WSR 14-20-034 PROPOSED RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed September 23, 2014, 4:15 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 14-13-001.
Title of Rule and Other Identifying Information: WAC 182-550-5380 Payment method—Sole community disproportionate share hospital (SCDSH).
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Conference Room, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at http://www.hca.wa.gov/documents/directions_to_csp.pdf or directions can be obtained by calling (360) 725-1000), on November 4, 2014, at 10:00 a.m.
Date of Intended Adoption: Not sooner than November 5, 2014.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail arc@hca.wa.gov, fax (360) 586-9727, by 5:00 p.m. on November 4, 2014.
Assistance for Persons with Disabilities: Contact Kelly Richters by October 27, 2014, TTY (800) 848-5429 or (360) 725-1307 or e-mail kelly.richters@hca.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: To comply with ESSB 6002, section 213 (10) and (11), chapter 221, Laws of 2014, (page 109 of operating budget-supplemental), the agency is amending this section to address the changes noted in the bill which will impact state fiscal year 2015 funds.
Reasons Supporting Proposal: See Purpose statement above.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160, ESSB 6002, section 213 (10) and (11), chapter 221, Laws of 2014.
Statute Being Implemented: RCW 41.05.021, 41.05.160, ESSB 6002, section 213 (10) and (11), chapter 221, Laws of 2014.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Wendy Barcus, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1306; Implementation and Enforcement: Mary O'Hare, P.O. Box 45500, Olympia, WA 98504-5500, (360) 725-9820.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has analyzed the proposed rules and concludes they do not impose more than minor costs for affected small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
September 23, 2014
Kevin M. Sullivan
Rules Coordinator
AMENDATORY SECTION (Amending WSR 14-08-038, filed 3/26/14, effective 4/26/14)
WAC 182-550-5380 Payment method—Sole community disproportionate share hospital (SCDSH).
(1) The medicaid agency's sole community disproportionate share hospital (SCDSH) program is a program for in-state hospitals that:
(a) Were certified by the Centers for Medicare and Medicaid Services (CMS) as sole community hospitals as of January 1, 2013;
(b) Had less than one hundred fifty acute care licensed beds in state fiscal year (SFY) 2011;
(c) Qualify under Section 1923(d) of the Social Security Act; ((and))
(d) Are not participating in the certified public expenditure (CPE) program; and
(e) Are rural hospitals in Lewis County.
(2) The agency pays qualifying hospitals SCDSH payments from a legislatively appropriated pool. This distribution is based on the hospital's medicaid payments. To determine the hospital's SCDSH payments, the agency:
(a) Identifies the sum of the medicaid payments to the individual hospital during the SFY two years prior to the current SFY for which DSH application is being made. These medicaid payment amounts:
(i) Are based on historical data;
(ii) Include payments from the agency; and
(iii) Include payments reported on encounter data supplied by agency-contracted managed care organizations.
(b) Divides the medicaid payment amount in (a) of this subsection by the sum of the medicaid payment amounts for all qualifying hospitals during the same period to determine the hospital's percentage; and
(c) Applies this percentage to the total dollars in the pool to determine the hospital's SCDSH payment.
(3) The SCDSH payments to a hospital eligible under this program may not exceed the hospital's DSH cap calculated according to WAC 182-550-4900(10).
(4) SCDSH payments are subject to the availability of DSH funds under the statewide DSH cap. If the statewide DSH cap is exceeded, the agency will recoup DSH payments in the order specified in WAC 182-550-4900 (13) and (14).
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