HEALTH CARE AUTHORITY
[Filed May 7, 2019, 12:41 p.m.]
Subject: Medicaid State Plan Amendment (SPA) 19-0019 Hospital Psychiatric Services Per Diem Rates.
Effective Date: April 24, 2019, through June 30, 2019.
Description: The health care authority (HCA) intends to submit medicaid SPA 19-0019 in order to comply with HB 1534, section 1, to increase rates for both medicaid and nonmedicaid (state-funded only) psychiatric per diem rates. The medicaid state plan addresses only medicaid-related services; therefore SPA 19-0019 applies only to medicaid psychiatric per diem rates.
Under HB 1534, psychiatric per diem payments for recipients eligible for medical assistance programs under chapter 74.09
RCW for services provided by a hospital, regardless of the beneficiary's managed care enrollment status, must be increased sufficiently to ensure services are provided by a hospital that:
|•||Is designated as a rural hospital by the department of health (DOH);|
|•||Has less than fifty staffed acute care beds, as reported in the hospital's 2017 DOH year-end report;|
|•||Is not participating in the certified public expenditure full cost reimbursement program; and|
|•||Has combined medicare and medicaid inpatient days greater than fifty percent of total days as reported in the hospital's 2017 cost report.|
SPA 19-0019 is expected to increase the annual aggregate payment for inpatient psychiatric services for qualifying hospitals by $181,000, assuming a blended federal match rate of 58.15 percent.
SPA 19-0019 is in the development process; therefore a copy is not yet available for review. HCA would appreciate any input or concerns regarding this SPA. To request a copy when it becomes available, you may contact the person named below. To submit comments, please contact the person named below (please note that all comments are subject to public review and disclosure, as are the names of those who comment).
The proposed rates, methodologies, and justifications are as follows:
Interested parties may submit comments and concerns about the rates or the effects the changes may have on beneficiary access to care or continued service access. Please submit comments and concerns to Abigail Cole by May 20, 2019. Please note that all comments are subject to public review and disclosure, as are the names of those who comment.
Contact Abigail Cole, Section Manager, Hospital Finance and Drug Rebate Section, P.O. Box 45510, Olympia, WA 98504, phone 360-725-1835, TRS (TDD/TTY) 711, email Abigail.Cole@hca.wa.gov, web site https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/hospital-reimbursement.