WSR 98-01-223

PREPROPOSAL STATEMENT OF INQUIRY

DEPARTMENT OF

LABOR AND INDUSTRIES

[Filed December 24, 1997, 11:35 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 to update the maximum allowable payments for most medical services. These updates follow the established methodologies of the Department of Labor and Industries, the Health Care Authority, and the Medical Assistance Administration. The proposed rule will do the following: 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 a medical reimbursement methodology consistent with other state agencies. Cost-of-living increases may be incorporated into the changes in the conversion factors.

In WAC 296-23-220 and 296-23-230, update the maximum daily reimbursement level for physical and occupational therapy services so the department may, if necessary, give cost-of-living increases to affected providers.

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 through its Anesthesia and Reimbursement Technical Advisory Groups on the updates to the conversion factors and to the physical and occupational therapy maximum daily reimbursement level. The department coordinates these updates with the Health Care Authority, the Medical Assistance Administration and the Health Care Financing Administration to insure consistent health care purchasing policies when possible. The proposed changes will be presented to the advisory groups 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 Simone Stilson, Department of Labor and Industries, Health Services Analysis, P.O. Box 44322, Olympia, WA 98504-4322, phone (360) 902-4744, FAX (360) 902-4249, Internet stil235@lni.wa.gov.

December 22, 1997

Gary Moore