PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 00-07-055.
Title of Rule: Repealing chapter 388-81 WAC, Medical care administration general; and new WAC 388-502-0260 Appeals and dispute resolution for contracts other than core provider agreements.
Purpose: The department originally intended to establish new chapter 388-526 WAC, Medical fair hearings and incorporate policies contained in chapters 388-81 and 388-41 WAC in the new chapters. Upon review, however, it was decided to incorporate policies in chapters 388-81 and 388-41 WAC that apply generally to providers into chapter 388-502 WAC, Administration of medical programs. The department is proposing to establish WAC 388-502-0260 to contain the policy in WAC 388-81-200, and to repeal chapter 388-81 WAC to avoid duplication. The new proposed rule does not change existing policy, and has been written to comply with the Governor's Executive Order 97-02 on regulatory reform.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.290.
Statute Being Implemented: RCW 74.08.090, 74.09.290.
Summary: The proposed rule directs those providers who have contracted with the department (other than core provider agreements) to provide medical and other services to eligible clients, to follow the dispute resolution process(es) that are in their contracts.
Reasons Supporting Proposal: To comply with the Governor's Executive Order 97-02 on regulatory reform, so that department policy is accurately reflected in rule.
Name of Agency Personnel Responsible for Drafting: Ann Myers, DPS/RIP, P.O. Box 45533, Olympia, WA 98504-5533, (360) 725-1345; Implementation and Enforcement: Charley Pugh, DOSS/PRS, P.O. Box 45500, Olympia, WA 98504-5500, (360) 725-1843.
Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: The rule directs those providers who contract with the department to provide medical and other services to eligible clients to follow the dispute resolution process(es) in their contracts when those providers disagree with a department action. This rule applies to those providers whose contract is other than a core provider agreement.
The proposed rule does not change current policy.
The purpose is to clearly state what providers must do to resolve disagreements with department actions.
The anticipated effect is to make department policy clear to those it affects.
Proposal Changes the Following Existing Rules: Chapter 388-81 WAC listed above is being repealed, and WAC 388-502-0260 is being established to replace it.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule and concludes that, since no new policy is being implemented, there should be no more than a minor impact on the businesses affected by the proposed rule.
RCW 34.05.328 does not apply to this rule adoption. The department has analyzed the proposed rule, and concludes that it does not meet the definition of a "significant legislative rule."
Hearing Location: Blake Office Building East, 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on October 3, 2000, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Kelly Cooper, Rules Coordinator, by September 26, 2000, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopeKD@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by October 3, 2000.
Date of Intended Adoption: No sooner than October 4, 2000.
August 17, 2000
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
2750.9(1) Providers of medical services who have a contract, other than a core provider agreement, with a dispute resolution provision must follow the dispute resolution process described in the contract.
(2) See WAC 388-502-0220 for disputes involving rates. See WAC 388-502-0240 for disputes involving audits. See WAC 388-502-0230 for disputes involving provider reviews and termination.
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The following sections of the Washington Administrative Code are repealed:
| WAC 388-81-175 | Audit dispute resolution. |
| WAC 388-81-200 | Appeal of adverse department action--Contractor/provider. |