SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Preproposal statement of inquiry was filed as WSR 00-19-049 and 00-19-042.
Title of Rule: WAC 388-550-1050 Hospital services definitions, 388-550-1100 Hospital coverage, 388-550-2800 Inpatient payment methods and limits, 388-550-2900 Payment limits -- Inpatient hospital services, 388-550-3300 Hospital peer groups and cost caps, 388-550-3600 Diagnosis-related group (DRG) payment -- Hospital transfers, 388-550-3700 DRG high-cost and low-cost outliers, 388-550-3800 Rebasing and recalibration, 388-550-4300 Hospitals and units exempt from the DRG payment method, 388-550-4400 Services -- Exempt from DRG payments, 388-550-4500 Payment method -- Inpatient RCC and administrative day rate and outpatient rate and 388-550-4800 Hospital payment method -- State-only programs; and repealing WAC 388-550-2700 Substance abuse detoxification services.
Purpose: To update and clarify: Payment methodology for DRG exempt hospitals and DRG exempt services for Title XIX and state programs; hospital payment method for state programs; outpatient services record retention language; effective dates for high-cost and low-cost outlier thresholds; policies with the department's Division of Alcohol and Substance Abuse (DASA) and the Mental Health Division (MHD); effective dates for recalibrating relative weights; those hospitals, units, and services exempt from DRG payment; and the method by which the department calculates hospital ratio of costs-to-charges (RCC). Also, to repeal a rule that no longer reflects current program policy.
Statutory Authority for Adoption: RCW 74.08.090.
Statute Being Implemented: RCW 74.08.090, 42 U.S.C. 1395x(v), 42 C.F.R. 447.271, .11303, and .2652.
Summary: This amendment updates and clarifies the payment methodology used for reimbursing hospital providers for services provided to MAA clients. It also (1) clarifies the requirements for outpatient services record retention language; (2) updates and clarifies high-cost and low-cost outlier thresholds; (3) updates effective dates for recalibrating relative weights; (4) coordinates policies with DASA and MHD; and (5) repeals WAC 388-550-2700 because it no longer reflects current program policy.
Reasons Supporting Proposal: It will provide hospital providers with a clearer understanding of current department policy and business practices.
Name of Agency Personnel Responsible for Drafting: Kathy Sayre, P.O. Box 45533, Olympia, WA 98504, (360) 725-1342; Implementation and Enforcement: Larry Linn, P.O. Box 45510, Olympia, WA 98504, (360) 725-1856.
Name of Proponent: Department of Social and Health Services, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: This rule amendment updates the payment methodology used to reimburse hospital providers for services provided to MAA clients. It also (1) clarifies the requirements for outpatient services record retention language; (2) updates and clarifies high-cost and low-cost outlier thresholds; (3) updates effective dates for recalibrating relative weights; (4) coordinates policies with DASA and MHD; and (5) repeals WAC 388-550-2700 because it no longer reflects current program policy. The purpose is to inform hospital providers of current MAA policy, and to make that policy clear and understandable. It is anticipated that this amendment will lessen the confusion and misunderstanding that hospital providers may have regarding MAA policy.
Proposal Changes the Following Existing Rules: The proposed rule amendment clarifies and updates current MAA operational policies for reimbursing hospitals for services provided to eligible clients.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule amendments and concluded that no new costs will be imposed on businesses affected by them.
RCW 34.05.328 does not apply to this rule adoption. The rule does not fit the definition of a significant legislative rule.
Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on June 26, 2001, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Kelly Cooper, DSHS Rules Coordinator, by June 21, 2001, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopeKD@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by June 26, 2001.
Date of Intended Adoption: Not sooner than June 27, 2001.
April 13, 2001
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 01-11 issue of the Register.