PREPROPOSAL STATEMENT OF INQUIRY
LABOR AND INDUSTRIES
Subject of Possible Rule Making: Revise sections of the medical aid rules, including chapter 296-20 WAC, General rules; chapter 296-23 WAC, Reimbursement policies; and chapter 296-23A WAC, Hospitals to allow reimbursement of selected outpatient services and supplies through a prospective payment system.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 51.04.020 and 51.04.030.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Pursuant to the above statutes, the Department of Labor and Industries (L&I) establishes and adopts rules governing administration of the industrial insurance laws. The purpose of the proposed rule changes is to allow the department to implement an outpatient prospective payment system (OPPS) in order to better manage outpatient expenditures, improve consistency of payment policies, improve consistency between payment levels and actual costs of service, establish greater uniformity between state agencies regarding reimbursement methodologies, allow for greater analysis and prediction of utilization and costs, and allow for rate adjustments to be based on more consistent and applicable data.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: L&I is working in coordination with the Health Care Authority (HCA) and the Department of Social and Health Services/Medical Assistance Administration (MAA) to develop and implement an OPPS system and develop rules. L&I is coordinating closely with MAA to draft OPPS rules.
Process for Developing New Rule: The department meets regularly with the HCA and the MAA through the interagency project work group to develop consistency in its health care purchasing rules and policies. External stakeholders will be involved through the existing outpatient prospective payment system technical advisory group (OPPS-TAG) and regional meetings. The proposed rule changes will be presented to variety of advisory groups and publicized in a letter to interested persons.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Jim Dick, Department of Labor and Industries, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, phone (360) 902-5131, fax (360) 902-4249, Internet dija235@Ini.wa.gov.
May 28, 1999