Chapter 182-550 WAC

Last Update: 10/31/18

HOSPITAL SERVICES

WAC Sections

182-550-1000Applicability.
182-550-1050Hospital services definitions.
182-550-1100Hospital care—General.
182-550-1200Restrictions on hospital coverage.
182-550-1300Revenue code categories and subcategories.
182-550-1350Revenue code categories and subcategories—CPT and HCPCS reporting requirements for outpatient hospitals.
182-550-1400Covered and noncovered revenue codes categories and subcategories for inpatient hospital services.
182-550-1500Covered and noncovered revenue code categories and subcategories for outpatient hospital services.
182-550-1600Specific items/services not covered.
182-550-1650Adverse events, hospital-acquired conditions, and present on admission indicators.
182-550-1700Authorization and utilization review (UR) of inpatient and outpatient hospital services.
182-550-1800Hospital specialty services not requiring prior authorization.
182-550-1900Transplant coverage.
182-550-2100Requirements—Transplant hospitals.
182-550-2200Transplant requirements—COE.
182-550-2301Hospital and medical criteria requirements for bariatric surgery.
182-550-2400Inpatient chronic pain management services.
182-550-2431Hospice services—Inpatient payments.
182-550-2500Inpatient hospice services.
182-550-2501Acute physical medicine and rehabilitation (acute PM&R) program—General.
182-550-2521Client eligibility requirements for acute PM&R services.
182-550-2531Requirements for becoming an acute PM&R provider.
182-550-2541Quality of care—Agency-approved acute PM&R hospital.
182-550-2551When the medicaid agency authorizes acute PM&R services.
182-550-2561The agency's prior authorization requirements for acute PM&R services.
182-550-2565The long-term acute care (LTAC) program—General.
182-550-2575Client eligibility requirements for LTAC services.
182-550-2580Requirements for becoming an LTAC hospital.
182-550-2585LTAC hospitals—Quality of care.
182-550-2590Agency prior authorization requirements for Level 1 and Level 2 LTAC services.
182-550-2595Identification of and payment methodology for services and equipment included in the LTAC fixed per diem rate.
182-550-2596Services and equipment covered by the agency but not included in the LTAC fixed per diem rate.
182-550-2598Critical access hospitals (CAHs).
182-550-2600Inpatient psychiatric services.
182-550-2650Base community psychiatric hospitalization payment method for medicaid and CHIP clients and nonmedicaid and non-CHIP clients.
182-550-2750Hospital discharge planning services.
182-550-2900Payment limits—Inpatient hospital services.
182-550-3000Payment method.
182-550-3381Payment method for acute PM&R services and administrative day services.
182-550-3400Case-mix index.
182-550-3470Payment method—Bariatric surgery—Per case rate.
182-550-3600Diagnosis-related group (DRG) payment—Hospital transfers.
182-550-3700DRG high outliers.
182-550-3800Rebasing.
182-550-3830Adjustments to inpatient rates.
182-550-3850Budget neutrality adjustment and measurement.
182-550-3900Payment method—Bordering city hospitals and critical border hospitals.
182-550-4000Payment method—Out-of-state hospitals.
182-550-4100Payment method—New hospitals.
182-550-4200Change in hospital ownership.
182-550-4300Hospitals and units exempt from the DRG payment method.
182-550-4400Services—Exempt from DRG payment.
182-550-4500Payment method—Ratio of costs-to-charges (RCC).
182-550-4550Administrative day rate and swing bed day rate.
182-550-4650"Full cost" public hospital certified public expenditure (CPE) payment program.
182-550-4670CPE payment program—"Hold harmless" provision.
182-550-4690Authorization requirements and utilization review for hospitals eligible for CPE payments.
182-550-4700Payment—Non-SCA participating hospitals.
182-550-4800Hospital payment methods—State-administered programs.
182-550-4900Disproportionate share hospital (DSH) payments—General provisions.
182-550-4925Eligibility for DSH programs—New hospital providers.
182-550-4935DSH eligibility—Change in hospital ownership.
182-550-4940Disproportionate share hospital independent audit findings and recoupment process.
182-550-5000Payment method—Low income disproportionate share hospital (LIDSH).
182-550-5130Payment method—Institution for mental diseases disproportionate share hospital (IMDDSH) and institution for mental diseases (IMD) state grants.
182-550-5150Payment method—Medical care services disproportionate share hospital (MCSDSH).
182-550-5200Payment method—Small rural disproportionate share hospital (SRDSH).
182-550-5210Payment method—Small rural indigent assistance disproportionate share hospital (SRIADSH).
182-550-5220Payment method—Nonrural indigent assistance disproportionate share hospital (NRIADSH).
182-550-5300Payment method—Children's health program disproportionate share hospital (CHPDSH).
182-550-5380Payment method—Sole community disproportionate share hospital (SCDSH).
182-550-5400Payment method—Public hospital disproportionate share hospital (PHDSH).
182-550-5410CPE medicaid cost report and settlements.
182-550-5425Upper payment limit (UPL) payments for inpatient hospital services.
182-550-5450Supplemental distributions to approved trauma service centers.
182-550-5500Payment—Hospital-based RHCs.
182-550-5550Public notice for changes in medicaid payment rates for hospital services.
182-550-5600Dispute resolution process for hospital rate reimbursement.
182-550-5700Hospital reports and audits.
182-550-5800Outpatient and emergency hospital services.
182-550-6000Outpatient hospital services—Conditions of payment and payment methods.
182-550-6100Outpatient hospital physical therapy.
182-550-6150Outpatient hospital occupational therapy.
182-550-6200Outpatient hospital speech therapy services.
182-550-6250Pregnancy—Enhanced outpatient benefits.
182-550-6300Outpatient nutritional counseling.
182-550-6400Outpatient hospital diabetes education.
182-550-6450Outpatient hospital weight loss program.
182-550-6500Blood and blood components.
182-550-6600Hospital-based physician services.
182-550-6700Hospital services provided out-of-state.
182-550-7000Outpatient prospective payment system (OPPS)—General.
182-550-7200OPPS—Billing requirements and payment method.
182-550-7300OPPS—Payment limitations.
182-550-7400OPPS EAPG relative weights.
182-550-7450OPPS budget target adjustor.
182-550-7500OPPS rate.
182-550-7550OPPS payment enhancements.
182-550-7600OPPS payment calculation.
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