WSR 10-05-032

PROPOSED RULES

DEPARTMENT OF HEALTH


[ Filed February 9, 2010, 9:57 a.m. ]

Original Notice.

Exempt from preproposal statement of inquiry under RCW 34.05.310(4).

Title of Rule and Other Identifying Information: WAC 246-319-990 Initial medicare certification survey fee schedule, adding a new chapter and section to implement RCW 43.70.125 and 2009 passed legislation, ESHB 1244, that authorize the department to assess fees for department-conducted initial medicare surveys whenever the department has not received sufficient funding from the Centers for Medicare and Medicaid Services.

Hearing Location(s): Department of Health, Point Plaza East, 310 Israel Road S.E., Rooms 152 and 153, Tumwater, WA 98501, on April 12, 2010, at 10:00 a.m.

Date of Intended Adoption: April 14, 2010.

Submit Written Comments to: John Hilger, Department of Health, P.O. Box 47852, Olympia, WA 98504-7852, web site http://www3.doh.wa.gov/policyreview/, fax (360) 236-2901, by April 12, 2010.

Assistance for Persons with Disabilities: Contact John Hilger by April 7, 2010, TTY (800) 833-6388 or 711.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposal is to add a new chapter and section to TITLE 246 WAC in response to 2009 passed legislation (ESHB 1244), which authorizes the department to establish a fee schedule to apply to applicants for initial certification surveys of health care facilities. These are facilities that want to receive federal reimbursement for services. These proposed fees would only apply when the department has determined that federal funding is not sufficient to compensate the department for the cost of conducting initial certification surveys.

Reasons Supporting Proposal: (1) ESHB 1244 authorizes the department to adopt rules to establish a fee schedule; and (2) the proposed rule reiterates that the department is authorized to charge fees established in law for initial certification surveys in the event that federal funding is not sufficient.

Statutory Authority for Adoption: RCW 43.70.125.

Statute Being Implemented: RCW 43.70.125.

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

Name of Proponent: Department of health, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Byron Plan, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-2916.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Under RCW 19.85.025 and 34.05.310 (4)(e), a small business economic impact statement is not required for a proposed rule where the content of the rule is explicitly and specifically dictated by statute.

A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 (5)(b)(v) exempts rules the content of which is explicitly and specifically dictated by statute.

February 9, 2010

Mary C. Selecky

Secretary

OTS-1200.3

Chapter 246-319 WAC

INITIAL MEDICARE CERTIFICATION SURVEY FEE SCHEDULE


NEW SECTION
WAC 246-319-990   Fees.   Purpose: This chapter implements RCW 43.70.125 allowing the department to assess a fee for the department to conduct an initial medicare survey. An applicant for medicare certification must pay the fee whenever the department has not received sufficient funding from the Centers for Medicare and Medicaid Services.

(1) Definitions:

(a) "Initial medicare certification survey" means an on-site visit conducted by department staff for the purpose of determining compliance with medicare regulations. This survey is required before a health care provider can receive medicare or medicaid reimbursement.

(b) "Insufficient funding" means the department has spent or encumbered eighty percent of the total available Title XVIII medicare grant award to complete required certification activities.

(c) "Sufficient funding" means the department has received, through the Title XVIII medicare grant, funds intended to fully reimburse the department for all required certification activities in the annual grant.

(d) "Title XVIII grant priority" means the four tier system established by the Centers for Medicare and Medicaid Services that guides state agencies to complete certification activities in accordance with statutory mandates and Centers for Medicare and Medicaid Services policy.

(e) "Title XVIII medicare grant" means the grant authorized in Section 1864(a) of the Federal Social Security Act and administered by the Centers for Medicare and Medicaid Services to the department to fund the annual certification activity requirements.

(2) In accordance with Centers for Medicare and Medicaid Services policy, an applicant must obtain an initial medicare certification survey from a national accreditation organization deemed for this purpose rather than the department when such accrediting organizations are available.

(3) The department will conduct an initial certification survey for those applicants for which there is no deemed accrediting organization. The department will not charge a fee to conduct these initial medicare certification surveys as long as sufficient funding exists.

(4) The department will only charge a fee for initial certification activities if there is insufficient funding.

(5) Notice of insufficient funding. When insufficient funding exists to complete the Title XVIII grant priority, the department will:

(a) Issue a notice to all potentially affected health care providers and provider associations known by the department; and

(b) Charge a fee according to the fee schedule in subsection (6) of this section to all applicants who apply for initial medicare certification surveys after the notice is issued.

(6) Fee. The department will charge an applicant for an initial medicare certification survey a fee to conduct the initial medicare survey as follows:


Ambulatory surgery center $ 1,815
Critical access hospital $ 2,015
End stage renal disease facility $ 980
Home health agency $ 2,285
Hospice agency $ 2,285
Hospital $ 2,285
Rehabilitation facility $ 520
Rural health clinic $ 690
Transplant hospital $ 7,000

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Washington State Code Reviser's Office