PREPROPOSAL STATEMENT OF INQUIRY
LABOR AND INDUSTRIES
Subject of Possible Rule Making: Revise chapter 296-20 WAC, General rules; chapter 296-23 WAC, Reimbursement policies; chapter 296-23A WAC, Hospitals and/or possibly a new chapter 296-23B or 296-23C WAC to allow reimbursement of selected outpatient services and supplies through a prospective payment system.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 51.04.020 and 51.04.030.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Pursuant to the above statutes, the Department of Labor and Industries (L&I) establishes and adopts rules governing administration of the industrial insurance laws. The purpose of the proposed rule changes is to allow the department to implement an outpatient prospective payment system (OPPS) in order to better manage outpatient expenditures, improve consistency of payment policies, improve consistency between payment levels and actual costs of service, establish greater uniformity between state agencies regarding reimbursement methodologies, allow for greater analysis and prediction of utilization and costs, and allow for rate adjustments to be based on more consistent and applicable data.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: L&I is working in coordination with the Health Care Authority (HCA) and the Department of Social and Health Services/Medical Assistance Administration (MAA) to develop and implement an OPPS system and develop rules. L&I is coordinating with MAA in drafting OPPS rules.
Process for Developing New Rule: The department meets regularly with the HCA and the MAA through an interagency work group to develop consistency in health care purchasing rules and policies. External stakeholders had been involved through an outpatient prospective payment technical advisory group (OPPS-TAG) and will continue involvement through the state TAG, meetings of the Washington State Hospital Association and other groups. The proposed rule changes will be presented to a variety of advisory groups and publicized in a letter to interested persons.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Jim Dick, Department of Labor and Industries, P.O. Box 44322, Olympia, WA 98504-4322, phone (360) 902-5131, fax (360) 902-4249, Internet dija235@lni.wa.gov.
July 5, 2001
Gary L. Moore
Director