are provided in the hospital's operating room, when: (a) The covered dental-related services are medically necessary and provided under chapter 182-535 WAC; (b) The covered dental-related services are billed on a UB claim form; and (c) At least one of the following is true: (i) The dental-related service(s) is provided to an eligible apple health client on an emergency basis; (ii) The client is eligible under the division of developmental disability program; (iii) The client is age eight or younger; or (iv) The dental service is prior authorized by the agency. (8) For inpatient voluntary or involuntary psychiatric admissions, see WAC 182-550-2600 . (9) For clients age 20 and younger, see the early periodic screening, diagnosis, and treatment (EPSDT) program described in chapter 182-534 WAC. ## Nearby sections - [WAC 182-550-1000 WAC 182-550-1000. Applicability](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1000.md) - [WAC 182-550-1050 WAC 182-550-1050. Hospital services definitions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1050.md) - [WAC 182-550-1100 WAC 182-550-1100. Hospital care — General](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1100.md) - [WAC 182-550-1200 WAC 182-550-1200. Restrictions on hospital coverage](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1200.md) - [WAC 182-550-1300 WAC 182-550-1300. Revenue code categories and subcategories](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1300.md) - [WAC 182-550-1350 WAC 182-550-1350. Revenue code categories and subcategories — CPT and HCPCS reporting requirements for outpatient hospitals](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1350.md) - [WAC 182-550-1400 WAC 182-550-1400. Covered and noncovered revenue code categories and subcategories for inpatient hospital services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1400.md) - [WAC 182-550-1500 WAC 182-550-1500. Covered and noncovered revenue code categories and subcategories for outpatient hospital services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1500.md) - [WAC 182-550-1600 WAC 182-550-1600. Specific items/services not covered](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1600.md) - [WAC 182-550-1650 WAC 182-550-1650. Adverse events, hospital-acquired conditions, and present on admission indicators](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1650.md) - [WAC 182-550-1700 WAC 182-550-1700. Authorization and utilization review (UR) of inpatient and outpatient hospital services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1700.md) - [WAC 182-550-1800 WAC 182-550-1800. Hospital specialty services not requiring prior authorization](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1800.md) - [WAC 182-550-1900 WAC 182-550-1900. Transplant coverage](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1900.md) - [WAC 182-550-2100 WAC 182-550-2100. Requirements — Transplant facilities](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_2100.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_182_550_1100. Check the current official text before relying on it. Not legal advice.