WSR 99-01-170

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Medical Assistance Administration)

[Filed December 23, 1998, 10:48 a.m.]



Original Notice.

Preproposal statement of inquiry was filed as WSR 98-19-013.

Title of Rule: WAC 388-550-1050 Definitions, 388-550-1200 Limitations on hospital coverage, 388-550-2800 Establishing inpatient payment rates, 388-550-2900 Payment limits--Inpatient hospital services, 388-550-3000 DRG payment system, 388-550-3100 Calculating DRG relative weights, 388-550-3500 Inflation adjustments, 388-550-3700 DRG outliers and administrative day rates, 388-550-4500 Payment method--RCC, 388-550-4700 Payment--Non-SCA participating hospitals, 388-550-4800 Hospital payment method--State-only programs, and 388-550-6000 Payment--Outpatient hospital services.

Purpose: To rewrite the rule per the Governor's Executive Order 97-02 which mandates readability, clarity, foundation in law, etc.; and to describe new methods of paying hospital providers. One new method is to change the high and low outlier thresholds for diagnosis-related group (DRG) claims. The other new method is to cap dual Medicare/Medicaid hospital payments at Medicaid's maximum.

Statutory Authority for Adoption: RCW 74.08.090; 42 USC 1395x(v); 42 USC 11303; 42 USC 2652; 42 CFR 447.271.

Statute Being Implemented: 42 USC 1395x(v); 42 USC 11303; 42 USC 2652; 42 CFR 447.271.

Summary: As of July 1, 1999, low-cost DRG outliers will be defined as: Allowed charges less than or equal to 10% of the applicable DRG payment or $450, whichever is greater. As of July 1, 1999, high-cost DRG outliers will be defined as allowed charges of three times the applicable DRG payment or $33,000, whichever is greater. Effective with the permanent adoption of the rule, the department's maximum Medicaid payment of dual Medicare/Medicaid hospital claims will be Medicaid's maximum.

Reasons Supporting Proposal: Federal legislation allows states to make these changes.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Larry Linn, P.O. Box 45510, Olympia, WA 98504-5510, (360) 753-4338.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: These rules describe the methodology the department uses to pay hospitals who provide inpatient and outpatient services to Medicaid and medical services client of the department.

Proposal Changes the Following Existing Rules: As of July 1, 1999, low-cost DRG outliers will be defined as allowed charges less than or equal to 10% of the applicable DRG payment or $450, whichever is greater. As of July 1, 1999, high-cost DRG outliers will be defined as allowed charges of three times the applicable DRG payment or $33,000, whichever is greater. Effective with the permanent adoption of the rule, the department's maximum Medicaid payment of dual Medicare/Medicaid hospital claims will be Medicaid's maximum.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Small businesses are not affected by these rule changes.

RCW 34.05.328 applies to this rule adoption. The department has prepared a cost-benefit analysis (CBA) regarding these rule changes. A copy of that CBA can be obtained from Larry Linn, Hospital Rates Section, Division of Operation Support Services, Medical Assistance Administration, Department of Social and Health Services, P.O. Box 45510, Olympia, WA 98504-5510, phone (360) 753-4338, e-mail linnld@dshs.wa.gov.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on February 23, 1999, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by February 13, 1999, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by February 23, 1999.

Date of Intended Adoption: February 24, 1999.

December 22, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit



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 99-03 issue of the Register.

Legislature Code Reviser 

Register

Washington State Code Reviser's Office