WSR 23-03-097
PROPOSED RULES
HEALTH CARE AUTHORITY
[Filed January 17, 2023, 10:32 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 22-22-070.
Title of Rule and Other Identifying Information: WAC 182-543-8200 Billing for clients eligible for medicare and medicaid.
Hearing Location(s): On February 21, 2023, at 10:00 a.m. In response to the coronavirus disease 2019 (COVID-19) public health emergency, the health care authority (HCA) continues to hold public hearings virtually without a physical meeting place. This promotes social distancing and the safety of the residents of Washington state. To attend the virtual public hearing, you must register in advance https://us02web.zoom.us/webinar/register/WN_O39grFzsQQio-J3HHuB5xQ. If the link above opens with an error message, please try using a different browser. After registering, you will receive a confirmation email containing information about joining the public hearing.
Date of Intended Adoption: February 22, 2023.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, by February 21, 2023, by 11:59 p.m.
Assistance for Persons with Disabilities: Contact Johanna Larson, phone 360-725-1349, fax 360-586-9727, telecommunication[s] relay service 711, email Johanna.Larson@hca.wa.gov, by February 10, 2023.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is revising this rule to remove subsections (1) and (2) regarding payment for services covered by medicare. The proposed rule replaces these subsections with a reference to HCA's general rules for medicare coinsurance, payments, and deductibles in WAC 182-502-0110, which is consistent with the federal requirements for cost sharing with qualified medicare beneficiaries.
Reasons Supporting Proposal: This amendment aligns WAC 182-543-8200 with federal requirements.
Rule is not necessitated by federal law, federal or state court decision.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Not applicable.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1408; Implementation and Enforcement: Erin Mayo, P.O. Box 45506, Olympia, WA 98504-5506, 360-725-1729.
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.
Scope of exemption for rule proposal from Regulatory Fairness Act requirements:
Is not exempt.
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. This rule does not impose any costs on small businesses.
January 17, 2023
Wendy Barcus
Rules Coordinator
OTS-4209.1
AMENDATORY SECTION(Amending WSR 18-24-021, filed 11/27/18, effective 1/1/19)
WAC 182-543-8200Billing for clients eligible for medicare and medicaid.
If a client is eligible for both medicare and medicaid((:
(1) The medicaid agency requires a provider to accept medicare assignment before any medicaid reimbursement;
(2) In accordance with WAC 182-502-0110(3):
(a) If the service provided is covered by medicare and medicaid, the agency pays only the deductible or coinsurance up to medicare's or medicaid's allowed amount, whichever is less.
(b) If the service provided is covered by medicare but is not covered by the agency, the agency pays only the deductible or coinsurance up to medicare's allowed amount)), see WAC 182-502-0110 Conditions of payment and prior authorization requirements—Medicare coinsurance, copayments, and deductibles.