WSR 14-03-072 PROPOSED RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed January 15, 2014, 9:25 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 13-23-047.
Title of Rule and Other Identifying Information: WAC 182-531-2010 Enhanced reimbursement—Independent advanced nurse practitioners (ARNPs).
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 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 February 25, 2014, at 10:00 a.m.
Date of Intended Adoption: Not sooner than February 26, 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 February 25, 2014.
Assistance for Persons with Disabilities: Contact Kelly Richters by February 18, 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 the legislature's directive to increase reimbursement rates to medicare's levels for independent ARNPs who provide qualified evaluation and management services and vaccine administration services to eligible clients for dates of service July 1, 2013, through December 31, 2014.
Reasons Supporting Proposal: This rule is required to comply with 3ESSB 5034, section 213(26), chapter 4, Laws of 2013 2nd sp. sess., 63rd legislature.
Statutory Authority for Adoption: RCW 41.05.021; 3ESSB 5034, section 213(26), chapter 4, Laws of 2013 2nd sp. sess., 63rd legislature.
Statute Being Implemented: 3ESSB 5034, section 213(26), chapter 4, Laws of 2013 2nd sp. sess., 63rd legislature.
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: Madina Cavendish, P.O. Box 45510, Olympia, WA 98504-5510, (360) 725-1486.
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.
January 15, 2014
Kevin M. Sullivan
Rules Coordinator
NEW SECTION
WAC 182-531-2010 Enhanced reimbursement—Independent advanced registered nurse practitioners (ARNPs).
(1) Effective for dates of service July 1, 2013, through December 31, 2014, the agency is authorized by the legislature to increase reimbursement rates to medicare levels for independent ARNPs who provide qualified primary care services to eligible medicaid clients.
(2) For the purpose of this section, the following definitions apply:
(a) Independent ARNP – Means a health care practitioner who is not supervised by an eligible primary care physician and not already receiving increased rates for evaluation and management services and vaccine administration services as provided under the Affordable Care Act, section 1202.
(b) Qualified primary care services – Means evaluation and management services and vaccine administration services provided to eligible medicaid clients.
(3) The agency calculates the enhanced rate for independent ARNPs using medicare's payment methodology.
(a) ARNP services are paid at eighty percent of the lesser of the actual charge or eighty-five percent of what a physician is paid under the medicare physician fee schedule.
(b) For the purpose of this enhanced rate calculation, the amount payable to a physician is determined by the Centers for Medicare and Medicaid Services (CMS) as authorized by C.F.R. 447.405 for qualified services in calendar years 2013 and 2014.
(4) If the enhanced rate is less than the agency's published fee schedule rate, the agency's payment will equal the published rate.
(5) This rate increase does not apply to either of the following:
(a) Federally qualified health center services and rural health clinic services reimbursed as part of the encounter rate.
(b) Services provided under state-only funded programs.
(c) Services paid at an enhanced or supplemental rate through a separate provision or regulation.
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