PREPROPOSAL STATEMENT OF INQUIRY
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Subject of Possible Rule Making: WAC 388-550-3700 DRG high-cost and low-cost outliers.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 74.08.090, 74.09.500.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The rule will allow MAA to update its diagnostic-related group (DRG) high cost outlier policy to provide better control and predictability of hospitals' costs. MAA proposes to incorporate more high cost outliers into the hospitals' cost-based conversion factors in order to reduce the portion of claims that are paid by the ratio of costs-to-charges (RCC) methodology. More of the hospitals' costs will be in the basic payment and fewer costs will go into the outlier calculation.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: None.
Process for Developing New Rule: The department invites the interested public to review and provide input on the draft language of this 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 Kathy Sayre, Rules Program Manager, P.O. Box 45533, Olympia, WA 98504-5533, phone (360) 725-1342, fax (360) 586-9727, TTY 1-800-848-5429, e-mail sayrek@dshs.wa.gov.
July 16, 2004
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit