WSR 98-20-107
PROPOSED RULES
DEPARTMENT OF HEALTH
[Filed October 7, 1998, 11:59 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 97-22-088.
Title of Rule: Children with special health care needs.
Purpose: Existing rules for the children with special health care needs program include obsolete provisions. Program operations have changed since current rules were adopted. The proposed changes would bring rules into compliance with current program operations.
Statutory Authority for Adoption: RCW 43.20.140.
Statute Being Implemented: RCW 43.70.080.
Summary: Changes in proposed rules include simplification of language, deletion of obsolete content, updated declaration of program purpose, changes in definitions, updated provisions on client financial eligibility and service payment authorization, qualifications of providers, and references to fees and payment schedules.
Reasons Supporting Proposal: This proposal is consistent with the Department of Health regulatory improvement plan.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Jan Fleming, CSHCN Program Manager, Olympia, (360) 236-3521.
Name of Proponent: Washington State Department of Health, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: This rule concerns the operation of the children with special health care needs program, including role of local CSHCN agencies, management of diagnostic and treatment funds, qualifications of providers, and related elements.
Proposal Changes the Following Existing Rules: The rules are updated to reflect current operations and language is simplified. Obsolete provisions are deleted. The declaration of program purpose is updated and definitions are updated. Provisions are updated for client financial eligibility and service payment authorization, qualifications of providers, and fees and payment schedules.
No small business economic impact statement has been prepared under chapter 19.85 RCW. Small businesses are not parties to, nor affected by, these rules or the children with special health care needs program. There is no economic impact on small business.
RCW 34.05.328 does not apply to this rule adoption. This rule does not subject a person to a penalty or sanction; does not establish, alter or revoke a qualification for professional licensure; and does not make a significant amendment to a policy or regulatory program. Proposed changes are intended to bring rules into conformance with program operations.
Hearing Location: Hilton Hotel, 17620 Pacific Highway South, Seattle, WA 98188, on November 12, 1998, at 11:30 a.m.
Assistance for Persons with Disabilities: Contact Frank Chestnut by November 3, 1998, TDD (800) 833-6388, or (360) 236-3574.
Submit Written Comments to: Jan Fleming, Department of Health, FAX (360) 586-7868, by November 5, 1998.
Date of Intended Adoption: November 12, 1998.
October 7, 1998
Sylvia Beck
Executive Director
State Board of Health
OTS-2357.2
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-001 Declaration of purpose. The following
rules ((are adopted pursuant to)) implement RCW 43.20.140
((wherein)) and chapter 43.70 RCW. The state board of health
((is empowered to promulgate)) may develop rules ((and
regulations as shall be)) that are necessary to ((carry out the
purposes of)) implement RCW 43.20A.635 ((empowering)) authorizing
the secretary of the department of ((social and)) health
((services)) to ((establish and)) administer a program of
services for ((crippled)) children with special health care
needs. ((It is)) The purpose of the ((crippled children's
services)) CSHCN program is to develop, extend, and improve
services and service systems for locating, diagnosing, and
treating children ((who are crippled or who are suffering from
physical conditions leading to crippling)) with special health
care needs within available resources.
((In accordance with RCW 43.20A.635 and these rules, the
crippled children's services (CCS) program shall limit services
in such manner and degree as will assure, in the judgment of the
physician-director, provision of optimum services to crippled
children with the greatest needs, commensurate with the fixed
funding available to CCS.
It is the declared purpose of the department of social and
health services and the state board of health that the CCS
program shall be administered strictly within the limits of funds
available for CCS purposes and that CCS may not authorize
provision of services beyond those limits.))
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-001, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-010, filed 12/2/82.]
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-010 Definitions. (1) "Client" means an
individual ((whose application for crippled children's services
program funds has been approved)) with special health care needs,
seventeen years of age or younger, who is being served by a local
CSHCN agency.
(2) (("Crippled child")) "Children with special health care
needs" means ((an individual below the age of eighteen years
having an organic disease, defect or condition substantially
interfering with normal growth and development)) children with
disabilities or handicapping conditions; chronic illnesses or
conditions; health related educational or behavioral problems; or
children at risk of developing such disabilities, conditions,
illnesses or problems.
(3) (("CCS")) "CSHCN" means ((crippled children's services))
the children with special health care needs program.
(4) (("DSHS")) "Department" means department of ((social
and)) health ((services)).
(5) (("Limited intervention" means treatment given during a
limited period of time designed to move a client's status from a
lower to a substantially higher level of functioning.
(6))) "Local ((CCS)) CSHCN agency" means the local health
((department and/or district)) jurisdiction or other agency
locally administering the ((CCS)) CSHCN program for the county
where the ((CCS applicant or)) client resides in the state of
Washington.
(((7) "Physician-director" means a medical doctor or
osteopath employed by the department of social and health
services having the following qualifications:
(a) Doctorate of medicine from a school of medicine
accredited by the liaison committee on medical education; and
(b) Licensed to practice medicine in the state of
Washington; and
(c) Certified (or eligible for certification) by an
appropriate medical specialty board.
(8))) (6) "Service systems" means community-based systems of
services such as primary and specialty medical services, early
intervention, special education, and social and family support
services for children with special health care needs and their
families.
(7) "Services" means health-related interventions, including
early identification, care coordination, medical, surgical and
rehabilitation care, and equipment ((and appliances)) provided in
hospitals, clinics, offices, and homes by ((approved)) local
CSHCN agencies, physicians and other ((approved)) health care
providers.
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-010, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-020, filed 12/2/82.]
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-030 Program limitations. (1) ((Reductions in))
The department may reduce the scope of ((the program shall be
made by the department when required to limit program
expenditures for services according to program funding
available)) CSHCN services and impose or revise funding
limitations on certain services when required for budgetary
reasons to accommodate available funding.
(2) ((CCS may, for budgetary reasons, upon the advice and
authority of the physician-director, impose or revise funding
limitations on certain CCS programs.)) Financial eligibility for
a client must be determined annually when health-related services
and equipment are paid for with CSHCN funds. Financial
eligibility will be determined according to national standards of
living for low-income families such as federal poverty levels or
state median income adjusted for family size. Financial
eligibility is not entitlement to CSHCN services.
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-030, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-040, filed 12/2/82.]
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-050 Authorization of services. Authorization
for services ((shall)) paid for with CSHCN funds will be
accomplished in ((the form and manner described by crippled
children's services, in)) accordance with the following:
(1) ((Using forms approved by CCS, the local CCS agency
secures financial resource information from the family and the
medical documentation of the crippling condition from the
provider, prepares a request for authorization, and forwards all
three to the state CCS office.
(2) Medical eligibility, under the supervision of the CCS
physician-director, and financial eligibility shall be determined
by the state CCS staff.
(3) If the child is accepted on the program, each requested
service is reviewed for appropriateness to)) Financial
eligibility for a client has been determined.
(2) A request for services to be paid for with CSHCN funds
has been reviewed for consistency with program ((policies and
guidelines, and quality assurance criteria)) directions.
Services must be ((of a nature and state of development as to be
a)) recognized as an acceptable form of treatment by a
significant portion of the professional community.
(((4) If all criteria are met and funding is available, an
authorization document is prepared by state CCS staff and sent
directly to the provider of service and local CCS agencies.
(5) Written notification of a child's acceptance or
nonacceptance to the program shall be mailed to the family.
(6))) (3) No services will be authorized for out-of-state
providers if an equivalent service is available within the state
of Washington. ((This does not preclude utilization)) However,
use of resources in ((contiguous)) bordering states will be
authorized when appropriate.
(((7) In cases of emergencies, and on the basis of
information available, the CCS physician-director shall have the
authority to approve requested services in advance of a written
application and service request being received.))
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-050, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-060, filed 12/2/82.]
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-060 Qualifications ((and assurances)) of
hospitals and providers. Providers of services paid for with
CSHCN funds must meet the following minimum qualifications.
(1) Hospitals ((authorized by CCS to provide services must
be accredited by the joint commission of accreditation of
hospitals and licensed by the state of location)) will be:
(a) Accredited by the joint commission on the accreditation of health care organizations; and
(b) Licensed in the state where the hospital is located.
(2) Physicians ((and other health care providers authorized
by CCS to provide services must meet all requirements and
assurances set forth in the crippled children's services provider
agreement form)) will be:
(a) Licensed to practice medicine in Washington, or other state where they practice; and
(b) Board-certified or board-eligible by the appropriate specialty board.
(3) Providers other than physicians will be:
(a) Licensed or certified in Washington or in the state where they practice; or
(b) Accredited by the appropriate national professional organization when there is no state licensure or certification process.
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-060, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-070, filed 12/2/82.]
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-070 Fees and payments. (1) Payments to
providers of services ((shall)) using CSHCN funds will be made
((in accordance with the DSHS schedule of maximum allowances and
the crippled children's services)) using the current CSHCN
standards and payment schedules, including the Washington state
department of social and health services medical assistance
administration fee schedule and the CSHCN supplemental fee
schedule.
(2) A provider will accept the fees paid under this section as full payment for services rendered.
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-070, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-080, filed 12/2/82.]
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-080 Third-party resources. ((CCS)) CSHCN is a
secondary payer to all private and other public funded health
programs. ((Such sources of funding must be utilized before CCS
payment is made. These sources include, but are not limited to,
insurance, Medicaid, Medicare, CHAMPUS (Civilians Health and
Medical Program of the Uniformed Services) including provisions
for basic benefits and benefits under the program for the
handicapped, and other special programs with liability for health
care, such as prisons, group or foster homes, and state mental
hospitals and facilities. No payment will be made where trust
funds or other protected assets are available.)) The department
may pay for services with CSHCN funds only after payment by all
entitlement programs and by all other private and public funding
resources, except where prohibited by federal law.
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-080, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-090, filed 12/2/82.]
AMENDATORY SECTION (Amending Order 124B, filed 12/27/90, effective 1/31/91)
WAC 246-710-090 Repayment. Repayment to the department
from the provider, family or other source is required should
insurance benefits, trusts, court-awarded damages or like funds
become available, and where payments have been made to the family
or provider for services paid for by ((CCS)) CSHCN.
[Statutory Authority: RCW 43.20.050. 91-02-051 (Order 124B), recodified as § 246-710-090, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 43.20.140 and 43.20.050. 83-01-002 (Order 247), § 248-105-100, filed 12/2/82.]
REPEALER
The following section of the Washington Administrative Code is repealed:
WAC 246-710-020 Program eligibility.