WSR 05-07-135

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed March 22, 2005, 4:42 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-12-093.

Title of Rule and Other Identifying Information: WAC 388-531-0150 Noncovered physician-related services, 388-531-0200 Physician-related services requiring prior authorization, 388-531-0250 Who can provide and bill for physician-related services, 388-531-0650 Hospital physician-related services not requiring authorization when provided in MAA-approved centers for excellence or hospitals authorized to provide the specific services, 388-531-1600 Bariatric surgery, 388-550-2300 Hospital and medical criteria requirements for bariatric surgery, 388-550-2800 Inpatient payment methods and limits, and 388-550-4400 Services -- Exempt from DRG payment.

Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on May 10, 2005, at 10:00 a.m.

Date of Intended Adoption: Not sooner than May 11, 2005.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., May 10, 2005.

Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by May 6, 2005, TTY (360) 664-6178 or (360) 664-6097.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The Medical Assistance Administration (MAA) is proposing to amend/add the above listed WAC sections to establish standards for selection of surgeons and hospitals performing gastric bypass surgery for MAA clients and to establish criteria and pre- and postoperative requirements for clients that would further prevent the likelihood of complications.

Recent studies of gastric bypass surgeries in Washington show an increased likelihood of complications. Specifically for 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% 30-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 by pass 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 the establishment of these rules are necessary.

Reasons Supporting Proposal: See above.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

Statute Being Implemented: RCW 74.08.090, 74.09.520.

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of Social and Health Services, governmental.

Name of Agency Personnel Responsible for Drafting: Wendy L. Boedigheimer, P.O. Box 45533, Olympia, WA 98504-5533, (360) 725-1306; Implementation and Enforcement: Dr. Carolyn Coyne, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-1904.

No small business economic impact statement has been prepared under chapter 19.85 RCW.

A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Dr. Carolyn Coyne, MD, MHA Senior Medical Consultant, Division of Medical Management, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-1904, fax (360) 586-9727, e-mail coynecm@dshs.wa.gov.

March 17, 2005

Andy Fernando, 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 05-08 issue of the Register.

Washington State Code Reviser's Office