WSR 08-15-110

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed July 18, 2008, 2:58 p.m. , effective August 18, 2008 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The department is amending this 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; 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.

Citation of Existing Rules Affected by this Order: Amending WAC 388-538-050, 388-538-060, 388-538-061, 388-538-067, 388-538-068, 388-538-070, 388-538-095, 388-538-100, 388-538-110, 388-538-111, 388-538-112, 388-538-120, 388-538-130, and 388-538-140.

Statutory Authority for Adoption: RCW 74.08.090 and 74.09.522.

Adopted under notice filed as WSR 08-09-029 on April 8, 2008.

Changes Other than Editing from Proposed to Adopted Version: Current language in subsection (8) deleted: The department helps facilitate the choice of a PCP by providing information regarding available providers in the MCOs in the client's service area. Subsection (8) was replaced as follows: (8) The department: (a) Helps facilitate the choice of a PCP by providing information regarding available providers contracted with the MCOs in the client's service area; and (b) Upon request, will assist clients in identifying an MCO with which their provider participates.

A final cost-benefit analysis is available by contacting Michael Paulson, P.O. Box 45530, Olympia, WA 98504-5530, phone (360) 725-1641, fax (360) 753-7315, e-mail paulsmj@dshs.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 14, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 14, Repealed 0.

Date Adopted: July 18, 2008.

Blake D. Chard

for Robin Arnold-Williams

Secretary

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 08-16 issue of the Register.

Washington State Code Reviser's Office