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PDFWAC 182-550-7550

OPPS payment enhancements.

(1) Pediatric adjustment.
(a) The medicaid agency establishes a policy adjustor to be applied to all enhanced ambulatory patient group (EAPG) services for clients under age eighteen years.
(b) Effective July 1, 2014, this adjustor equals one point thirty-five (1.35).
(2) Chemotherapy and combined chemotherapy/pharmacotherapy adjustment.
(a) The agency establishes a policy adjustor to be applied to services grouped as chemotherapy drugs or combined chemotherapy and pharmacotherapy drugs.
(b) Effective July 1, 2014, this adjustor equals one point one (1.1).
(3) Sole community hospitals (SCH).
(a) To qualify as an SCH, a hospital must meet all of the following criteria. The hospital must:
(i) Be certified as an SCH by the Centers for Medicare and Medicaid Services (CMS) as of January 1, 2013;
(ii) Have a level III adult trauma service designation by the department of health as of January 1, 2014;
(iii) Have less than one hundred fifty acute-care-licensed beds in state fiscal year 2011; and
(iv) Be owned and operated by the state or one of its political subdivisions.
(b) Effective January 1, 2015, the agency will apply an adjustor of one point twenty-five (1.25) to the EAPG conversion factor for any hospital that meets the conditions in (a) of this subsection.
[Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW. WSR 14-14-049, ยง 182-550-7550, filed 6/25/14, effective 7/26/14.]
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