WSR 97-02-097




[Filed January 2, 1997, 11:04 a.m.]

Subject of Possible Rule Making: Medical aid rules updates.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 51.04.020 and 51.04.030.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: This rule follows the established process used by the department for updating the system for paying for most medical services. The proposed rule may do the following:

(1) In WAC 296-20-135, update the conversion factors used by the department for calculating reimbursement rates for most medical services and anesthesia. The conversion factors will be updated to correspond to changes in the medical procedure codes, the relative value units, and anesthesia base units. These changes will enable the department to continue to maintain a medical reimbursement methodology consistent with other state agencies. Cost-of-living increases may also be incorporated into the changes in the conversion factors.

(2) In WAC 296-23-220, 296-23-230 and chapter 296-23A WAC, increase the maximum daily reimbursement level for physical and occupational therapy services in order to give cost-of-living increases to affected providers.

(3) Amend WAC 296-20-125 to allow massage therapists to use the national standard HCFA 1500 health insurance claim form to bill the department when billing with paper bills only (not electronic).

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: None.

Process for Developing New Rule: The department is working with external stakeholders on the updates to the conversion factors and the physical and occupational therapy cap. The proposed changes will be presented to the RBRVS Technical Advisory Group and publicized in a letter to interested persons.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Marilyn Gisser, Medical Program Specialist, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, phone (360) 902-6801, FAX (360) 902-4249, Internet GISM235@LNI.WA.GOV.

January 2, 1997

Mike Watson

for Mark O. Brown


Legislature Code Reviser


Washington State Code Reviser's Office