SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: October 3, 2003.
Purpose: The department is adopting rules to reflect operating changes that are necessary to: (1) Comply with federal requirements for Medicaid dialysis reimbursements; (2) meet Department of Social and Health Services (DSHS) utilization and cost containment initiative (UCCI) budget targets; and (3) comply with the Governor's Executive Order on Regulatory Reform. The new sections created by this rule change are WAC 388-540-015, 388-540-025, 388-540-035, 388-540-045, 388-540-055, 388-540-065, 388-540-101, 388-540-105, 388-540-110, 388-540-120, 388-540-130, 388-540-140, 388-540-150, 388-540-160, 388-540-170, 388-540-180, 388-540-190, 388-540-200, and 388-540-210.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-540-010, 388-540-020, 388-540-030, 388-540-040, 388-540-050 and 388-540-060; and amending WAC 388-540-001 and 388-540-005.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.510, 74.09.520, 74.09.522.
Other Authority: 42 C.F.R. 405.2101.
Adopted under notice filed as WSR 03-14-103 on June 30, 2003.
Changes Other than Editing from Proposed to Adopted Version: There is a correction to WAC 388-540-110 Eligibility, adding alien emergency medical and deleting medically indigent (MI). WAC 388-540-200 Epoetin alpha (EPO) therapy. WAC 388-540-200(1) was amended to add subsections (1)(c)(i) and (1)(c)(ii).
As a result of comments received, the following changes
were made in the rules as proposed (Additions indicated by
underlined text, deletions indicated by
WAC 388-540-110 Eligibility. (1) To be eligible for the kidney center services described in this section, a client must be diagnosed with end-stage renal disease (ESRD) or acute renal failure and be covered under one of the following programs:
(a) Categorically needy program (CNP);
(b) Children's health insurance program (CHIP);
(c) Medically indigent program (MI) (Emergency hospital
and ambulance only);
d) General assistance-unemployable (GAU);
e) Limited casualty program--Medically needy program
(e) Alien emergency medical; or
(f) Qualified Medicare beneficiary (QMB)--(MAA pays only for Medicare premium, co-insurance and deductible);
(2) Managed care enrollees must have dialysis services arranged directly through their designated plan.
WAC 388-540-200 Epoetin alpha (EPO) therapy. The medical assistance administration (MAA) reimburses the kidney center for EPO therapy when:
(1) Administered in the kidney center to a client:
(a) With a hematocrit less than thirty-three percent or a hemoglobin less than eleven when therapy is initiated; or
(b) Continuing EPO therapy with a hematocrit between thirty and thirty-six percent.
(c) Medical justification documented in the client's record is required for hematocrits greater than thirty-six or hemoglobins greater than twelve. Medical justification includes:
(i) Documentation that dose is being titrated downward to bring a patient's hematocrit back within target range; or
(ii) Documentation that it is medically necessary for the client to have a target hematocrit greater than thirty-six percent.
(2) Provided to a home dialysis client:
(a) Under the same hematocrit/hemoglobin guidelines as stated in (1)(a) and (b) of this section; and
(b) When permitted by Washington Board of Pharmacy Rules. (Refer to WAC 246-905-020 Home dialysis program -- Legend drugs.)
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 6, 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 13, Amended 2, Repealed 6.
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.
October 3, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 03-22 issue of the Register.