PDFWAC 182-550-4700

Payment—Non-SCA participating hospitals.

This section applies only for dates of admission before July 1, 2007. The hospital selective contracting program ends on June 30, 2007.
(1) In a selective contracting area (SCA), the medicaid agency pays any qualified hospital for inpatient hospital services provided to an eligible medical care client for treatment of an emergency medical condition.
(2) The agency pays any qualified hospital for medically necessary but nonemergent inpatient hospital services provided to an eligible medical care client deemed by the agency to reside an excessive travel distance from a contracting hospital.
(a) The client is deemed to have an excessive travel burden if the travel distance from a client's residence to the nearest contracting hospital exceeds the client's county travel distance standard, as follows:
County
Community Travel Distance Standard
Adams
25 miles
Asotin
15 miles
Benton
15 miles
Chelan
15 miles
Clallam
20 miles
Clark
15 miles
Columbia
19 miles
Cowlitz
15 miles
Douglas
20 miles
Ferry
27 miles
Franklin
15 miles
Garfield
30 miles
Grant
24 miles
Grays Harbor
23 miles
Island
15 miles
Jefferson
15 miles
King
15 miles
Kitsap
15 miles
Kittitas
18 miles
Klickitat
15 miles
Lewis
15 miles
Lincoln
31 miles
Mason
15 miles
Okanogan
29 miles
Pacific
21 miles
Pend Oreille
25 miles
Pierce
15 miles
San Juan
34 miles
Skagit
15 miles
Skamania
40 miles
Snohomish
15 miles
Spokane
15 miles
Stevens
22 miles
Thurston
15 miles
Wahkiakum
32 miles
Walla Walla
15 miles
Whatcom
15 miles
Whitman
20 miles
Yakima
15 miles
(b) If a client must travel outside his or her SCA to obtain inpatient services not available within the community, such as treatment from a tertiary hospital, the client may obtain the services from a contracting hospital appropriate to the client's condition.
(3) The agency requires prior authorization for all nonemergent admissions to nonparticipating hospitals in an SCA. See WAC 182-550-1700.
(4) The agency pays a licensed hospital all applicable medicare deductible and coinsurance amounts for inpatient services provided to medicaid clients who are also beneficiaries of medicare Part A subject to the medicaid maximum allowable as established in WAC 182-550-1200 (8)(a).
(5) The agency pays any licensed hospital DRG-exempt services as listed in WAC 182-550-4400.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 15-18-065, § 182-550-4700, filed 8/27/15, effective 9/27/15. WSR 11-14-075, recodified as § 182-550-4700, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-12-040, § 388-550-4700, filed 5/30/07, effective 7/1/07. Statutory Authority: RCW 74.08.090, 42 U.S.C. 1395 x(v), 42 C.F.R. 447.271, 447.11303, and 447.2652. WSR 99-06-046, § 388-550-4700, filed 2/26/99, effective 3/29/99. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-4700, filed 12/18/97, effective 1/18/98.]