PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 01-10-059, 01-07-008, 00-19-069, and 00-23-050.
Title of Rule: Chapter 388-538 WAC, Managed care and chapter 388-542 WAC, Children's health insurance program (CHIP).
| Amend WAC | 388-538-050 | Definitions. |
| 388-538-060 | Managed care and choice. | |
| 388-538-065 | Medicaid eligible basic health plan enrollees. | |
| Repeal WAC | 388-538-066 | Children's health insurance program (CHIP) enrollees. |
| New WAC | 388-538-067 | Managed care provided through managed care organizations (MCOs) |
| New WAC | 388-538-068 | Managed care provided through primary care case management (PCCM). |
| Amend WAC | 388-538-070 | Managed care payment. |
| Amend WAC | 388-538-080 | Healthy options exemptions. |
| Amend WAC | 388-538-095 | Scope of care for managed care enrollees. |
| Amend WAC | 388-538-100 | Managed care emergency services. |
| Amend WAC | 388-538-110 | Managed care complaints, appeals and fair hearings. |
| Amend WAC | 388-538-120 | Enrollee request for a second medical opinion. |
| Amend WAC | 388-538-130 | Ending enrollment in healthy options. |
| Amend WAC | 388-538-140 | Quality of care. |
| Amend WAC | 388-542-0050 | Definitions for children's health insurance program (CHIP) terms. |
| Amend WAC | 388-542-0100 | CHIP scope of care. |
| Amend WAC | 388-542-0125 | Access to care. |
| Amend WAC | 388-542-0150 | Client eligibility requirements for CHIP. |
| Amend WAC | 388-542-0200 | CHIP managed care enrollment. |
| New WAC | 388-542-0220 | Ending CHIP client eligibility. |
| Amend WAC | 388-542-0250 | CHIP client costs. |
| Amend WAC | 388-542-0275 | Reimbursement. |
| Amend WAC | 388-542-0300 | Waiting period for CHIP coverage following employer coverage. |
| Amend WAC | 388-542-0500 | Managed care rules that apply to CHIP. |
Purpose: The department has reviewed these chapters of rules to address exemptions/disenrollments in the healthy options and CHIP programs in order to assure that clients have adequate access to care. The department is changing the competitive process for contracting with managed care organizations and is preparing to expand the primary care case management portion of its managed care program. The department is altering the CHIP program in response to the need to make healthy options and CHIP more alike and more compatible. Part of this change to the CHIP program calls for the elimination of client copays.
Statutory Authority for Adoption: RCW 74.08.090.
Statute Being Implemented: RCW 74.08.510, [74.08.]522, 74.09.450, 1115 Wavier, 42 U.S.C. 1396.
Summary: The proposed revised rules describe client eligibility, provider requirements and billing limitations for the managed care programs of the Medical Assistance Administration, DSHS. This includes both the managed care program and the children's health insurance program (CHIP). The rules have been revised to include clarification of existing policy and policy alterations to achieve the purposes stated above.
Reasons Supporting Proposal: The proposed changes simplify program administration and reduce the administrative burden and costs of those who must comply.
Name of Agency Personnel Responsible for Drafting: L. Mike Freeman, Rules and Publications, P.O. Box 45533, Olympia, WA, (360) 725-1350; Implementation and Enforcement: Alison Robbins, Program Manager, P.O. Box 45530, Olympia, WA, (360) 725-1634.
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 rules clarify existing policy, provide the possibility for expansion of the primary care case management (PCCM) type of managed care and make the CHIP program more compatible with its parallel program for the Medicaid eligible population, also served by the Medical Assistance Administration. In addition, the contractor requirements are changed to allow broader participation - including noncompetitive contracting.
Proposal Changes the Following Existing Rules: The rules provide for broader contractor participation, they eliminate the copayment requirement for the CHIP program and they clarify existing department policy.
No small business economic impact statement has been prepared under chapter 19.85 RCW. MAA reviewed its proposed rules and determined that the impact of these rules will not place a more than minor economic impact on businesses.
RCW 34.05.328 applies to this rule adoption. The proposed rules meet the definition of a significant legislative rule. However, the new rules impose no additional significant costs to businesses or local governments. A cost-benefit analysis was completed and is available upon request from the person listed above.
Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on November 27, 2001, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Fred Swenson by November 20, 2001, phone (360) 664-6097, TTY (360) 664-6178, e-mail swensFH@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, Department of Social and Health Services, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by November 27, 2001.
Date of Intended Adoption: Not before November 28, 2001.
September 26, 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 01-21 issue of the Register.