WSR 06-19-100



(Health and Recovery Services Administration)

[ Filed September 19, 2006, 4:05 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 05-17-140.

     Title of Rule and Other Identifying Information: Sections in Title 388 WAC regarding covered and noncovered services - Part 3 of 3.

     WAC Sections Proposed in Part 3: WAC 388-543-1100 Scope of coverage and limitations for DME, 388-543-1150 Limits and limitation extensions, 388-543-1300 Equipment, related supplies, or other nonmedical supplies, and devices not covered, 388-544-0010 Vision care -- General, 388-544-0450 Vision care -- Prior authorization, 388-544-1100 Hearing aid services -- General, 388-544-1400 Hearing aid services -- noncovered services, 388-545-900 Neurodevelopmental centers, 388-546-0200 Scope of coverage for ambulance transportation, 388-546-0250 Ambulance services the department does not cover, 388-550-2596 Services and equipment covered by the department but not included in LTAC fixed per diem rate, 388-551-2130 Noncovered home health services, 388-551-3000 Private duty nursing services for clients seventeen and younger, 388-553-500 Home infusion therapy/parenteral nutrition program -- Coverage, 388-554-500 Orally administered enteral nutrition products -- Coverage, 388-554-600 Tube-delivered enteral nutrition products and related equipment and supplies -- Coverage, 388-556-0500 Medical care services under state-administered cash programs, and 388-800-0045 What services are offered by ADATSA?

     Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at or by calling (360) 664-6097), on November 7, 2006, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than November 8, 2006.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail, fax (360) 664-6185, by 5:00 p.m. on November 7, 2006.

     Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by November 3, 2006, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposal is to:

Improve the quality of care received by DSHS clients by using a consistent, evidence-based approach to making benefit coverage decisions.
Make HRSA benefit coverage rules clearer, more transparent, and consistent.
Establish a clear, transparent process by which HRSA determines what services are included under its benefit coverage.
Maximize program resources through prudent use of cost-effective practices.
     Changes to Rule in Parts 1, 2, and 3: In this proposal, the department has:

Replaced "medical assistance administration" and "MAA" with "the department" or "HRSA."
Substituted WAC 388-501-0160 cross reference in place of WAC 388-501-0165 where noncovered services are addressed.
Replaced all references to chapter 388-529 WAC with new WAC 388-501-0060 and 388-501-0065.
Added reference to new WAC 388-501-0169 in rules where limitations on covered services are addressed.
Repealed chapter 388-529 WAC which is being replaced with WAC 388-501-0060 and 388-501-0065.
Repealed WAC 388-501-0300 because it was incorporated into WAC 388-501-0050 and 388-501-0070.
Removed gender reassignment surgery from covered service status.
More clearly defined what is covered and not covered in the way of cosmetic and reconstructive surgery, treatment, and procedures in WAC 388-531-0100 and new WAC 388-501-0070.
Added more detail to WAC 388-501-0160 regarding the criteria and steps in the exception to rule (ETR) process.
In new WAC 388-501-0065, added brief descriptions of services available under each category of service listed in the table in new WAC 388-501-0060.
Included cross references (in new WAC 388-501-0065 and 388-501-0070) to other program WACs where the reader can find more specific detail of the covered or noncovered service.
Codified the evaluation criteria HRSA will use when evaluating requests for covered services beyond the maximum allowed.

     Reasons Supporting Proposal: It will make HRSA's rules regarding covered and noncovered medical services clearer and easier to understand for our clients and medical providers.

     Statutory Authority for Adoption: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700.

     Statute Being Implemented: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700.

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

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, 626 8th Avenue, Olympia, WA 98504-5504, (360) 725-1344; Implementation and Enforcement: Gail Kreiger, 626 8th Avenue, Olympia, WA 98504-5504, (360) 725-1681.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. This amendment does not create more than minor costs to small businesses.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kevin Sullivan, HRSA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-4405, phone (360) 725-1344, fax (360) 586-9727, e-mail, TYY/TDD 1-800-848-5429.

September 15, 2006

Andy Fernando, 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 06-20 issue of the Register.

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