WSR 10-13-169

PERMANENT RULES

DEPARTMENT OF HEALTH


[ Filed June 23, 2010, 9:08 a.m. , effective July 24, 2010 ]


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

Purpose: The rules adopt a new chapter in WAC and establish a fee schedule for initial certification surveys of health care facilities. The rules are in response to 2007 legislation (SHB 2087) and 2009 legislation (ESHB 1244). This legislation authorizes the department to assess set fees to conduct initial certification surveys for health care facilities in the event of insufficient federal funding.

Statutory Authority for Adoption: RCW 40.70.125.

Adopted under notice filed as WSR 10-05-032 on February 9, 2010.

Changes Other than Editing from Proposed to Adopted Version: The department removed language in WAC 246-319-990 (2) and (3) that required applicants to obtain an initial certification survey from a national accreditation organization rather than the department when such accrediting organizations were available. Such requirements were not specifically identified in the authorizing legislation and therefore have been removed.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.

Date Adopted: June 22, 2010.

Mary C. Selecky

Secretary

OTS-1200.5

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. The definitions in this section apply throughout this section unless the context clearly requires otherwise.

(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) The department will not charge a fee to conduct initial medicare certification surveys as long as sufficient funding exists.

(3) 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 (4) of this section to all applicants who apply for initial medicare certification surveys after the notice is issued.

(4) Fees. The following fees will be charged to an applicant to conduct an initial medicare certification survey when there is insufficient funding:


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