Last Update: 12/6/17

Chapter 182-550 WAC


WAC Sections

Hospital services definitions.
Hospital careGeneral.
Restrictions on hospital coverage.
Revenue code categories and subcategories.
Revenue code categories and subcategoriesCPT 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.
RequirementsTransplant hospitals.
Transplant requirementsCOE.
Hospital and medical criteria requirements for bariatric surgery.
Inpatient chronic pain management services.
Hospice servicesInpatient payments.
Inpatient hospice services.
Acute physical medicine and rehabilitation (acute PM&R) programGeneral.
Client eligibility requirements for acute PM&R services.
Requirements for becoming an acute PM&R provider.
Quality of careAgency-approved acute PM&R hospital.
When the medicaid agency authorizes acute PM&R services.
The agency's prior authorization requirements for acute PM&R services.
The long-term acute care (LTAC) programGeneral.
Client eligibility requirements for LTAC services.
Requirements for becoming an LTAC hospital.
LTAC hospitalsQuality of care.
Agency 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 agency 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 CHIP clients and nonmedicaid and non-CHIP clients.
Hospital discharge planning services.
Payment limitsInpatient hospital services.
Payment method.
Payment method for acute PM&R services and administrative day services.
Case-mix index.
Payment methodBariatric surgeryPer case rate.
Diagnosis-related group (DRG) paymentHospital transfers.
DRG high outliers.
Adjustments to inpatient rates.
Payment adjustment for potentially preventable readmissions.
Budget neutrality adjustment and measurement.
Payment methodBordering city hospitals and critical border hospitals.
Payment methodOut-of-state hospitals.
Payment methodNew hospitals.
Change in hospital ownership.
Hospitals and units exempt from the DRG payment method.
ServicesExempt from DRG payment.
Payment methodRatio of costs-to-charges (RCC).
Administrative day rate and swing bed day rate.
"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.
PaymentNon-SCA participating hospitals.
Hospital payment methods—State-administered programs.
Disproportionate share hospital (DSH) paymentsGeneral provisions.
Eligibility for DSH programsNew hospital providers.
DSH eligibilityChange in hospital ownership.
Disproportionate share hospital independent audit findings and recoupment process.
Payment methodLow income disproportionate share hospital (LIDSH).
Payment methodInstitution for mental diseases disproportionate share hospital (IMDDSH) and institution for mental diseases (IMD) state grants.
Payment methodMedical care services disproportionate share hospital (MCSDSH).
Payment methodSmall rural disproportionate share hospital (SRDSH).
Payment methodSmall rural indigent assistance disproportionate share hospital (SRIADSH).
Payment methodNonrural indigent assistance disproportionate share hospital (NRIADSH).
Payment methodChildren's health program disproportionate share hospital (CHPDSH).
Payment methodSole community disproportionate share hospital (SCDSH).
Payment methodPublic 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.
PaymentHospital-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 servicesConditions of payment and payment methods.
Outpatient hospital physical therapy.
Outpatient hospital occupational therapy.
Outpatient hospital speech therapy services.
PregnancyEnhanced 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.
OPPSBilling requirements and payment method.
OPPSPayment limitations.
OPPS EAPG relative weights.
OPPS budget target adjustor.
OPPS rate.
OPPS payment enhancements.
OPPS payment calculation.
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