WSR 15-04-134

[Filed February 4, 2015, 11:06 a.m.]

Title or Subject: Medicaid State Plan Amendments.

Effective Date: April 1, 2015.

Description: The health care authority (the agency) anticipates that one or more medicaid state plan amendments (SPAs) may need to be submitted to (1) update effective dates for selected fee schedules to April 1, 2015, and (2) revise language regarding fee schedules and their effective dates. In regard to (2) above, the following context may be useful. Currently, the medicaid state plan references most fee schedules as "state-developed," and does not go into the details or the basis of rate calculation, such as being based upon medicare rates. The Centers for Medicare and Medicaid Services (CMS) has advised the agency to add such information to the medicaid state plan. Consequently, the agency will be submitting one or more SPAs in order to add additional detail as instructed. These SPAs will alter the descriptive language within the state plan but there is no actual change in methodologies or rate structures associated with these new descriptions. For example, when "state-defined reimbursement method" is replaced with "based upon Medicare rates," no methodology change is taking place as the "state-defined rate" has been based upon medicare rates for many years. These newly detailed descriptions are not associated with actual methodology changes and are being submitted only to comply with CMS's request to add explanatory language.

The fee schedules that may be affected include adult day health, ambulance/air ambulance, ambulatory surgery centers, applied behavior analysis, advanced registered nurse practitioner, audiology, birthing center services, blood banks, chemical dependency, children's mental health, chiropractic services, childbirth education, clinic services, dental, diabetes education, durable medical equipment, enteral nutrition, EPSDT, family planning, FQHC, habilitative services, hearing services, home health, home infusion/parenteral nutrition, hospice, hospitals – inpatient and outpatient, infant case management, kidney center services, laboratory and radiology services, medical nutrition, mental health, neurodevelopmental centers, nondurable medical equipment, occupational therapy, OPPS, ophthalmologists/optometrists, other practitioners, oxygen, personal care services, pharmacy services/drugs, physical therapy, physicians services, planned home births, prenatal diagnosis genetic counseling, private duty nursing for children, prosthetics and orthotics, rehabilitative services, RHC, school-based health care services, speech/audiology, targeted case management services (HIV/AIDS, MSS/ICM, etc.), tobacco cessation, telemedicine, transportation, and vision care.

Updating the language regarding these fee schedules is not anticipated to have an effect on annual aggregate expenditures.

For additional information, contact Jean Bui, Rates Development, 626 8th Avenue S.E., Olympia, WA 98501, phone (360) 725-1973, TDD/TTY 800-848-5429, fax (253) 350-6512, e-mail jean.bui@hca.wa.gov.