WSR 02-01-075

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed December 14, 2001, 4:45 p.m. ]

Date of Adoption: December 10, 2001.

Purpose: The department is adopting rules to reflect program changes in MAA's managed care programs. Rules regarding exemptions and disenrollments have been clarified and the CHIP program has been made more consistent and compatible with the healthy options program. Primary care case management has been expanded to allow greater access to managed care for MAA's clients.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-538-066 Children's health insurance program (CHIP) enrollees; amending WAC 388-538-050 Definitions, 388-538-060 Managed care and choice, 388-538-065 Medicaid eligible basic health plan enrollees, 388-538-070 Managed care payment, 388-538-080 Healthy options exemptions, 388-538-095 Scope of care for managed care enrollees, 388-538-100 Managed care emergency services, 388-538-110 Managed care complaints, appeals and fair hearings, 388-538-120 Enrollee request for a second medical opinion, 388-538-130 Ending enrollment in healthy options, 388-538-140 Quality of care, 388-542-0050 Definitions for children's health insurance program (CHIP) terms, 388-542-0100 CHIP scope of care, 388-542-0125 Access to care, 388-540-0150 Client eligibility requirements for CHIP, 388-542-0200 CHIP managed care enrollment, 388-542-0250 CHIP client costs, 388-542-0275 Reimbursement, 388-542-0300 Waiting period for CHIP coverage following employer coverage and 388-542-0500 Managed care rules that apply to CHIP; and New WAC 388-538-067 Managed care provided through managed care organizations (MCOs), 388-538-068 Managed care provided through primary care case management (PCCM), and 388-542-0220 Ending CHIP client eligibility.

Statutory Authority for Adoption: RCW 74.09.080.

Other Authority: RCW 74.08.510, [74.08.]522, 74.09.450, 1115 Waiver, 42 U.S.C. 1396.

Adopted under notice filed as WSR 01-20-113 on October 3, 2001.

Changes Other than Editing from Proposed to Adopted Version: As a result of testimony received, the following changes have been made to the text of the proposed rule (added language is underlined; deleted language is struck-through):

WAC 388-538-068(1) A provider may contract with DSHS as a primary care case management (PCCM) provider to provide health care services to eligible medical assistance administration (MAA) clients under MAA's managed care program. The PCCM provider or the individual providers in a PCCM group or clinic must:...

WAC 388-542-0220 (3)(b) Serve a waiting period of four consecutive months as described in WAC 388-542-0300. The waiting period begins the day after termination of CHIP coverage for nonpayment of premiums as described in this section. The waiting period ends once four full consecutive months of CHIP noncoverage has elapsed. The client does not have CHIP coverage during the waiting period.

WAC 388-542-0300 (1)(b) Fails to exercise an optional coverage extension (e.g., COBRA) that meets the following conditions. The waiting period begins on the day there is a documented refusal of the coverage extension when the extended coverage is:

(i) (a) Subsidized in part or in whole by the employer or union;

(ii) (b) Available and accessible to the applicant or family; and

(iii) (c) At a monthly cost to the family meeting the limitations of subsection (32)(b)(iv).

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 3, Amended 20, Repealed 1.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 3, Amended 20, Repealed 1.
Effective Date of Rule: Thirty-one days after filing.

December 10, 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 02-02 issue of the Register.

Washington State Code Reviser's Office