WSR 12-04-022

PERMANENT RULES

HEALTH CARE AUTHORITY


(Medicaid Program)

[ Filed January 25, 2012, 1:44 p.m. , effective February 25, 2012 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The agency is revising the rules to clarify that hospitals must be "operated" by a public hospital district (PHD) to qualify as a certified public expenditure hospital rather than "owned" by a PHD. This change ensures that the state remains in compliance with 42 C.F.R. 433.51(b). This rule revision also includes housekeeping changes such as replacing "department" with "agency" and cross-reference fixes from TITLE 388 WAC to TITLE 182 WAC as a result of the merge with health care authority on July 1, 2011.

Citation of Existing Rules Affected by this Order: Amending WAC 182-550-4650 and 182-550-5400.

Statutory Authority for Adoption: RCW 41.05.021.

Other Authority: 42 C.F.R. 433.51(b).

Adopted under notice filed as WSR 12-01-042 on December 13, 2011.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 2, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: January 25, 2012.

Kevin M. Sullivan

Rules Coordinator

OTS-4524.2


AMENDATORY SECTION(Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)

WAC 182-550-4650   "Full cost" public hospital certified public expenditure (CPE) payment program.   (1) The ((department's)) agency's "full cost" public hospital certified public expenditure (CPE) payment program provides payments to participating hospitals based on the "full cost" of covered medically necessary services and requires the expenditure of local funds in lieu of state funds to qualify for federal matching funds. The ((department's)) agency's payments to participating hospitals equal the federal matching amount for allowable costs. The ((department)) agency uses the ratio of costs-to-charges (RCC) method described in WAC ((388-550-4500)) 182-550-4500 to determine "full cost."

(2) Only the following facilities are reimbursed through the "full cost" public hospital CPE payment program:

(a) Public hospitals located in the state of Washington that are:

(i) ((Owned)) Operated by public hospital districts; and

(ii) Not certified by the department of health (DOH) as a critical access hospital;

(b) Harborview Medical Center; and

(c) University of Washington Medical Center.

(3) Payments made under the CPE payment program are limited to medically necessary services provided to medical assistance clients eligible for inpatient hospital services.

(4) Each hospital described in subsection (2) of this section is responsible to provide certified public expenditures as the required state match for claiming federal medicaid funds.

(5) The ((department)) agency determines the actual payment for inpatient hospital services under the CPE payment program by:

(a) Multiplying the hospital's medicaid RCC ((rate)) by the covered charges (to determine allowable costs), then;

(b) Subtracting the client's responsibility and any third party liability (TPL) from the amount derived in (a) of this subsection, then;

(c) Multiplying the state's federal ((matching)) medical assistance percentage (FMAP) by the amount derived in (b) of this subsection.

[11-14-075, recodified as 182-550-4650, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. 06-08-046, 388-550-4650, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050, 74.08.090. 05-12-132, 388-550-4650, filed 6/1/05, effective 7/1/05.]


AMENDATORY SECTION(Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)

WAC 182-550-5400   Payment method--Public hospital disproportionate share hospital (PHDSH).   (1) The ((department's)) agency's public hospital disproportionate share hospital (PHDSH) program is a ((public hospital)) program for:

(a) Public hospitals located in the state of Washington that are:

(i) ((Owned)) Operated by a public hospital district; and

(ii) Not certified by the department of health (DOH) as a critical access hospital;

(b) Harborview Medical Center; and

(c) University of Washington Medical Center.

(2) The PHDSH payments to a hospital eligible under this program may not exceed the hospital's disproportionate share hospital (DSH) cap calculated according to WAC ((388-550-4900)) 182-550-4900(10). The hospital receives only the federal ((matching)) medical assistance percentage of the total computable payment amount.

(3) Hospitals receiving payment under the PHDSH program must provide the local match for the federal funds through certified public expenditures (CPE). Payments are limited to costs incurred by the participating hospitals.

(4) A hospital receiving payment under the PHDSH program must submit to the ((department)) agency federally required medicaid cost report schedules apportioning inpatient and outpatient costs, beginning with the services provided during state fiscal year 2006. See WAC ((388-550-5410)) 182-550-5410.

(5) PHDSH payments are subject to the availability of DSH funds under the statewide DSH cap. If the statewide DSH cap is exceeded, the ((department)) agency will recoup PHDSH payments first, but only from hospitals that received total inpatient and DSH payments above the hold harmless level, and only to the extent of the excess amount above the hold harmless level. See WAC ((388-550-4900)) 182-550-4900 (13) and (14), and WAC ((388-550-4670)) 182-550-4670.

[11-14-075, recodified as 182-550-5400, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. 07-14-090, 388-550-5400, filed 6/29/07, effective 8/1/07; 06-08-046, 388-550-5400, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050, 74.08.090. 05-12-132, 388-550-5400, filed 6/1/05, effective 7/1/05. Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.035(1), and 43.88.290. 03-13-055, 388-550-5400, filed 6/12/03, effective 7/13/03. Statutory Authority: RCW 74.08.090, 74.09.730, chapter 74.46 RCW and 42 U.S.C. 1396r-4. 99-14-025, 388-550-5400, filed 6/28/99, effective 7/1/99. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. 98-01-124, 388-550-5400, filed 12/18/97, effective 1/18/98.]

Washington State Code Reviser's Office