SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.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:
Pilot Rule Making:
or Other Alternative Rule Making:
Effective Date of Rule: Thirty-one days after filing.
August 28, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit3260.1
(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.]