WSR 16-24-075

PREPROPOSAL STATEMENT OF INQUIRY

[Filed December 6, 2016, 2:54 p.m.]

Subject of Possible Rule Making: The department proposes to amend sections in chapter 388-877 WAC regarding the grievance system and the administrative hearing process, and other related rules as may be required.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 71.05.560, 71.24.035 (5)(c), 71.24.520, and 71.34.380.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The department is amending its current grievance system rules in chapter 388-877 WAC in order to align with the Centers for Medicare and Medicaid Services (CMS) revised rules in 42 C.F.R. Parts 431, 433, 438, 440, 457, and 495 that govern the grievance and appeals system for medicaid managed care. The proposed updated definitions, updated appeal time frames, and alignment of certain processes for appeals and grievances will provide consumers with a more streamlined, manageable, and consumer-friendly grievance and appeals process, and will allow behavioral health agencies and behavioral health organizations to further align rules applicable to private health insurance and group health plans that apply across the market. Other related rules may be updated to improve clarity or update policy.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The health care authority.

Process for Developing New Rule: DSHS welcomes the public to take part in developing the rules. Anyone interested should contact the staff person identified below. At a later date, DSHS will file a proposal with the office of the code reviser with a notice of proposed rule making. A copy of the proposal will be sent to everyone on the mailing list and to anyone who requests a copy.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Kathy Sayre, DBHR Rules Program Manager, Division of Behavioral Health and Recovery, P.O. Box 45330, Olympia, WA 98504-5330, e-mail kathy.sayre@dshs.wa.gov, phone (360) 725-1342, fax (360) 586-0341, TTY 1-800-833-6384.

December 6, 2016

Katherine I. Vasquez

Rules Coordinator