PREPROPOSAL STATEMENT OF INQUIRY
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Subject of Possible Rule Making: Reimbursement of bariatric surgery, chapters 388-531 and 388-550 WAC and other related sections of WAC.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 74.08.090 and 74.09.520.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Recent studies of gastric bypass surgeries in Washington show an increased likelihood of complications. Specifically for Medical Assistance Administration (MAA) clients following gastric bypass surgery, recent statistics show a 2.1% in-hospital mortality rate (compared to 0.9% for all other patients in Washington state) and a 3.6% thirty day mortality rate following the surgery (compared to 1.7% in all other Washington state patients). The mortality rates for MAA clients in both instances are more than double that of other patients. The national mortality rate from peer-reviewed literature for gastric bypass surgery is between 0% and 1%.
Because evidence shows that surgeon experience and competence is one of the most important factors in predicting the likelihood of complications, rules are needed to establish standards for selection of surgeons and hospitals performing gastric bypass surgery for MAA clients. Rules are also needed to establish criteria and pre- and post-operative requirements for clients that would further prevent the likelihood of complications.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The Department of Health will be involved in the rule-making process through external review.
Process for Developing New Rule: The department invites the interested public to review and provide input on the draft language of the rule. Draft material and information about how to participate may be obtained from the department representative listed below.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Wendy Boedigheimer, MAA Rules Program Manager, P.O. Box 45533, Olympia, WA 98504-5533, phone (360) 725-1306, fax (360) 586-9727, e-mail boediwl@dshs.wa.gov, TDD 1-800-848-5429.
May 27, 2004
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit