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Chapter 182-550 WAC

Last Update: 3/13/13

HOSPITAL SERVICES

WAC Sections

182-550-1000 Applicability.
182-550-1050 Hospital services definitions.
182-550-1100 Hospital care -- General.
182-550-1200 Restrictions on hospital coverage.
182-550-1300 Revenue code categories and subcategories.
182-550-1350 Revenue code categories and subcategories -- CPT and HCPCS reporting requirements for outpatient hospitals.
182-550-1400 Covered and noncovered revenue codes categories and subcategories for inpatient hospital services.
182-550-1500 Covered and noncovered revenue code categories and subcategories for outpatient hospital services.
182-550-1600 Specific items/services not covered.
182-550-1650 Adverse events, hospital-acquired conditions, and present on admission indicators.
182-550-1700 Authorization and utilization review (UR) of inpatient and outpatient hospital services.
182-550-1800 Hospital specialty services not requiring prior authorization.
182-550-1900 Transplant coverage.
182-550-2100 Requirements--Transplant hospitals.
182-550-2200 Transplant requirements--COE.
182-550-2301 Hospital and medical criteria requirements for bariatric surgery.
182-550-2400 Inpatient chronic pain management services.
182-550-2431 Hospice services--Inpatient payments.
182-550-2500 Inpatient hospice services.
182-550-2501 Acute physical medicine and rehabilitation (acute PM&R) program -- General.
182-550-2511 Acute PM&R definitions.
182-550-2521 Client eligibility requirements for acute PM&R services.
182-550-2531 Requirements for becoming an acute PM&R provider.
182-550-2541 Quality of care--Department-approved acute PM&R hospital.
182-550-2551 How a client qualifies for acute PM&R services.
182-550-2561 The department's prior authorization requirements for acute PM&R services.
182-550-2565 The long-term acute care (LTAC) program -- General.
182-550-2570 LTAC program definitions.
182-550-2575 Client eligibility requirements for LTAC services.
182-550-2580 Requirements for becoming an LTAC hospital.
182-550-2585 LTAC hospitals -- Quality of care.
182-550-2590 Department prior authorization requirements for Level 1 and Level 2 LTAC services.
182-550-2595 Identification of and payment methodology for services and equipment included in the LTAC fixed per diem rate.
182-550-2596 Services and equipment covered by the department but not included in the LTAC fixed per diem rate.
182-550-2598 Critical access hospitals (CAHs).
182-550-2600 Inpatient psychiatric services.
182-550-2650 Base community psychiatric hospitalization payment method for medicaid and SCHIP clients and nonmedicaid and non-SCHIP clients.
182-550-2750 Hospital discharge planning services.
182-550-2800 Payment methods and limits -- Inpatient hospital services for medicaid and SCHIP clients.
182-550-2900 Payment limits--Inpatient hospital services.
182-550-3000 Payment method--DRG.
182-550-3010 Payment method--Per diem payment.
182-550-3020 Payment method -- Bariatric surgery -- Per case payment.
182-550-3100 Calculating DRG relative weights.
182-550-3150 Base period costs and claims data.
182-550-3200 Medicaid cost proxies.
182-550-3250 Indirect medical education costs -- Conversion factors, per diem rates, and per case rates.
182-550-3300 Hospital peer groups and cost caps.
182-550-3350 Outlier costs.
182-550-3381 Payment methodology for acute PM&R services and administrative day services.
182-550-3400 Case-mix index.
182-550-3450 Payment method for calculating medicaid DRG conversion factor rates.
182-550-3460 Payment method--Per diem rate.
182-550-3470 Payment method--Bariatric surgery--Per case rate.
182-550-3500 Hospital annual inflation adjustment determinations.
182-550-3600 Diagnosis-related group (DRG) payment--Hospital transfers.
182-550-3700 DRG high-cost and low-cost outliers, and new system DRG and per diem high outliers.
182-550-3800 Rebasing and recalibration.
