WSR 06-22-061

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed October 30, 2006, 11:25 a.m. , effective November 1, 2006 ]


Effective Date of Rule: November 1, 2006.

Purpose: To comply with the requirements of the 2005 legislature, the department is adding new section WAC 388-550-2650, to adopt two separate base community psychiatric hospital payments. One is for Medicaid clients and the other is for non-Medicaid clients. The new rule also clarifies that both Involuntary Treatment Act (ITA)-certified hospitals and hospitals that have ITA-certified beds that have been used to treat ITA patients are included in the base community psychiatric hospitalization payment method for Medicaid and non-Medicaid clients.

This emergency rule replaces the emergency filing for WAC 388-550-2650, under WSR 06-14-086.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.500.

Other Authority: Section 204, chapter 518, Laws of 2005 (ESSB 6090), Part II.

Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

Reasons for this Finding: The legislature appropriated funds for fiscal year 2006 and 2007 to establish a separate based community psychiatric hospitalization payment rate for Medicaid and non-Medicaid clients at hospitals that accept commitments under the ITA and free-standing psychiatric hospitals that accept commitments under the ITA and also hospitals that have ITA-certified beds that have been used to treat ITA patients. This rule replaces the emergency rule filed under WSR 06-14-086. The new rule carries out the legislature's directive while the department completes the permanent rule-making process begun under WSR 05-14-145 and filed on July 5, 2005.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.

Date Adopted: October 23, 2006.

Andy Fernando, Manager

Rules and Policies Assistance Unit

3646.2
NEW SECTION
WAC 388-550-2650   Base community psychiatric hospitalization payment method for Medicaid and non-Medicaid clients.   (1) Effective July 1, 2005 and in accordance with legislative directive, the department implemented two separate base community psychiatric hospitalization payment rates, one for Medicaid clients and one for non-Medicaid clients. (For the purpose of this section, a "non-Medicaid client" is defined as a client eligible under the general assistance unemployable (GAU) program, the Alcoholism and Drug Addiction Treatment and Support Act (ADATSA), the psychiatric indigent inpatient (PII) program, or other state-administered programs, as determined by the department.)

(a) The Medicaid base community psychiatric hospitalization payment rate is a minimum per diem allowable calculated for claims for psychiatric services provided to Medicaid covered patients, to pay hospitals that accept commitments under the involuntary treatment act (ITA).

(b) The non-Medicaid base community psychiatric hospitalization payment rate is a minimum per diem allowable calculated for claims for psychiatric services provided to indigent patients to pay hospitals that accept commitments under the ITA.

(2) A client's inpatient psychiatric hospitalization must have a root cause that is psychiatric in nature. The department:

(a) Defines "root cause" as the reason the client was admitted based on the principal diagnosis and the department's review of the client's medical record; and

(b) Does not consider detoxification to be psychiatric in nature.

(3) All inpatient hospital psychiatric admissions require regional support network (RSN) prior authorization. The RSN-approved length of stay (LOS) is based on a client's discharge diagnosis.

(a) The number of department-covered days that are linked to claims paid under the DRG payment method becomes the RSN-approved LOS for those claims. If the case is a transfer case, the DRG average LOS becomes the LOS that is used to determine the allowable on the claim. See WAC 388-550-3600.

(b) The RSN-approved LOS for claims paid using a non-DRG payment method is established by the RSN in conjunction with the mental health division.

(4) Payment for claims is based on covered days within a client's approved LOS, subject to client eligibility and department-covered services.

(5) The Medicaid base community psychiatric hospitalization payment rate applies only to a Medicaid client admitted to a nonstate-owned free-standing psychiatric hospital located in Washington state.

(6) The non-Medicaid base community psychiatric hospitalization payment rate applies only to a non-Medicaid client admitted to a hospital:

(a) Designated by the department as an Involuntary Treatment Act (ITA)-certified hospital; or

(b) That has a department certified ITA bed that has been used to provide ITA services at the time of the non-Medicaid admission.

(7) For inpatient hospital psychiatric services provided to eligible clients on and after July 1, 2005, the department pays:

(a) A hospital's DOH-certified distinct psychiatric unit, as follows:

(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using the department-specific non-DRG payment method.

(ii) For non-Medicaid clients, the department uses as the allowable for inpatient hospital psychiatric claims, the greater of:

(A) The state-only diagnostic-related group (DRG) allowable (including the high cost outlier allowable, of applicable), or the department-specified non-DRG payment method if no relative weight exists for the DRG in the department's payment system; or

(B) The non-Medicaid base community psychiatric hospitalization payment rate multiplied by the covered days.

(b) A hospital without a DOH-certified distinct psychiatric unit, as follows:

(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using:

(A) The DRG payment method; or

(B) The department-specified non-DRG payment method if no relative weight exists for the DRG in the department's payment system.

(ii) For non-Medicaid clients, the department uses as the allowable for inpatient hospital psychiatric claims, the greater of:

(A) The state-only diagnostic-related group (DRG) allowable (including the high cost outlier allowable, if applicable), or the department-specified non-DRG payment method if no relative weight exists for the DRG in the department's payment system; or

(B) The non-Medicaid base community psychiatric hospitalization payment rate multiplied by the covered days.

(c) A non-state-owned free-standing psychiatric hospital, as follows:

(i) For Medicaid clients, the department uses as the allowable for inpatient hospital psychiatric claims, the greater of:

(A) The RCC allowable; or

(B) The Medicaid base community psychiatric hospitalization payment rate multiplied by covered days.

(ii) For non-Medicaid clients, the department pays inpatient hospital psychiatric claims the same as for Medicaid clients, except the base community psychiatric hospitalization payment rate is the non-Medicaid rate, and the RCC allowable is the state-only RCC allowable.

(d) A hospital, or a distinct psychiatric unit of a hospital, that is participating in the CPE payment program, as follows:

(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using the methods identified in WAC 388-550-4650.

(ii) For non-Medicaid clients, the department pays inpatient hospital psychiatric claims using the methods identified in WAC 388-550-4650, except that the allowable to which the federal financial participation (FFP) percentage is applied is the greater of:

(A) The RCC allowable; or

(B) The non-Medicaid base community psychiatric hospitalization payment rate multiplied by covered days.

(e) A hospital, or a distinct psychiatric unit of a hospital that is participating in the CAH program, as follows:

(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using the department-specified non-DRG payment method.

(ii) For non-Medicaid clients, the department pays inpatient hospital psychiatric claims using the department-specified non-DRG payment method.

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Washington State Code Reviser's Office