WSR 00-14-072

PREPROPOSAL STATEMENT OF INQUIRY

DEPARTMENT OF

LABOR AND INDUSTRIES

[ Filed July 5, 2000, 10:37 a.m. ]

Subject of Possible Rule Making: The Department of Labor and Industries (L&I) is considering revising its payment method for ambulatory surgery centers (ASCs) and other nonhospital surgical suite services provided to injured workers. The ASC payment method may also affect the crime victims compensation (CVC) program. L&I would adopt this new rule as new chapter 296-23B WAC.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 51.04.020, 51.04.030(1), and 51.36.080.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: L&I uses a number of different payment methods, such as fee schedules and discounting, to pay for medical services purchased for injured workers and crime victims. Most of these payment methods are designed to help assure that L&I meets its responsibility to cost-effectively purchase health care while assuring access to services. The current ASC payment method is unlike most other L&I medical payment methods in that it has no provisions for managing costs, and partly as a result of this, L&I's ASC payments have been rising much more rapidly than other medical costs. The new ASC payment method will help L&I better manage these costs and make ASC payment more consistent with other medical payment methods used by L&I.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The federal Health Care Financing Administration (HCFA), the state Health Care Authority and the DSHS/Medical Assistance Administration have rules or other procedures in place establishing their payment methods for similar services. When we evaluate our options for an ASC payment method, we will consider the methods used by those agencies.

Process for Developing New Rule: Agency staff will evaluate ASC payment method options with input from ASCs and other stakeholders. Draft rules will be developed by staff and shared with stakeholders for their input. We will work with stakeholders through an ASC project workgroup as well as established professional organizations and advisory committees.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Marilyn Gisser, Department of Labor and Industries, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, phone (360) 902-6801, fax (360) 902-4249, Internet gism235@lni.wa.gov.

July 5, 2000

Gary L. Moore

Director

Washington State Code Reviser's Office