PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: July 27, 2001.
Purpose: To update and clarify payment methodology used for reimbursing hospital providers for services provided to MAA clients; to update high-cost and low-cost outlier thresholds; to update effective dates for recalibrating relative weights; to clarify requirements for outpatient services record retention language; and to coordinate policies with DASA and MHD.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-550-2700; and amending WAC 388-550-1050, 388-550-1100, 388-550-2800, 388-550-2900, 388-550-3300, 388-550-3600, 388-550-3700, 388-550-3800, 388-550-4300, 388-550-4400, 388-550-4500, and 388-550-4800.
Statutory Authority for Adoption: RCW 74.08.090.
Other Authority: 42 U.S.C. 1395x(v), 42 C.F.R. 447.271, .11303, and .2652.
Adopted under notice filed as WSR 01-09-070 on April 16, 2001.
Changes Other than Editing from Proposed to Adopted Version: WAC 388-550-1050 "Fee-for-service" means the general payment
method the department uses to reimburse providers for covered
medical services provided to medical assistance clients when
these services are not covered under MAA's healthy options
program the department's managed care programs.
WAC 388-550-1050 "Noncovered service or charge" means a
service or charge that is not reimbursed by the department
recognized by the department as a covered service.
WAC 388-550-1050, to clarify outpatient hospital reimbursement methods, the department added this definition: "Outpatient rate" means the standard rate used to reimburse a hospital for outpatient services not excluded in WAC 388-550-6000(2). This rate has as its base the hospital inpatient RCC rate adjusted by an outpatient factor.
WAC 388-550-1100(1) The medical assistance administration
(MAA) department covers the admission of a medical assistance
client to a hospital only when the client's attending physician
orders admission and when the admission and treatment provided
meet the requirements of this chapter medically necessary as
indicated by an attending physician's admission order, and when
the admission and treatment provided meet the requirements of
this chapter.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.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 12, Repealed 1.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 12, Repealed 1.
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 12,
Repealed 1.
Effective Date of Rule:
Thirty-one days after filing.
July 27, 2001
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 01-18 issue of the Register.