182-550-3900 Payment method -- Bordering city hospitals and critical border hospitals.
182-550-4000 Payment method -- Out-of-state hospitals.
182-550-4100 Payment method -- New hospitals.
182-550-4200 Change in hospital ownership.
182-550-4300 Hospitals and units exempt from the DRG payment method.
182-550-4400 Services--Exempt from DRG payment.
182-550-4500 Payment method--Ratio of costs-to-charges (RCC).
182-550-4550 Administrative day rate and swing bed day rate.
182-550-4600 Hospital selective contracting program.
182-550-4650 "Full cost" public hospital certified public expenditure (CPE) payment program.
182-550-4670 CPE payment program -- "Hold harmless" provision.
182-550-4690 Authorization requirements and utilization review for hospitals eligible for CPE payments.
182-550-4700 Payment--Non-SCA participating hospitals.
182-550-4800 Hospital payment methods--State administered programs.
182-550-4900 Disproportionate share hospital (DSH) payments--General provisions.
182-550-4925 Eligibility for DSH programs--New hospital providers.
182-550-4935 DSH eligibility--Change in hospital ownership.
182-550-5000 Payment method--Low income disproportionate share hospital (LIDSH).
182-550-5125 Payment method -- Psychiatric indigent inpatient disproportionate share hospital (PIIDSH).
182-550-5130 Payment method--Institution for mental diseases disproportionate share hospital (IMDDSH) and institution for mental diseases (IMD) state grants.
182-550-5150 Payment method--Medical care services disproportionate share hospital (MCSDSH).
182-550-5200 Payment method--Small rural disproportionate share hospital (SRDSH).
182-550-5210 Payment method -- Small rural indigent assistance disproportionate share hospital (SRIADSH).
182-550-5220 Payment method -- Nonrural indigent assistance disproportionate share hospital (NRIADSH).
182-550-5300 Payment method -- Children's health program disproportionate share hospital (CHPDSH).
182-550-5400 Payment method--Public hospital disproportionate share hospital (PHDSH).
182-550-5410 CPE medicaid cost report and settlements.
182-550-5425 Upper payment limit (UPL) payments for inpatient hospital services.
182-550-5450 Supplemental distributions to approved trauma service centers.
182-550-5500 Payment--Hospital-based RHCs.
182-550-5550 Public notice for changes in medicaid payment rates for hospital services.
182-550-5600 Dispute resolution process for hospital rate reimbursement.
182-550-5700 Hospital reports and audits.
182-550-5800 Outpatient and emergency hospital services.
182-550-6000 Outpatient hospital services -- Conditions of payment and payment methods.
182-550-6100 Outpatient hospital physical therapy.
182-550-6150 Outpatient hospital occupational therapy.
182-550-6200 Outpatient hospital speech therapy services.
182-550-6250 Pregnancy--Enhanced outpatient benefits.
182-550-6300 Outpatient nutritional counseling.
182-550-6400 Outpatient hospital diabetes education.
182-550-6450 Outpatient hospital weight loss program.
182-550-6500 Blood and blood components.
182-550-6600 Hospital-based physician services.
182-550-6700 Hospital services provided out-of-state.
182-550-7000 Outpatient prospective payment system (OPPS) -- General.
182-550-7050 OPPS -- Definitions.
182-550-7100 OPPS -- Exempt hospitals.
182-550-7200 OPPS -- Billing requirements and payment method.
182-550-7300 OPPS -- Payment limitations.
182-550-7400 OPPS APC relative weights.
182-550-7450 OPPS budget target adjustor.
182-550-7500 OPPS rate.
182-550-7600 OPPS payment calculation.
DISPOSITIONS OF SECTIONS FORMERLY CODIFIED IN THIS CHAPTER
182-550-6350 Outpatient sleep apnea/sleep study programs. [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. 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. 98-01-124, § 388-550-6350, filed 12/18/97, effective 1/18/98.]  Repealed by 13-07-029, filed 3/13/13, effective 4/13/13. Statutory Authority: RCW 41.05.021