WSR 02-22-043

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed October 30, 2002, 9:54 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 02-18-098.

Title of Rule: Amending WAC 388-550-2595 Identification of and payment methodology for services and equipment included in the LTAC fixed per diem rate and 388-550-2596 Services and equipment covered by MAA but not included in the LTAC fixed per diem rate.

Purpose: To clarify existing policy by adding language that states the long term acute care (LTAC) fixed per diem rate includes up to and including two hundred dollars per day in total allowed charges for any combination of pharmacy services that includes prescription drugs, total parental nutrition (TPN) therapy, IV infusion therapy, and/or epogen/neupogen therapy. Any combination of these charges after the first two hundred dollars per day is paid using the ratio of costs-to-charges (RCC) payment method.

Statutory Authority for Adoption: RCW 74.08.090.

Statute Being Implemented: RCW 74.08.090.

Summary: The rule clarifies existing policy by listing the pharmacy services, up to and including two hundred dollars per day in total allowed charges, that are included in the LTAC fixed per diem rate. MAA uses the ratio of costs-to-charges (RCC) payment method to reimburse total allowed charges for pharmacy services after the first two hundred dollars per day.

Reasons Supporting Proposal: To clarify existing policy by adding language that states which pharmacy services are included in the up to and including two hundred dollars allowed in the LTAC fixed per diem rate.

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: See Purpose, Summary, and Reasons Supporting Proposal above.

Proposal Changes the Following Existing Rules: See Summary and Reasons Supporting Proposal above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule and concludes that it will have no more than minor impact upon affected businesses.

RCW 34.05.328 does not apply to this rule adoption. The department has analyzed the proposed rule and determined that it does not meet the definition of a "significant legislative rule" per RCW 34.05.328 (5)(c)(iii). The proposed rule merely clarifies existing policy by adding which pharmacy services are included in the LTAC fixed per diem rate up to and including two hundred dollars per day of total allowed charges. It also clarifies that pharmacy services after the first two hundred dollars per day of total allowed charges are paid using the RCC payment method. A determination of the probable cost and benefits is available from the person listed in Name of Agency Personnel above.

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on December 10, 2002, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by December 6, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@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, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., December 10, 2002.

Date of Intended Adoption: Not sooner than December 11, 2002.

October 28, 2002

Wanda Emmick

for Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3180.1
AMENDATORY SECTION(Amending WSR 02-14-162, filed 7/3/02, effective 8/3/02)

WAC 388-550-2595   Identification of and payment methodology for services and equipment included in the LTAC fixed per diem rate.   (1) In addition to room and board, the LTAC fixed per diem rate includes, but is not limited to, the following (see MAA's LTAC billing instructions for applicable revenue codes):

(a) Room and board - Rehabilitation;

(b) Room and board - Intensive care;

(c) Pharmacy - Up to and including two hundred dollars per day in total allowed charges for any combination of pharmacy services that includes prescription drugs, total parenteral nutrition (TPN) therapy, IV infusion therapy, and/or epogen/neupogen therapy;

(d) Medical/surgical supplies and devices;

(((d))) (e) Laboratory - General;

(((e))) (f) Laboratory - Chemistry;

(((f))) (g) Laboratory - Immunology;

(((g))) (h) Laboratory - Hematology;

(((h))) (i) Laboratory - Bacteriology and microbiology;

(((i))) (j) Laboratory - Urology;

(((j))) (k) Laboratory - Other laboratory services;

(((k))) (l) Respiratory services;

(((l))) (m) Physical therapy;

(((m))) (n) Occupational therapy; and

(((n))) (o) Speech-language therapy.

(2) MAA pays the LTAC facility the LTAC fixed per diem rate in effect at the time the LTAC services are provided, minus the sum of:

(a) Client liability, whether or not collected by the provider; and

(b) Any amount of coverage from third parties, whether or not collected by the provider, including, but not limited to, coverage from:

(i) Insurers and indemnitors;

(ii) Other federal or state medical care programs;

(iii) Payments made to the provider on behalf of the client by individuals or organizations not liable for the client's financial obligations; and

(iv) Any other contractual or legal entitlement of the client, including, but not limited to:

(A) Crime victims' compensation;

(B) Workers' compensation;

(C) Individual or group insurance;

(D) Court-ordered dependent support arrangements; and

(E) The tort liability of any third party.

(3) MAA may make annual rate increases to the LTAC fixed per diem rate by using the same inflation factor and date of rate increase that MAA uses for acute care hospital diagnostic-related group (DRG) rates. This DRG rate adjustment method is described in WAC 388-550-3450(5).

[Statutory Authority: RCW 74.08.090. 02-14-162, 388-550-2595, filed 7/3/02, effective 8/3/02.]


AMENDATORY SECTION(Amending WSR 02-14-162, filed 7/3/02, effective 8/3/02)

WAC 388-550-2596   Services and equipment covered by MAA but not included in the LTAC fixed per diem rate.   (1) MAA uses the ratio of costs-to-charges (RCC) payment method to reimburse an LTAC facility for the following that are not included in the LTAC fixed per diem rate:

(a) ((Prescription drugs;

(b) Total parenteral nutrition (TPN) therapy;

(c) Epogen/neupogen therapy;

(d))) Pharmacy - After the first two hundred dollars per day in total allowed charges for any combination of pharmacy services that includes prescription drugs, total parenteral nutrition (TPN) therapy, IV infusion therapy, and/or epogen/neupogen therapy;

(b) Radiology services;

(((e))) (c) Nuclear medicine services;

(((f))) (d) Computerized tomographic (CT) scan;

(((g))) (e) Operating room services;

(((h))) (f) Anesthesia services;

(((i))) (g) Blood storage and processing;

(((j))) (h) Blood administration;

(((k))) (i) Other imaging services - Ultrasound;

(((l))) (j) Pulmonary function services;

(((m))) (k) Cardiology services;

(((n))) (l) Recovery room services;

(((o))) (m) EKG/ECG services;

(((p))) (n) Gastro-intestinal services;

(((q))) (o) Inpatient hemodialysis; and

(((r))) (p) Peripheral vascular laboratory services.

(2) MAA uses the appropriate inpatient or outpatient payment method described in other published WAC to reimburse providers other than LTAC facilities for services and equipment that are covered by MAA but not included in the LTAC fixed per diem rate. The provider must bill MAA directly and MAA reimburses the provider directly.

(3) Transportation services that are related to transporting a client to and from another facility for the provision of outpatient medical services while the client is still an inpatient at the LTAC facility, or related to transporting a client to another facility after discharge from the LTAC facility:

(a) Are not covered or reimbursed through the LTAC fixed per diem rate;

(b) Are not reimbursable directly to the LTAC facility;

(c) Are subject to the provisions in chapter 388-546 WAC; and

(d) Must be billed directly to the:

(i) Department by the transportation company to be reimbursed if the client required ambulance transportation; or

(ii) Department's contracted transportation broker, subject to the prior authorization requirements and provisions described in chapter 388-546 WAC, if the client:

(A) Required nonemergent transportation; or

(B) Did not have a medical condition that required transportation in a prone or supine position.

(4) MAA evaluates requests for covered transportation services that are subject to limitations or other restrictions, and approves such services beyond those limitations or restrictions when medically necessary, under the standards of WAC 388-501-0165.

[Statutory Authority: RCW 74.08.090. 02-14-162, 388-550-2596, filed 7/3/02, effective 8/3/02.]

Washington State Code Reviser's Office