WSR 20-20-066
PROPOSED RULES
HEALTH CARE AUTHORITY
[Filed October 1, 2020, 3:40 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 20-10-077.
Title of Rule and Other Identifying Information: WAC 182-501-0180 Health care services provided outside the state of Washington—General.
Hearing Location(s): On November 10, 2020, at 10:00 a.m.
As the Governor's Safe Start plan progresses, it is yet unknown whether by the date of this public hearing restrictions of meeting in public places will be eased. To continue to be safe, this hearing is being scheduled as a virtual only hearing. This will not be an in-person hearing and there is not a physical location available. To attend, you must register prior to the virtual public hearing (November 10, 2020, 10:00 a.m. Pacific Time). Registration URL https://attendee.gotowebinar.com/register/7954220468570504976. Webinar ID: 257-880-459. After registering, you will receive a confirmation email containing the information about joining the webinar.
Date of Intended Adoption: Not sooner than November 11, 2020.
Submit Written Comments to: Health Care Authority (HCA) Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, by November 10, 2020.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication relay services 711, email amber.lougheed@hca.wa.gov, by October 23, 2020.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is amending WAC 182-501-0180 so it applies to both fee-for-service clients and clients enrolled in a managed care organization.
Reasons Supporting Proposal: See purpose.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Jason Crabbe, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-9563; Implementation and Enforcement: Joan Chappell, P.O. Box 45506, Olympia, WA 98504-5506, 360-752-1071.
A school district fiscal impact statement is not required under RCW
28A.305.135.
A cost-benefit analysis is not required under RCW
34.05.328. RCW
34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. These rules do not impose a disproportionate cost impact on small businesses or nonprofits.
October 1, 2020
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 15-15-053, filed 7/9/15, effective 8/9/15)
WAC 182-501-0180Health care services provided outside the state of Washington—General provisions.
WAC 182-501-0180 through 182-501-0184 ((apply only to))describe the health care services ((payable))available to a Washington apple health client on a fee-for-service basis ((for Washington apple health (WAH) clients))or to a client enrolled in a managed care organization (MCO) (defined in WAC 182-538-050).
(1) Subject to the requirements, exceptions, and limitations in this section, WAC 182-501-0182, and 182-501-0184, the medicaid agency covers emergency and nonemergency out-of-state health care services provided to eligible ((WAH))Washington apple health recipients when the services are:
(a) Within the scope of the client's or enrollee's health care program as specified under chapter 182-501 WAC or other program rules;
(b) Allowed to be provided outside the state of Washington by specific program WAC; and
(c) Medically necessary as defined in WAC 182-500-0070.
(2) The agency does not cover services provided outside the state of Washington under the Involuntary Treatment Act (chapter
71.05 RCW ((
and chapter 388-865 WAC))), including designated bordering cities.
(3) When the agency pays for covered health care services furnished to an eligible ((WAH))Washington apple health client or enrollee outside the state of Washington, its payment is payment in full according to 42 C.F.R. 447.15. No additional payment may be sought from the client (see WAC 182-502-0160).
(4) The agency determines coverage for transportation services provided out of state, including ambulance services, according to chapter 182-546 WAC.
(5) With the exception of designated bordering cities (see WAC 182-501-0175), if the client or enrollee travels out of state expressly to obtain health care, the service must be prior authorized by the agency. See WAC 182-501-0182 for requirements related to out-of-state nonemergency treatment and WAC 182-501-0165 for the agency's medical necessity determination process.
(6) The agency does not cover health care services provided outside the United States and U.S. territories, except in British Columbia, Canada. See WAC 182-501-0184 for limitations on coverage of, and payment for, health care provided to ((WAH))Washington apple health clients or enrollees in British Columbia, Canada.
(7) See WAC 182-502-0120 for provider requirements for payment of health care provided outside the state of Washington.