WSR 03-21-039

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed October 8, 2003, 2:55 p.m. ]

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 strikethrough text):

NEW SECTION

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);

(cd) General assistance-unemployable (GAU);

(de) Limited casualty program--Medically needy program (MNP); or

(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.

NEW SECTION

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: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 19, Amended 2, Repealed 6.
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.

Legislature Code Reviser 

Register

Washington State Code Reviser's Office