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Chapter 182-550 WAC

Last Update: 8/9/13

HOSPITAL SERVICES

WAC Sections

Applicability.
Hospital services definitions.
Hospital care—General.
Restrictions on hospital coverage.
Revenue code categories and subcategories.
Revenue code categories and subcategories—CPT and HCPCS reporting requirements for outpatient hospitals.
Covered and noncovered revenue codes categories and subcategories for inpatient hospital services.
Covered and noncovered revenue code categories and subcategories for outpatient hospital services.
Specific items/services not covered.
Adverse events, hospital-acquired conditions, and present on admission indicators.
Authorization and utilization review (UR) of inpatient and outpatient hospital services.
Hospital specialty services not requiring prior authorization.
Transplant coverage.
Requirements—Transplant hospitals.
Transplant requirements—COE.
Hospital and medical criteria requirements for bariatric surgery.
Inpatient chronic pain management services.
Hospice services—Inpatient payments.
Inpatient hospice services.
Acute physical medicine and rehabilitation (acute PM&R) program—General.
Acute PM&R definitions.
Client eligibility requirements for acute PM&R services.
Requirements for becoming an acute PM&R provider.
Quality of care—Department-approved acute PM&R hospital.
How a client qualifies for acute PM&R services.
The department's prior authorization requirements for acute PM&R services.
The long-term acute care (LTAC) program—General.
LTAC program definitions.
Client eligibility requirements for LTAC services.
Requirements for becoming an LTAC hospital.
LTAC hospitals—Quality of care.
Department prior authorization requirements for Level 1 and Level 2 LTAC services.
Identification of and payment methodology for services and equipment included in the LTAC fixed per diem rate.
Services and equipment covered by the department but not included in the LTAC fixed per diem rate.
Critical access hospitals (CAHs).
Inpatient psychiatric services.
Base community psychiatric hospitalization payment method for medicaid and SCHIP clients and nonmedicaid and non-SCHIP clients.
Hospital discharge planning services.
Payment methods and limits—Inpatient hospital services for medicaid and SCHIP clients.
Payment limits—Inpatient hospital services.
Payment method—DRG.
Payment method—Per diem payment.
Payment method—Bariatric surgery—Per case payment.
Calculating DRG relative weights.
Base period costs and claims data.
Medicaid cost proxies.
Indirect medical education costs—Conversion factors, per diem rates, and per case rates.
Hospital peer groups and cost caps.
Outlier costs.
Payment methodology for acute PM&R services and administrative day services.
Case-mix index.
Payment method for calculating medicaid DRG conversion factor rates.
Payment method—Per diem rate.
Payment method—Bariatric surgery—Per case rate.
Hospital annual inflation adjustment determinations.
Diagnosis-related group (DRG) payment—Hospital transfers.
DRG high-cost and low-cost outliers, and new system DRG and per diem high outliers.
Rebasing and recalibration.
Payment method—Bordering city hospitals and critical border hospitals.
Payment method—Out-of-state hospitals.
Payment method—New hospitals.
Change in hospital ownership.
Hospitals and units exempt from the DRG payment method.
Services—Exempt from DRG payment.
Payment method—Ratio of costs-to-charges (RCC).
Administrative day rate and swing bed day rate.
Hospital selective contracting program.
"Full cost" public hospital certified public expenditure (CPE) payment program.
CPE payment program—"Hold harmless" provision.
Authorization requirements and utilization review for hospitals eligible for CPE payments.
Payment—Non-SCA participating hospitals.
Hospital payment methods—State administered programs.
Disproportionate share hospital (DSH) payments—General provisions.
Eligibility for DSH programs—New hospital providers.
DSH eligibility—Change in hospital ownership.
Payment method—Low income disproportionate share hospital (LIDSH).
Payment method—Psychiatric indigent inpatient disproportionate share hospital (PIIDSH).
Payment method—Institution for mental diseases disproportionate share hospital (IMDDSH) and institution for mental diseases (IMD) state grants.
Payment method—Medical care services disproportionate share hospital (MCSDSH).
Payment method—Small rural disproportionate share hospital (SRDSH).
Payment method—Small rural indigent assistance disproportionate share hospital (SRIADSH).
Payment method—Nonrural indigent assistance disproportionate share hospital (NRIADSH).
Payment method—Children's health program disproportionate share hospital (CHPDSH).
Payment method—Public hospital disproportionate share hospital (PHDSH).
CPE medicaid cost report and settlements.
Upper payment limit (UPL) payments for inpatient hospital services.
Supplemental distributions to approved trauma service centers.
Payment—Hospital-based RHCs.
Public notice for changes in medicaid payment rates for hospital services.
Dispute resolution process for hospital rate reimbursement.
Hospital reports and audits.
Outpatient and emergency hospital services.
Outpatient hospital services—Conditions of payment and payment methods.
Outpatient hospital physical therapy.
Outpatient hospital occupational therapy.
Outpatient hospital speech therapy services.
Pregnancy—Enhanced outpatient benefits.
Outpatient nutritional counseling.
Outpatient hospital diabetes education.
Outpatient hospital weight loss program.
Blood and blood components.
Hospital-based physician services.
Hospital services provided out-of-state.
Outpatient prospective payment system (OPPS)—General.
OPPS—Definitions.
OPPS—Exempt hospitals.
OPPS—Billing requirements and payment method.
OPPS—Payment limitations.
OPPS APC relative weights.
OPPS budget target adjustor.
OPPS rate.
OPPS payment calculation.
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS CHAPTER
182-550-6350
Outpatient sleep apnea/sleep study programs. [WSR 11-14-075, recodified as § 182-550-6350, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-13-100, § 388-550-6350, filed 6/20/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-6350, filed 12/18/97, effective 1/18/98.] Repealed by WSR 13-07-029, filed 3/13/13, effective 4/13/13. Statutory Authority: RCW 41.05.021.