WSR 00-19-030

PREPROPOSAL STATEMENT OF INQUIRY

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed September 11, 2000, 3:52 p.m. ]

Subject of Possible Rule Making: Amending WAC 388-550-2501 Acute physical medicine and rehabilitation (Acute PM&R) program -- General, 388-550-2511 Acute PM&R definitions, 388-550-2521 Client eligibility requirements for acute PM&R services, 388-550-2531 Requirements for becoming an MAA Level A or B acute PM&R provider, 388-550-2541 Quality of care for acute PM&R clients through audits and reviews, 388-550-2551 How MAA determines client placement in Level A or B acute PM&R, 388-550-2561 MAA's requirements for authorizing acute PM&R services, 388-550-3381 How MAA pays acute PM&R facilities for Level A services, and 388-550-3401 How MAA pays acute PM&R facilities for Level B services.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 74.08.090, 74.09.520, and 42 C.F.R. 482.56.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The department is placing requirements for acute PM&R in rule to support the paperwork reduction initiative. Since contracts are not used to negotiate rates or services provided, and are not required to keep the acute PM&R program operational, the rules will replace the contract. The amended rules will clarify the limitations of the program and reimbursement methodology for Level A and Level B services. The amended rules will also clarify to providers that they must comply with these rules in order to receive payment, and that the benefits are limited to the acute phase of rehabilitation for clients.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: Medicare/HCFA - MAA uses federal Medicare rehabilitation guidelines as a guide for the acute PM&R program(s). The Department of Health (DOH) - MAA sets the standards for Level B acute PM&R services by requiring facilities to operate per the standards in WAC 246-976-840 Designation standards for facilities providing Level II trauma rehabilitation service (excluding the certified rehabilitation registered nurse (CRRN) requirement). MAA coordinates with DOH and DOH's rules contain the CARF standards required by MAA's acute PM&R program.

Process for Developing New Rule: The department will invite the interested public to review the proposed WAC and provide input. Draft material and information about how to participate are available by contacting the DSHS representative identified below.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Kathy Sayre, Regulatory Improvement Project, P.O. Box 45533, Medical Assistance Administration, Olympia, WA 98504, phone (360) 725-1342, fax (360) 586-9727, TTY 1-800-848-5429, e-mail sayrek@dshs.wa.gov.

September 8, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

Washington State Code Reviser's Office