SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Preproposal statement of inquiry was filed as WSR 07-12-061.
Title of Rule and Other Identifying Information: The department is creating WAC 388-501-0055 Healthcare coverage -- How the department determines coverage of services for its healthcare programs using health technology assessments.
Hearing Location(s): Office Building 2, Auditorium, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html or by calling (360) 664-6094), on May 26, 2009, at 10:00 a.m.
Date of Intended Adoption: Not sooner than May 27, 2009.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on May 26, 2009.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by May 12, 2009, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at firstname.lastname@example.org.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: To codify how health technology assessments are used in HRSA's determinations of what services are included in the benefit design of its medical assistance programs.
Reasons Supporting Proposal: It makes HRSA's determination process more transparent to the public.
Statutory Authority for Adoption: RCW 70.14.090 and 74.08.090.
Statute Being Implemented: RCW 70.14.090 and 74.08.090.
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: Kevin Sullivan, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1344; Implementation and Enforcement: Gail Kreiger, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-1681.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule does not impose any new costs on small businesses.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kevin Sullivan, P.O. Box 45504, Olympia, WA 98504-5504, phone (360) 725-1344, fax (360) 586-9727, e-mail email@example.com.
April 13, 2009
Stephanie E. Schiller
(a) The department; or
(b) The health technology assessment clinical committee (HTACC) according to RCW 70.14.080 through 70.14.140.
(2) The department reviews available evidence relevant to a medical or dental service or healthcare-related equipment and uses a technology evaluation matrix, in order to:
(a) Determine its efficacy, effectiveness, and safety;
(b) Determine its impact on health outcomes;
(c) Identify indications for use;
(d) Identify potential for client misuse or abuse; and
(e) Compare to alternative technologies to assess benefit vs. harm and cost effectiveness.
(3) The department may determine the technology, device, or technology-related supply is:
(a) Covered (refer to WAC 388-501-0060);
(b) Covered with authorization (refer to WAC 388-501-0165);
(c) Covered with limitations (refer to WAC 388-501-0169); or
(d) Noncovered (refer to WAC 388-501-0070).
(4) The department may periodically review existing technologies, devices, or technology-related supplies and reassign authorization requirements as necessary according to the same provisions as outlined above for new technologies, devices, or technology-related supplies.
(5) The department evaluates the evidence and criteria presented by HTACC to determine whether a service is covered in accordance with WAC 388-501-0050 (6) and (7) and this section.