WSR 24-12-083
PERMANENT RULES
HEALTH CARE AUTHORITY
[Filed June 5, 2024, 7:16 a.m., effective July 6, 2024]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The health care authority is expanding the age limit for the enhancement rate for pediatric care services and the administration of vaccines provided to clients from age 18 and younger to age 20 and younger.
Citation of Rules Affected by this Order: Amending WAC 182-531-2030.
Adopted under notice filed as WSR 24-10-079 on April 30, 2024.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: June 5, 2024.
Wendy Barcus
Rules Coordinator
OTS-5284.1
AMENDATORY SECTION(Amending WSR 18-17-047, filed 8/8/18, effective 10/1/18)
WAC 182-531-2030Enhanced rates for pediatric care services and administration of vaccines.
(1) Subject to available funds, the medicaid agency pays an enhanced rate for covered pediatric care services and the administration of vaccines provided to clients age ((eighteen))20 and younger.
(2) For the purposes of this section, pediatric care services are defined as covered evaluation and management services.
(3) The agency uses the resource-based relative value scale (RBRVS) payment methodology described in WAC 182-531-1850 to calculate the enhanced rate.
(4) If the enhanced rate is less than the agency's published fee schedule rate, the agency pays the published rate.
(5) This enhanced rate applies only to pediatric care services and administration of vaccines for clients age ((eighteen))20 and younger that are not already paid at an enhanced rate.