WSR 24-15-073
PROPOSED RULES
HEALTH CARE AUTHORITY
[Filed July 17, 2024, 4:23 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 24-11-132.
Title of Rule and Other Identifying Information: WAC 182-550-3830 Adjustments to inpatient rates, and 182-550-7550 OPPS payment enhancements.
Hearing Location(s): On August 27, 2024, at 10:00 a.m. The health care authority (HCA) holds public hearings virtually without a physical meeting place. To attend the virtual public hearing, you must register in advance https://us02web.zoom.us/webinar/register/WN_Jx4tOCLyTByfJfI1Pj88Cg. 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: Not sooner than August 28, 2024.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, beginning July 18, 2024, 8:00 a.m., by August 27, 2024, by 11:59 p.m.
Assistance for Persons with Disabilities: Contact Johanna Larson, phone 360-725-1349, fax 360-586-9727, TTY/TRS 711, email Johanna.Larson@hca.wa.gov, by August 9, 2024.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: HCA is amending these rules to reduce the sole community hospital rate multiplier to 1.25, effective July 1, 2024.
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: Valerie Freudenstein, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1344; Implementation and Enforcement: Melissa Craig, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-0938.
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.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Scope of exemption for rule proposal:
Is fully exempt.
July 17, 2024
Wendy Barcus
Rules Coordinator
OTS-5556.1
AMENDATORY SECTION(Amending WSR 23-20-048, filed 9/28/23, effective 10/29/23)
WAC 182-550-3830Adjustments to inpatient rates.
(1) The medicaid agency updates all of the following components of a hospital's specific diagnosis-related group (DRG) factor and per diem rates at rebase:
(a) Wage index adjustment;
(b) Direct graduate medical education (DGME); and
(c) Indirect medical education (IME).
(2) Effective January 1, 2015, the agency updates the sole community hospital adjustment.
(3) The agency does not update the statewide average DRG factor between rebasing periods, except:
(a) To satisfy the budget neutrality conditions in WAC 182-550-3850; and
(b) When directed by the legislature.
(4) The agency updates the wage index to reflect current labor costs in the core-based statistical area (CBSA) where a hospital is located. The agency:
(a) Determines the labor portion by multiplying the base factor or rate by the labor factor established by medicare; then
(b) Multiplies the amount in (a) of this subsection by the most recent wage index information published by the Centers for Medicare and Medicaid Services (CMS) when the rates are set; then
(c) Adds the nonlabor portion of the base rate to the amount in (b) of this subsection to produce a hospital-specific wage adjusted factor.
(5) DGME. The agency obtains DGME information from the hospital's most recently filed medicare cost report that is available in the CMS health care cost report information system (HCRIS) dataset.
(a) The hospital's medicare cost report must cover a period of 12 consecutive months in its medicare cost report year.
(b) If a hospital's medicare cost report is not available on HCRIS, the agency may use the CMS Form 2552-10 to calculate DGME.
(c) If a hospital has not submitted a CMS medicare cost report in more than 18 months from the end of the hospital's cost reporting period, the agency considers the current DGME costs to be zero.
(d) The agency calculates the hospital-specific DGME by dividing the DGME cost reported on worksheet B, part 1 of the CMS cost report by the adjusted total costs from the CMS cost report.
(6) IME. The agency sets the IME adjustment equal to the "IME adjustment factor for Operating PPS" available in the most recent CMS final rule impact file on CMS's website as of May 1st of the rate-setting year.
(7) Sole community hospitals.
(a) For sole community hospitals' rate enhancements, the agency multiplies an in-state hospital's specific conversion factor and per diem rates by a multiplier if the hospital meets all the following criteria per RCW
74.09.5225:
(i) Be certified by CMS as a sole community hospital as of January 1, 2013;
(ii) Have a level III adult trauma service designation from the Washington state department of health (DOH) as of January 1, 2014;
(iii) Have less than 150 acute care licensed beds in fiscal year 2011;
(iv) Be owned and operated by the state or a political subdivision; and
(v) Not participate in the certified public expenditures (CPE) payment program defined in WAC 182-550-4650.
(b) ((
As of July 1, 2021, through June 30, 2023, an additional increase is applied for hospitals that accept single bed certifications per RCW 71.05.745.))
Effective July 1, 2024, the enhancement multiplier equals 1.25. This may be adjusted in future years to account for legislatively approved increases. (See RCW 74.09.5225)Enhancement Multiplier by Year |
Provider Category | Effective For the Dates |
07/01/2015 - 06/30/2020 | 07/01/2020 - 06/30/2021 | 07/01/2021 - 06/30/2022 | 07/01/2022 - 06/30/2023 | 07/01/2023 - 12/31/2023 | 01/01/2024 - 06/30/2024 | 07/01/2024 |
Sole community hospital | 1.25 | 1.5 | ((N/A)) 1.5 | 1.25 | 1.25 | 1.5 | 1.25 |
Sole community hospital accepting single bed certifications | N/A | N/A | 1.5 | 1.5 | N/A | N/A | N/A |
AMENDATORY SECTION(Amending WSR 23-20-048, filed 9/28/23, effective 10/29/23)
WAC 182-550-7550OPPS payment enhancements.
(1) Pediatric adjustment.
(a) The medicaid agency establishes a policy adjustor to be applied to all enhanced ambulatory patient group (EAPG) services for clients under age 18 years.
(b) Effective July 1, 2014, this adjustor equals one point thirty-five (1.35).
(2) Chemotherapy and combined chemotherapy/pharmacotherapy adjustment.
(a) The agency establishes a policy adjustor to be applied to services grouped as chemotherapy drugs or combined chemotherapy and pharmacotherapy drugs.
(b) Effective July 1, 2014, this adjustor equals one point one (1.1).
(3) Sole community hospitals.
(a) For sole community hospital's rate enhancements, the agency multiplies the in-state hospital's specific EAPG conversion factor by a multiplier if the hospital meets all of the following criteria per RCW
74.09.5225:
(i) Be certified by CMS as a sole community hospital as of January 1, 2013;
(ii) Have a level III adult trauma service designation from the Washington state department of health (DOH) as of January 1, 2014;
(iii) Have less than 150 acute care licensed beds in fiscal year 2011; and
(iv) Be owned and operated by the state or a political subdivisions.
(b) ((
As of July 1, 2021, through June 30, 2023, an additional increase may be applied for hospitals that accept single bed certifications per RCW 71.05.745.))
Effective July 1, 2024, the enhancement multiplier equals 1.25. This may be adjusted in future years to account for legislatively approved increases. (See RCW 74.09.5225)Enhancement Multiplier by Year |
Provider Category | Effective For the Dates |
07/01/2015 - 06/30/2020 | 07/01/2020 - 06/30/2021 | 07/01/2021 - 06/30/2022 | 07/01/2022 - 06/30/2023 | 07/01/2023 - 12/31/2023 | 01/01/2024 - 06/30/2024 | 07/01/2024 |
Sole community hospital | 1.25 | 1.5 | ((N/A)) 1.5 | 1.25 | 1.25 | 1.50 | 1.25 |
Sole community hospital accepting single bed certifications | N/A | N/A | 1.5 | 1.5 | N/A | N/A | N/A |