SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Continuance of WSR 03-22-088.
Preproposal statement of inquiry was filed as WSR 02-24-010.
Title of Rule: WAC 388-501-0165 Determination process for coverage of medical equipment and medical or dental services.
Purpose: The department is extending the written comment deadline for this proposed rule to 5:00 p.m., January 16, 2004. Written comments may be sent to the postal address, fax number or e-mail address, or delivered to the location listed below. Comments sent by postal mail must be postmarked by January 16, 2004. A public hearing was held on December 9, 2003.
The proposed rule updates the definition of "medical necessity" and supporting terms in order to incorporate the use of medical information that is supported by scientific evidence in its determination of services. In order to ensure consistency with the updated definitions and support the use of evidence-based health care service determinations, the department is amending WAC 388-501-0165 to include definitions specific to the determination process, clarify provider responsibilities to support the determination of a service or equipment as being medically necessary, and clarify the department's basis for determining medical necessity.
Statutory Authority for Adoption: RCW 74.08.090, ESHB 1299 (chapter 276, Laws of 2003).
Statute Being Implemented: RCW 74.08.090, ESHB 1299 (chapter 276, Laws of 2003).
Summary: See Purpose above.
Reasons Supporting Proposal: See Purpose above.
Name of Agency Personnel Responsible for Drafting: Ann Myers, P.O. Box 45533, Olympia, WA 98504, (360) 725-1345; Implementation and Enforcement: Bill Hagens, P.O. Box 45500, Olympia, WA 98504, (360) 725-1237.
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: The rule is being amended to include the use of scientific evidence in the department's coverage and service determinations; to help ensure the department's clients will not be harmed or injured by inappropriate service utilization in view of the robust development and availability of new drugs, treatments, and therapies; to help ensure that available resources be spent in the most effective manner to improve the health of clients; and to help expedite service determinations.
The anticipated effects are as stated above.
Proposal Changes the Following Existing Rules: The rule described in Title of Rule and Purpose above is being amended to include definitions related to a new definition of "medical necessity," and to ensure the process and provisions described in the rule are consistent with the new definition.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule and concludes that it will not have a more than minor impact on the small businesses affected by it.
RCW 34.05.328 applies to this rule adoption. The department has analyzed the proposed rule and concludes that it meets the definition of a "significant legislative rule" as defined by the legislature. An analysis of the probable costs and probable benefits is available from the person listed above.
Hearing Location: A public hearing was held on December 9, 2003, in Lacey, Washington. See Purpose above.
Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail firstname.lastname@example.org, by 5:00 p.m., January 16, 2004.
Date of Intended Adoption: Not sooner than January 17, 2004.
December 10, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit