WSR 17-08-031 PROPOSED RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed March 28, 2017, 3:09 p.m.]
Supplemental Notice to WSR 16-20-081.
Preproposal statement of inquiry was filed as WSR 16-15-050.
Title of Rule and Other Identifying Information: WAC 182-551-1860 Concurrent care for hospice clients twenty years of age and younger.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Pear Conference Room 107, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at http://www.hca.wa.gov/documents/directions_to_csp.pdf or directions can be obtained by calling (360) 725-1000), on May 9, 2017, at 10:00 a.m.
Date of Intended Adoption: Not sooner than May 10, 2017.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia WA, 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, email arc@hca.wa.gov, fax (360) 586-9727, by 5:00 p.m. on May 9, 2017.
Assistance for Persons with Disabilities: Contact Amber Lougheed by May 5, 2017, email amber.lougheed@hca.wa.gov, (360) 725-1349, or TTY (800) 848-5429 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency amended this rule to align the language with the federal rules in 42 U.S.C. 1396d (o)(1)(C) for hospice concurrent care. The amended language states that a client age twenty and younger may voluntarily elect hospice care without waiving any rights to services that the client is entitled to under Title XIX Medicaid and Title XXI Children's Health Insurance Program (CHIP) that are related to the treatment of the client's condition for which a diagnosis of terminal illness has been made. The agency also removed the prior authorization requirement for enrollment in a concurrent care plan.
Reasons Supporting Proposal: The agency revised these rules in response to comments received from stakeholders in the first public hearing held on November 8, 2016, filed under WSR 16-20-081.
Statute Being Implemented: RCW 41.05.021, 41.05.160, Section 2302 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. 1396d (o)(1)(C).
Rule is necessary because of federal law, Section 2302 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. 1396d (o)(1)(C).
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Wendy Barcus, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1306; Implementation and Enforcement: Nancy Hite, P.O. Box 75506, Olympia, WA 98504-5506, (360) 725-1611.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has determined that the proposed filing does not impose a disproportionate cost impact on small businesses or nonprofits.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
March 28, 2017
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 12-09-079, filed 4/17/12, effective 5/18/12)
WAC 182-551-1860 Concurrent care for hospice clients age twenty ((years of age)) and younger.
(1) In accordance with ((Section 2302 of the Patient Protection and Affordable Care Act of 2010 and Section 1814(a)(7) of the Social Security Act, hospice palliative services are available to)) 42 U.S.C. 1396d (o)(1)(C), a client((s)) age twenty ((years of age)) and younger ((without forgoing curative services which)) may voluntarily elect hospice care without waiving any rights to services that the client is entitled to under Title XIX Medicaid and Title XXI Children's Health Insurance Program (CHIP) ((for treatment of the terminal condition)) that are related to the treatment of the client's condition for which a diagnosis of terminal illness has been made.
(2) ((Unless otherwise specified within this section, curative treatment including)) The related services in subsection (1) of this section and medications requested for clients age twenty ((years of age)) and younger are subject to the medicaid agency's specific program rules governing those services or medications.
(3) ((The following services aimed at achieving a disease-free state are included under the curative care benefit:
(a) Radiation;
(b) Chemotherapy;
(c) Diagnostics, including laboratory and imaging;
(d) Licensed health care professional services;
(e) Inpatient and outpatient hospital care;
(f) Surgery;
(g) Medication;
(h) Equipment and related supplies; and
(i) Ancillary services, such as medical transportation.
(4) The following are not included under the curative care benefit:
(a) Hospice covered services as described in WAC 182-551-1210;
(b) Services related to symptom management such as:
(I) Radiation;
(II) Chemotherapy;
(III) Surgery;
(IV) Medication; and
(V) Equipment and related supplies; and
(c) Ancillary services, such as medical transportation.
(5) Health care professionals must request prior authorization from the agency in accordance with WAC 182-501-0163 for enrollment in a concurrent care plan. Prior authorization requests are subject to medical necessity review under WAC 182-501-0165.
(6))) If the ((curative treatment)) services in this section include((s)) noncovered services ((in accordance with)) listed in WAC 182-501-0070, the provider must request an exception to rule ((in accordance with)) under WAC 182-501-0160.
(((7))) (4) If the medicaid agency denies a request for a covered service, refer to WAC 182-502-0160, billing a client, for when a client may be responsible to pay for a covered service.
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