WSR 03-10-091

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed May 6, 2003, 4:53 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 03-03-017.

Title of Rule: WAC 388-502-0010 Payment -- Eligible providers defined.

Purpose: To add the "hold harmless" language from the core provider agreement (CPA), DSHS 09-048, that was inadvertently omitted when the CPA was revised in August 2002. This rule has been in effect since January 8, 2003, as an emergency rule.

Statutory Authority for Adoption: RCW 74.08.090.

Statute Being Implemented: RCW 74.08.090, 74.09.080, 74.09.120.

Summary: MAA is adding the "hold harmless" language that was inadvertently omitted from the revised core provider agreement.

Reasons Supporting Proposal: Without the adoption of this amendment, access to medical care for DSHS clients could be negatively impacted. Medical providers will be reluctant to sign the CPA without the "hold harmless" provision. Without a signed CPA, medical providers cannot be reimbursed by MAA. Without the prospect of reimbursement from MAA, providers may stop accepting DSHS clients as patients. Adding the "hold harmless" language to WAC 388-502-0010 also avoids having to require MAA providers to complete a new core provider agreement, which would be costly and inconvenient to both providers and MAA.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kevin Sullivan, MAA, P.O. Box 45533, Olympia, WA 98504-5533, (360) 725-1344.

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: See Purpose and Reasons Supporting Proposal above.

Proposal does not change existing rules. Although this provision is being added to this rule, it has always been a part of the core provider agreement between MAA and MAA providers.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This amendment causes no economic impact on small businesses.

RCW 34.05.328 applies to this rule adoption. The rule meets the definition of a significant legislative rule. MAA has evaluated the potential benefits and costs associated with this rule change, and has determined the benefits far outweigh the costs. MAA has determined there are no costs associated with this rule change. The proposed amendment adds a provision that state both MAA and MAA providers who sign a core provider agreement will each hold the other harmless from a legal action based on the negligent actions or omissions of the other.

Hearing Location: Office Building 2, Auditorium, 14th and Jefferson, Olympia, Washington 98504, on June 10, 2003, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by June 3, 2003, phone (360) 664-6097, TTY (360) 664-6178, e-mail swensfh@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail swensfh@dshs.wa.gov, by June 10, 2003.

Date of Intended Adoption: Not sooner than June 11, 2003.

April 20, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3197.3
AMENDATORY SECTION(Amending WSR 01-07-076, filed 3/20/01, effective 4/20/01)

WAC 388-502-0010   Payment -- Eligible providers defined.   The department reimburses enrolled providers for covered medical services, equipment and supplies they provide to eligible clients.

(1) To be eligible for enrollment, a provider must:

(a) Be licensed, certified, accredited, or registered according to Washington state laws and rules; and

(b) Meet the conditions in this chapter and chapters regulating the specific type of provider, program, and/or service.

(2) To enroll, an eligible provider must sign a core provider agreement or a contract with the department and receive a unique provider number. (Note: Section 13 of the core provider agreement, DSHS 09-048 (REV. 06/2002), is hereby rescinded. The department and each provider signing a core provider agreement will hold each other harmless from a legal action based on the negligent actions or omissions of either party under the terms of the agreement.)

(3) Eligible providers listed in this subsection may request enrollment. Out-of-state providers listed in this subsection are subject to conditions in WAC 388-502-0120.

(a) Professionals:

(i) Advanced registered nurse practitioners;

(ii) Anesthesiologists;

(iii) Audiologists;

(iv) Chiropractors;

(v) Dentists;

(vi) Dental hygienists;

(vii) Denturists;

(viii) Dietitians or nutritionists;

(((xiv))) (ix) Maternity case managers;

(x) Midwives;

(xi) Occupational therapists;

(xii) Ophthalmologists;

(xiii) Opticians;

(xiv) Optometrists;

(xv) Orthodontists;

(xvi) Osteopathic physicians;

(xvii) Podiatric physicians;

(xviii) Pharmacists;

(xix) Physicians;

(xx) Physical therapists;

(xxi) Psychiatrists;

(xxii) Psychologists;

(xxiii) Registered nurse delegators;

(xxiv) Registered nurse first assistants;

(xxv) Respiratory therapists;

(xxvi) Speech/language pathologists;

(xvii) Radiologists; and

(xviii) Radiology technicians (technical only);

(b) Agencies, centers and facilities:

(i) Adult day health centers;

(ii) Ambulance services (ground and air);

(iii) Ambulatory surgery centers (Medicare-certified);

(iv) Birthing centers (licensed by the department of health);

(v) Blood banks;

(vi) Chemical dependency treatment facilities certified by the department of social and health services (DSHS) division of alcohol and substance abuse (DASA), and contracted through either:

(A) A county under chapter 388-810 WAC; or

(B) DASA to provide chemical dependency treatment services;

(vii) Centers for the detoxification of acute alcohol or other drug intoxication conditions (certified by DASA);

(viii) Community AIDS services alternative agencies;

(ix) Community mental health centers;

(x) Early and periodic screening, diagnosis, and treatment (EPSDT) clinics;

(xi) Family planning clinics;

(xii) Federally qualified health care centers (designated by the Federal Health Care Financing Administration);

(xiii) Genetic counseling agencies;

(xiv) Health departments;

(xv) HIV/AIDS case management;

(xvi) Home health agencies;

(xvii) Hospice agencies;

(xviii) Hospitals;

(xix) Indian Health Service;

(xx) Tribal or urban Indian clinics;

(xxi) Inpatient psychiatric facilities;

(xxii) Intermediate care facilities for the mentally retarded (ICF-MR);

(xxiii) Kidney centers;

(xxiv) Laboratories (CLIA certified);

(xxv) Maternity support services agencies;

(xxvi) Neuromuscular and neurodevelopmental centers;

(xxvii) Nursing facilities (approved by DSHS Aging and Adult Services);

(xxviii) Pharmacies;

(xxix) Private duty nursing agencies;

(xxx) Rural health clinics (Medicare-certified);

(xxxi) Tribal mental health services (contracted through the DSHS mental health division); and

(xxxii) Washington state school districts and educational service districts.

(c) Suppliers of:

(i) Durable and nondurable medical equipment and supplies;

(ii) Infusion therapy equipment and supplies;

(iii) Prosthetics/orthotics;

(iv) Hearing aids; and

(v) Oxygen equipment and supplies;

(d) Contractors of:

(i) Transportation brokers;

(ii) Interpreter services agencies; and

(iii) Eyeglass and contact lens providers.

(4) Nothing in this chapter precludes the department from entering into other forms of written agreements to provide services to eligible clients.

(5) The department does not enroll licensed or unlicensed practitioners who are not specifically addressed in subsection (3) of this section, including, but not limited to:

(a) Acupuncturists;

(b) Counselors;

(c) Sanipractors;

(d) Naturopaths;

(e) Homeopaths;

(f) Herbalists;

(g) Massage therapists;

(h) Social workers; or

(i) Christian Science practitioners or theological healers.

[Statutory Authority: RCW 74.08.090, 74.09.500, and 74.09.530. 01-07-076, 388-502-0010, filed 3/20/01, effective 4/20/01; 00-15-050, 388-502-0010, filed 7/17/00, effective 8/17/00.]

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