Date of Adoption: August 16, 2000.

Purpose: To correct a recently adopted rule (WAC 388-502-0020 General requirements for providers) which was filed as WSR 00-15-050. This will rescind a requirement that MAA providers include a specific signed statement with each request for payment. This is no longer required and is not possible with MAA's electronic billing system. MAA will begin the expedited adoption process to permanently amend this rule.

Citation of Existing Rules Affected by this Order: Amending WAC 388-502-0020.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.500, 74.09.530.

Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.

Reasons for this Finding: In a recent adoption, MAA required people who provide services/equipment to MAA clients (providers) to include a certification with their bills as a condition of payment. This is impossible when using MAA's electronic billing system. MAA must remove this requirement immediately so providers can be reimbursed for the services/equipment they furnish (and continue to serve MAA clients).

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 1, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0. Effective Date of Rule: August 17, 2000, immediately after the permanent rule (filed as WSR 00-15-050) becomes effective.

August 16, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

(1) Enrolled providers must:

     (a) Keep legible, accurate, and complete charts and records to justify the services provided to each client, including, but not limited to:

     (i) Patient's name and date of birth;

     (ii) Dates of services;

     (iii) Name and title of person performing the service, if other than the billing practitioner;

     (iv) Chief complaint or reason for each visit;

     (v) Pertinent medical history;

     (vi) Pertinent findings on examination;

     (vii) Medications, equipment, and/or supplies prescribed or provided;

     (viii) Description of treatment (when applicable);

     (ix) Recommendations for additional treatments, procedures, or consultations;

     (x) X-rays, tests, and results;

     (xi) Dental photographs and teeth models;

     (xii) Plan of treatment and/or care, and outcome; and

     (xiii) Specific claims and payments received for services.

     (b) Assure charts are authenticated by the person who gave the order, provided the care, or performed the observation, examination, assessment, treatment or other service to which the entry pertains;

     (c) Make charts and records available to DSHS, its contractors, and the US Department of Health and Human Services upon request, for six years from the date of service or longer if required specifically by federal or state law or regulation;

     (d) Bill the department according to department rules and billing instructions;

     (e) ((Include and sign the following statement with each bill submitted to the department for reimbursement: "I hereby certify under penalty of perjury, that the material furnished and service rendered is a correct charge against the state of Washington; the claim is just and due; that no part of the same has been paid and I am authorized to sign for the payee; and that all goods furnished and/or services rendered have been provided without discrimination on the grounds of race, creed, color, sex, religion, national origin, marital status, or the presence of any sensory, mental or physical handicap."

     (f))) Accept the payment from the department as payment in full;

     (((g))) (f) Follow the requirements in WAC 388-502-0160 and 388-538-095 about billing clients;

     (((h))) (g) Fully disclose ownership and control information requested by the department;

     (((i))) (h) Not pay a third party biller a percentage of amounts collected, or discount client accounts to a third party biller;

     (((j))) (i) Provide all services without discriminating on the grounds of race, creed, color, age, sex, religion, national origin, marital status, or the presence of any sensory, mental or physical handicap; and

     (((k))) (j) Provide all services according to federal and state laws and rules, and billing instructions issued by the department.

     (2) A provider may contact MAA with questions regarding its programs.      However, MAA's response is based solely on the information provided to MAA's representative at the time of inquiry, and in no way exempts a provider from following the laws and rules that govern the department's programs.

[Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.530.      00-15-050, § 388-502-0020, filed 7/17/00, effective 8/17/00.]

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