WSR 18-07-105 PROPOSED RULES OFFICE OF FINANCIAL MANAGEMENT [Filed March 21, 2018, 8:54 a.m.] Original Notice. Preproposal statement of inquiry was filed as WSR 18-03-036. Title of Rule and Other Identifying Information: Amending chapter 82-75 WAC related to the statewide all-payer health care claims database. Specifically, the rules will address the procedures for establishing appropriate fees. Hearing Location(s): On April 24, 2018, at 9:30 a.m., at 302 Sid Snyder Avenue S.W., Fourth Floor, Room 440, Olympia, WA 98501. Date of Intended Adoption: May 1, 2018. Submit Written Comments to: Thea Mounts, 106 11th Avenue S.W., P.O. Box 43124, Olympia, WA 98504, email apcd@ofm.wa.gov, by April 24, 2018. Assistance for Persons with Disabilities: Contact office of financial management (OFM), phone 360-902-3092, TTY 360-753-4107, email hayden.mackley@ofm.wa.gov, by April 20, 2018. Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the rule is to establish the procedures that need to be followed by the lead organization in appropriate fees for data from the Washington all-payer claims database. The rule ensures review by the appropriate advisory committee and OFM, as well as providing transparency for the process. Reasons Supporting Proposal: Chapter 43.371 RCW directs OFM to establish a statewide all-payer health care claims database to support transparent public reporting of health care information. To accomplish this requirement, OFM is further directed to select a lead organization to coordinate and manage the database. RCW 43.371.070 (1)(f) provides that the OFM director shall adopt rules necessary to implement this chapter including the procedures for establishing appropriate fees. Statutory Authority for Adoption: RCW 43.371.070 (1)(f). Statute Being Implemented: Chapter 43.371 RCW. Rule is not necessitated by federal law, federal or state court decision. Name of Proponent: OFM, governmental. Name of Agency Personnel Responsible for Drafting: Roselyn Marcus, Insurance Building, Olympia, Washington, 360-902-0434; Implementation and Enforcement: Thea Mounts, Helen Sommers Building, Olympia, Washington, 360-902-0552. A school district fiscal impact statement is not required under RCW 28A.305.135. A cost-benefit analysis is not required under RCW 34.05.328. OFM is not a listed agency in RCW 34.05.328 (5)(a)(i). This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal: Is exempt under RCW 19.85.025(3) as the rule content is explicitly and specifically dictated by statute. March 21, 2018 Roselyn Marcus Assistant Director for
Legal and Legislative Affairs
FEE SCHEDULES
NEW SECTION
WAC 82-75-550 Requirement for fee schedules and processes.
(1) RCW 43.371.020 (5)(g) requires the lead organization to develop a plan for the financial sustainability of the database, and charge fees for reports and data files to fund the database.
(2) The office must approve any fee established by the lead organization.
(3) RCW 43.371.070 requires the office to establish by rule, procedures for the lead organization to establish these statutorily required fees.
(4) The process to develop, review and approve fee schedules will be open and transparent, and allow for stakeholder feedback.
NEW SECTION
WAC 82-75-560 Process to establish fee schedules.
(1) The lead organization must develop a draft fee schedule consistent with the requirements in RCW 43.371.020 (5)(g). The lead organization must maintain documentation that supports the development of and final decisions regarding the fee schedule.
(2) The lead organization must present the draft fee schedule and supporting documentation to the data policy committee for review and feedback. The lead organization must provide any other available data requested by the DPC that supports the development and draft fee schedule presented.
(3) The DPC must review the draft fee schedule, supporting documentation, and adopt recommendations, including the basis for each recommendation, as to whether the fee schedule should be approved by the office. The DPC must provide the recommendations to the lead organization for its consideration.
(4) The lead organization must review the DPC recommendations and make any changes to the draft fee schedule based on the recommendations. The lead organization must document which recommendations it implemented into the fee schedule. For those recommendations that the lead organization did not act upon, the lead organization must document the reasons why each recommendation was not accepted.
(5) The lead organization must provide the office the draft fee schedule, as modified, supporting documentation, the DPC recommendations, and the reasoning for why the lead organization did not make changes for any recommendation not accepted. The lead organization must also provide any other available data requested by the office that supports the development and draft fee schedule provided to the office.
(6) The office shall post on the agency web site the draft fee schedule, and solicit public comment for thirty days. The office may also convene a stakeholder meeting to provide an opportunity for interested parties another avenue to give feedback on the draft fee schedule. If the office decides to hold a stakeholder meeting, the meeting may be in person, by telephone or other electronic means, as determined by the office.
After the comment period, the office will review all the stakeholder feedback, recommendations of the DPC, and any data received from the lead organization and make a final determination regarding the fee schedule. The office shall provide the final determination to the lead organization, publish the final determination on the agency web site, and send notification through the office listserv or other electronic means.
NEW SECTION
WAC 82-75-570 Process to modify fee schedules.
(1) Fee schedules shall be reissued no less frequently than on an annual basis. The reissuance of the fee schedule can include maintaining the fee schedule without modification, modifying the fee schedule, or a combination of these two actions.
(2) The lead organization shall review fee schedules at least once every year. Annual period shall be from the date upon which the fee schedule is adopted. The review shall include whether any fee should be changed, removed from the schedule, or new fees added. The lead organization must maintain documentation that supports the recommended changes from the review of the fee schedule.
(3) The lead organization must present the changes, supporting documentation, and proposed modifications to the fee schedule to the data policy committee for review and feedback. The lead organization must provide any other available data requested by the DPC that supports the proposed modifications to the fee schedule.
(4) The DPC must review the changes, supporting documentation, and proposed modifications to the fee schedule and adopt recommendations, including the basis for each recommendation, as to whether the changes should be accepted and the modified fee schedule approved by the office. The DPC must provide the recommendations to the lead organization for its consideration.
(5) The lead organization must review the DPC recommendations and make any changes to the recommendations and proposed modifications to the fee schedule based on the recommendations. The lead organization must document which recommendations it implemented into the fee schedule. For those recommendations that the lead organization did not act upon, the lead organization must document the reasons why each recommendation was not accepted.
(6) The lead organization must provide the office the proposed modifications to the fee schedule, as modified, with supporting documentation, the DPC recommendations, and the reasoning for why the lead organization did not make changes for any recommendation not accepted. The lead organization must provide any other available data requested by the office that supports the changes and proposed modified fee schedule provided to the office.
(7) The office shall post on the agency web site the recommendations and proposed modifications to the fee schedule, and solicit public comment for thirty days. The office may also convene a stakeholder meeting to provide an opportunity for interested parties another avenue to give feedback on the draft fee schedule. If the office decides to hold a stakeholder meeting, the meeting may be in person, by telephone or other electronic means, as determined by the office.
(8) After the comment period, the office will review all the stakeholder feedback, recommendations of the DPC, and any data received from the lead organization and make a final determination regarding the fee schedule. The office shall provide the final determination to the lead organization, publish the final determination on the agency web site, and send notification through the office listserv or other electronic means.
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