PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 09-06-080.
Title of Rule and Other Identifying Information: The department is amending chapter 388-554 WAC, Enteral nutrition program.
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, Washington 98503
(one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on October 27, 2009, at 10:00 a.m.
Date of Intended Adoption: Not sooner than October 28, 2009.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on October 27, 2009.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by October 6, 2009, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Major Change: The department is no longer covering orally administered enteral nutrition for clients twenty-one years of age and older.
Other Changes/Updates to the Enteral Nutrition Chapter Include:
| • | Reorganized the chapter to mirror other recently reorganized medical program chapters. |
| • | Changed references from "MAA" to the "department." |
| • | Clarified when the department will pay for enteral nutrition products. |
| • | Updated the definition for "Women, infants, and children (WIC) program" to match the department of health's current definition. |
| • | Added children's healthcare programs as defined in WAC 388-505-0210 to the list of eligible clients. |
| • | Clarified that "emergency medical only programs" are eligible only when the services are necessary to treat the client's emergency medical condition. |
| • | Removed language that the department would pay separately for oral enteral nutrition for a client who resides in a nursing facility when the client's need for enteral nutrition meets 100% of the client's nutritional needs. Adult family homes, assisted living facilities, boarding homes, or any other residence where the provision of food is part of the per diem rate are required to provide food for their clients. |
| • | Added the "client's caregiver" as a sufficient person for providers to confirm with whether the client's next month's delivery of authorized orally administered enteral nutrition products is necessary. Current language states that the provider must confirm with the client. |
| • | Clarified that when a client has indicated that he or she is not using the enteral nutrition product as prescribed, in addition to notifying the client's physician, the provider must also document the notification in the client's file. |
| • | Clarified what the department means by a "valid" prescription. |
| • | Clarified that providers must request prior authorization for covered orally administered enteral nutrition products and tube-delivered enteral equipment and related supplies as required in the chapter or when the clinical criteria is not met. Requests for prior authorization must be submitted to the department on DSHS 13-743 form (Oral Enteral Nutrition Worksheet Prior Authorization Request). |
| • | Codified expedited prior authorization (EPA) criteria for oral enteral nutrition for clients twenty years of age and younger. |
| • | Created a new noncovered section (WAC 388-554-800) to include orally administered enteral nutrition for clients twenty-one years of age and older and nonmedical equipment, supplies, and related services, including but not limited to, backpacks, pouches, bags, baskets, or other carrying containers. The department does not pay for these items but needed to codify this. |
Reasons Supporting Proposal: This amendment is necessary for the department to fully meet the legislatively mandated appropriation reduction in section 1109, chapter 564, Laws of 2009 (ESHB 1244) for durable medical equipment (DME) for fiscal years 2010-2011 and to further clarify the department's coverage policy for enteral nutrition.
Statutory Authority for Adoption: Section 1109, chapter 564, Laws of 2009 (ESHB 1244), RCW 74.04.050, 74.08.090.
Statute Being Implemented: Section 1109, chapter 564, Laws of 2009 (ESHB 1244).
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: Wendy L. Boedigheimer, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1306; Implementation and Enforcement: Maureen Guzman, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-2033.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department analyzed the proposed rule amendments and concludes that they will impose no new costs on small businesses. The preparation of a comprehensive small business economic impact statement is not required.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Maureen Guzman, Enteral Program Manager, DSHS/HRSA/Division of Healthcare Services, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-2330, fax (360) 586-9727, e-mail guzmam@dshs.wa.gov.
August 27, 2009
Stephanie E. Vaughn
Rules Coordinator
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 09-19 issue of the Register.