WSR 23-24-103
HEALTH CARE AUTHORITY
[Filed December 6, 2023, 11:59 a.m.]
NOTICE
Title or Subject: Medicaid State Plan Amendment (SPA) 24-0006 Third Party Liability Update.
Effective Date: January 1, 2024.
Description: In compliance with Title 42, Chapter IV, Subchapter C, Part 433 C.F.R., Washington pursues reimbursement from liable third parties, other than health insurance or medicare, when medicaid has paid for certain services provided to a medicaid client when that client has primary insurance coverage. A casualty case to recover such costs is opened when the medicaid costs exceed a certain cumulative amount. Currently, the state opens a casualty case for a medicaid client when the cumulative cost for claims related to an accident/injury is $50.00 and for ambulance claims is $2,200.00. Also, ProviderOne automatically reviews the paid amount on an accident- or injury-related claim and sends a treatment questionnaire (TQ) to the client if the total claim payment is $110.00 or more. The health care authority (HCA) intends to submit SPA 24-0006 to increase the cumulative paid amount on all types of claims to $250.00 to open a casualty case and total claims payment to $250.00 to send a TQ.
SPA 24-0006 is expected to have no effect on annual aggregate expenditures/reimbursement/payment.
A copy of SPA 24-0006 is available for review. HCA would appreciate any input or concerns regarding this SPA. To request a copy of the SPA or submit comments, please contact the person named below (please note that all comments are subject to public review and disclosure, as are the names of those who comment).
CONTACT: Kasandra Wilson, Medicaid Eligibility and Community Support, 628 8th Avenue S.E., Olympia, WA 98504, phone 360-725-1351, TRS 711, email Kasandra.wilson@hca.wa.gov.