PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 00-03-011.
Title of Rule: Repealing WAC 388-86-115 Medical care provided out-of-state and amending WAC 388-501-0180 Out-of-state medical care.
Purpose: To avoid duplicative rules, the department is repealing WAC 388-86-115 and incorporating language into WAC 388-501-0180. Also, to clarify and update program requirements and to comply with the Governor's Executive Order 97-02, which mandates all rules be reviewed for clarity, necessity, fairness, etc.
Statutory Authority for Adoption: RCW 74.08.090 and 74.09.035.
Statute Being Implemented: RCW 74.08.090 and 74.09.035.
Summary: These amendments update and clarify department policy on coverage of medical services provided out-of-state to eligible medical assistance clients. The amendments also state that MAA requires out-of-state providers to meet the same criteria as in-state providers in order to be reimbursed for medical services provided to eligible clients.
Reasons Supporting Proposal: To set in rule current department policy regarding clients, providers, and services. To comply with the Governor's Executive Order 97-02.
Name of Agency Personnel Responsible for Drafting: Kathy Sayre, DPS/RIP, P.O. Box 45533, Olympia, WA 98507, (360) 725-1342; Implementation and Enforcement: Diane Stevens, DHSQS, P.O. Box 45506, Olympia, WA 98507, (360) 725-1551.
Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The rule updates and clarifies department policy on coverage of medical services provided out-of-state to eligible clients. It also states that MAA requires out-of-state providers to meet the same criteria as in-state providers in order to be reimbursed for medical services provided to eligible medical assistance clients.
The purpose of the rule is to set in rule current department policy regarding clients, providers and medical services. Its anticipated effect is a clearer understanding of MAA policy.
Proposal Changes the Following Existing Rules: The rules propose repealing WAC 388-86-115 and putting that policy into WAC 388-501-0180, using updated language that reflects current department policy.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule amendments and concludes that because the proposed rule does not change existing department policy, no new costs will be imposed on businesses affected by them.
RCW 34.05.328 does not apply to this rule adoption. The department has analyzed this rule and concluded that it does not fit the definition of a significant legislative rule.
Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on September 26, 2000, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Kelly Cooper, Rules Coordinator, by September 19, 2000, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopeKD@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by September 26, 2000.
Date of Intended Adoption: No sooner than September 27, 2000.
August 7, 2000
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
2779.3
(1) ((A
Washington state Medicaid client temporarily out of the state may
be provided medical care within the scope of the Medicaid
program.
(a) Residency requirements in WAC 388-505-0510 must be met.
(b) Medical assistance may be provided only in areas of Canada that border on the United States when no other resource is available.
(2) Persons eligible for the medically needy program may be provided medical care within the scope of that program.
(3) When an eligible person goes to another state, excluding bordering cities, expressly to obtain medical care that is available within the state of Washington, medical assistance will only be provided on an emergency basis.
(4) Medicaid will be provided to persons who enter the state and are determined to be financially eligible, provided the residency requirements in WAC 388-505-0510 are met.
(5) The department shall not provide medical care services out-of-state except in designated bordering cities under WAC 388-501-0175)) For medical services coverage and reimbursement purposes, the medical assistance administration (MAA) considers cities bordering Washington state and listed in WAC 388-501-0175 the same as in-state cities.
(2) MAA covers emergent medical services provided out-of-state to an eligible client if the medical services are within the scope of the client's medical care program as specified under chapter 388-529 WAC.
(3) MAA covers nonemergent medical services provided out-of-state to an eligible client only if the medical services:
(a) Are not readily available within the state of Washington;
(b) Are within the scope of the client's medical care program as specified under chapter 388-529 WAC; and
(c) Have prior authorization through MAA's process described in WAC 388-501-0165.
(4) MAA does not cover out-of-state medical services for clients under state-administered (Washington state medical care only) medical programs. See WAC 388-556-0500.
(5) MAA determines out-of-state coverage for transportation services, including ambulance services, according to chapter 388-546 WAC.
(6) MAA reimburses an out-of-state provider for medical care provided to an eligible client if the provider:
(a) Meets the licensing requirements of the state in which care is provided;
(b) Contracts with MAA to be an enrolled provider; and
(c) Meets the same criteria for payment as in-state providers.
[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), § 388-501-0180, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-82-135 and 388-92-015.]
2741.1 The following section of the Washington Administrative Code is repealed:
| WAC 388-86-115 | Medical care provided out-of-state. |