Date of Adoption: December 26, 2002.

     Purpose: Adds language to clarify that the long-term acute care (LTAC) fixed per diem rate includes up to and including two hundred dollars per day in total allowed charges for any combination of pharmacy services that includes prescription drugs, total parenteral nutrition (TPN) therapy, IV infusion therapy, and/or epogen/neupogen therapy. Any combination of these charges after the first two hundred dollars per day is paid using the ratio of costs-to-charges (RCC) payment method.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-550-2595 and 388-550-2596.

     Statutory Authority for Adoption: RCW 74.08.090.

      Adopted under notice filed as WSR 02-22-043 on October 30, 2002.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

December 20, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

     (a) Room and board - Rehabilitation;

     (b) Room and board - Intensive care;

     (c) Pharmacy - Up to and including two hundred dollars per day in total allowed charges for any combination of pharmacy services that includes prescription drugs, total parenteral nutrition (TPN) therapy, IV infusion therapy, and/or epogen/neupogen therapy;

     (d) Medical/surgical supplies and devices;

     (((d))) (e) Laboratory - General;

     (((e))) (f) Laboratory - Chemistry;

     (((f))) (g) Laboratory - Immunology;

     (((g))) (h) Laboratory - Hematology;

     (((h))) (i) Laboratory - Bacteriology and microbiology;

     (((i))) (j) Laboratory - Urology;

     (((j))) (k) Laboratory - Other laboratory services;

     (((k))) (l) Respiratory services;

     (((l))) (m) Physical therapy;

     (((m))) (n) Occupational therapy; and

     (((n))) (o) Speech-language therapy.

     (2) MAA pays the LTAC facility the LTAC fixed per diem rate in effect at the time the LTAC services are provided, minus the sum of:

     (a) Client liability, whether or not collected by the provider; and

     (b) Any amount of coverage from third parties, whether or not collected by the provider, including, but not limited to, coverage from:

     (i) Insurers and indemnitors;

     (ii) Other federal or state medical care programs;

     (iii) Payments made to the provider on behalf of the client by individuals or organizations not liable for the client's financial obligations; and

     (iv) Any other contractual or legal entitlement of the client, including, but not limited to:

     (A) Crime victims' compensation;

     (B) Workers' compensation;

     (C) Individual or group insurance;

     (D) Court-ordered dependent support arrangements; and

     (E) The tort liability of any third party.

     (3) MAA may make annual rate increases to the LTAC fixed per diem rate by using the same inflation factor and date of rate increase that MAA uses for acute care hospital diagnostic-related group (DRG) rates. This DRG rate adjustment method is described in WAC 388-550-3450(5).

[Statutory Authority: RCW 74.08.090. 02-14-162, § 388-550-2595, filed 7/3/02, effective 8/3/02.]

     (a) ((Prescription drugs;

     (b) Total parenteral nutrition (TPN) therapy;

     (c) Epogen/neupogen therapy;

     (d))) Pharmacy - After the first two hundred dollars per day in total allowed charges for any combination of pharmacy services that includes prescription drugs, total parenteral nutrition (TPN) therapy, IV infusion therapy, and/or epogen/neupogen therapy;

     (b) Radiology services;

     (((e))) (c) Nuclear medicine services;

     (((f))) (d) Computerized tomographic (CT) scan;

     (((g))) (e) Operating room services;

     (((h))) (f) Anesthesia services;

     (((i))) (g) Blood storage and processing;

     (((j))) (h) Blood administration;

     (((k))) (i) Other imaging services - Ultrasound;

     (((l))) (j) Pulmonary function services;

     (((m))) (k) Cardiology services;

     (((n))) (l) Recovery room services;

     (((o))) (m) EKG/ECG services;

     (((p))) (n) Gastro-intestinal services;

     (((q))) (o) Inpatient hemodialysis; and

     (((r))) (p) Peripheral vascular laboratory services.

     (2) MAA uses the appropriate inpatient or outpatient payment method described in other published WAC to reimburse providers other than LTAC facilities for services and equipment that are covered by MAA but not included in the LTAC fixed per diem rate. The provider must bill MAA directly and MAA reimburses the provider directly.

     (3) Transportation services that are related to transporting a client to and from another facility for the provision of outpatient medical services while the client is still an inpatient at the LTAC facility, or related to transporting a client to another facility after discharge from the LTAC facility:

     (a) Are not covered or reimbursed through the LTAC fixed per diem rate;

     (b) Are not reimbursable directly to the LTAC facility;

     (c) Are subject to the provisions in chapter 388-546 WAC; and

     (d) Must be billed directly to the:

     (i) Department by the transportation company to be reimbursed if the client required ambulance transportation; or

     (ii) Department's contracted transportation broker, subject to the prior authorization requirements and provisions described in chapter 388-546 WAC, if the client:

     (A) Required nonemergent transportation; or

     (B) Did not have a medical condition that required transportation in a prone or supine position.

     (4) MAA evaluates requests for covered transportation services that are subject to limitations or other restrictions, and approves such services beyond those limitations or restrictions when medically necessary, under the standards of WAC 388-501-0165.

[Statutory Authority: RCW 74.08.090. 02-14-162, § 388-550-2596, filed 7/3/02, effective 8/3/02.]

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