WSR 03-18-112

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed September 2, 2003, 5:25 p.m. ]

     Date of Adoption: September 2, 2003.

     Purpose: To provide the potential for broader provider participation in managed care.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-538-067.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.522.

      Adopted under notice filed as WSR 03-14-067 on June 25, 2003.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

August 28, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3260.1
AMENDATORY SECTION(Amending WSR 02-01-075, filed 12/14/01, effective 1/14/02)

WAC 388-538-067   Managed care provided through managed care organizations (MCOs).   (1) Managed care organizations (MCOs) may contract with the department of social and health services (DSHS) to provide prepaid health care services to eligible medical assistance administration (MAA) clients ((under the healthy options (HO) managed care program)). The MCOs must meet the qualifications in this section to be eligible to contract with DSHS. The MCO must:

     (a) Have a certificate of registration from the office of the insurance commissioner (OIC) ((as either a health maintenance organization (HMO) or a health care services contractor (HCSC).)) that allows the MCO to provide the services in subsection (1) of this section;

     (b) Accept the terms and conditions of DSHS' HO contract;

     (c) Be able to meet the network and quality standards established by DSHS; and

     (d) Accept the prepaid rates published by DSHS.

     (2) DSHS reserves the right not to contract with any otherwise qualified MCO.

[Statutory Authority: RCW 74.09.080, RCW 74.08.510, [74.08.]522, 74.09.450, 1115 Waiver, 42 U.S.C. 1396. 02-01-075, § 388-538-067, filed 12/14/01, effective 1/14/02.]

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