Original Notice.

Expedited Adoption -- Proposed rule-making notice was filed as WSR 00-18-033.

Title of Rule: WAC 388-502-0010 Payment -- Eligible providers defined and 388-502-0020 General requirements for providers.

Purpose: To correct terminology and delete unnecessary requirements.

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

Statute Being Implemented: RCW 74.08.090, 74.09.500, 74.09.530.

Summary: Medical Assistance Administration (MAA) is correcting terminology in WAC 388-502-0010 and adding pharmacists to the list of eligible providers; and amending WAC 388-502-0020 to remove the requirement that providers include a signed statement each time they bill Medical Assistance Administration; and to remove a subsection that prohibits providers from paying third-party billers a percentage of amounts collected.

Name of Agency Personnel Responsible for Drafting: Leslie Saeger, P.O. Box 45533, Olympia, WA 98504, (360) 725-1347; Implementation and Enforcement: Ann Lawrence, P.O. Box 45533, Olympia, WA 98504, (360) 725-1347.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The proposed amendments will correct terminology; allow pharmacists to enroll as MAA providers; remove unnecessary requirements that providers must submit a signed statement with every bill; and remove the subsection that disallows providers to pay third-party billers on a percentage basis.

Proposal Changes the Following Existing Rules: WAC 388-502-0010 correcting terminology, adds pharmacists to the list of professionals who can enroll with DSHS to provide services to MAA clients.

     WAC 388-502-0020, removes the requirement that providers must submit a signed statement with every bill. Removes the subsection that restricts providers from paying third-party billers on a percentage basis.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rules an concluded that they do not add a financial burden to the businesses affected by them.

RCW 34.05.328 does not apply to this rule adoption. The proposed rules qualify as significant legislative rules. Therefore, MAA has analyzed the probable costs and the probable benefits of the proposed rules, taking into account both the qualitative and quantitative benefits and costs. MAA's analysis revealed that no new costs will be imposed, existing costs will not be increased, and benefits to businesses will increase. MAA has prepared the cost/benefit analysis as required by RCW 34.05.328.

Hearing Location: Blake Office Building East, 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on January 9, 2001, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Kelly Cooper, Rules Coordinator, by January 2, 2001, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopeKD@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by January 9, 2001.

Date of Intended Adoption: No sooner than January 10, 2001.

December 4, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

     (1) To be eligible for enrollment, a provider must:

     (a) Be licensed, certified, accredited, or registered according to Washington state laws and rules; and

     (b) Meet the conditions in this chapter and chapters regulating the specific type of provider, program, and/or service.

     (2) To enroll, an eligible provider must sign a core provider agreement or a contract with the department and receive a unique provider number.

     (3) Eligible providers listed in this subsection may request enrollment. Out-of-state providers listed in this subsection are subject to conditions in WAC 388-502-0120.

     (a) Professionals:

     (i) Advanced registered nurse practitioners;

     (ii) Anesthesiologists;

     (iii) Audiologists;

     (iv) Chiropractors;

     (v) Dentists;

     (vi) Dental hygienists;

     (vii) Denturists;

     (viii) Dietitians or nutritionists;

     (xiv) Maternity case managers;

     (x) Midwives;

     (xi) Occupational therapists;

     (xii) Ophthalmologists;

     (xiii) Opticians;

     (xiv) Optometrists;

     (xv) Orthodontists;

     (xvi) ((Osteopaths)) Osteopathic physicians;

     (xvii) Podiatric physicians;

     (xviii) Pharmacists

     (xix) Physicians;

     (((xix))) (xx) Physical therapists;

     (((xx))) (xxi) Psychiatrists;

     (((xxi))) (xxii) Psychologists;

     (((xxii))) (xxiii) Registered nurse delegators;

     (((xxiii))) (xxiv) Registered nurse first assistants;

     (((xxiv))) (xxv) Respiratory therapists;

     (((xxv))) (xxvi) Speech/language pathologists;

     (((xxvi))) (xvii) Radiologists; and

     (((xvii))) (xviii) Radiology technicians (technical only);

     (b) Agencies, centers and facilities:

     (i) Adult day health centers;

     (ii) ((Ambulatory)) Ambulance services (ground and air);

     (iii) Ambulatory surgery centers (Medicare-certified);

     (iv) Birthing centers (licensed by the department of health);

     (v) Blood banks;

     (vi) Chemical dependency treatment facilities certified by the department of social and health services (DSHS) division of alcohol and substance abuse (DASA), and contracted through either:

     (A) A county under chapter 388-810 WAC; or

     (B) DASA to provide chemical dependency treatment services;

     (vii) Centers for the detoxification of acute alcohol or other drug intoxication conditions (certified by DASA);

     (viii) Community AIDS services alternative agencies;

     (ix) Community mental health centers;

     (x) Early and periodic screening, diagnosis, and treatment (EPSDT) clinics;

     (xi) Family planning clinics;

     (xii) Federally qualified health care centers (designated by the Federal Health Care Financing Administration);

     (xiii) Genetic counseling agencies;

     (xiv) Health departments;

     (xv) HIV/AIDS case management;

     (xvi) Home health agencies;

     (xvii) Hospice agencies;

     (xviii) Hospitals;

     (xix) Indian Health Service;

     (xx) Tribal or urban Indian clinics;

     (xxi) Inpatient psychiatric facilities;

     (xxii) Intermediate care facilities for the mentally retarded (ICF-MR);

     (xxiii) Kidney centers;

     (xxiv) Laboratories (CLIA certified);

     (xxv) Maternity support services agencies;

     (xxvi) Neuromuscular and neurodevelopmental centers;

     (xxvii) Nursing facilities (approved by DSHS Aging and Adult Services);

     (xxviii) Pharmacies;

     (xxix) Private duty nursing agencies;

     (xxx) Rural health clinics (Medicare-certified);

     (xxxi) Tribal mental health services (contracted through the DSHS mental health division); and

     (xxxii) Washington state school districts and educational service districts.

     (c) Suppliers of:

     (i) Durable and nondurable medical equipment and supplies;

     (ii) Infusion therapy equipment and supplies;

     (iii) Prosthetics/orthotics;

     (iv) Hearing aids; and

     (v) Oxygen equipment and supplies;

     (d) Contractors of:

     (i) Transportation brokers;

     (ii) Interpreter services agencies; and

     (iii) Eyeglass and contact lens providers.

     (4) Nothing in this chapter precludes the department from entering into other forms of written agreements to provide services to eligible clients.

     (5) The department does not enroll licensed or unlicensed practitioners who are not specifically addressed in subsection (3) of this section, including, but not limited to:

     (a) Acupuncturists;

     (b) Counselors;

     (c) Sanipractors;

     (d) Naturopaths;

     (e) Homeopaths;

     (f) Herbalists;

     (g) Massage therapists;

     (h) Social workers; or

     (i) Christian Science practitioners or theological healers.

[Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.530.      00-15-050, § 388-502-0010, filed 7/17/00, effective 8/17/00.]

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

     (j))) (h) 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))) (i) 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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