WSR 08-01-082



(Health and Recovery Services Administration)

[ Filed December 17, 2007, 10:42 a.m. ]

Subject of Possible Rule Making: Sections in chapter 388-538 WAC regarding the department's managed care delivery system.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 74.08.090, 74.09.522.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The department is amending the rule to update and clarify existing sections, clarify/add criteria regarding the department's patient review and coordination (PRC) program; add language regarding the monthly capitated premiums the department pays to managed care organizations (MCOs); remove language regarding information on the original agreement when the provider may bill the client for noncovered services; add language regarding MCO coverage of emergency services. (42 C.F.R. 438.114 (d)(1)(ii)); and add language to clarify the department pays MCOs a delivery case rate separate from the capitation payment when an enrollee delivers a child(ren) and the MCO pays for any part of labor and delivery.

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. At a later date, the department of social and health services will file a proposal with the office of the code reviser with a notice of proposed rule making. A copy of the proposal will be sent to everyone on the mailing list and to anyone who requests a copy.

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 45504, Olympia, WA 98504-45504 [98504-5504], phone (360) 725-1342, fax (360) 586-9727, TTY 1-800-848-5429, e-mail

December 17, 2007

Stephanie E. Schiller

Rules Coordinator

Washington State Code Reviser's Office