Title of Rule: WAC 388-502-0010 Payment -- Eligible providers defined and 388-502-0020 General requirements for providers.

Purpose: To correct terminology and remove an unnecessary requirement.

Other Identifying Information: These rules were recently adopted as WSR 00-15-050.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.500, 74.09.530.

Statute Being Implemented: RCW 74.08.090, 74.09.500, 74.09.530.

Summary: These proposed amendments will correct WAC 388-502-0010 by changing the term "osteopaths" to "osteopathic physicians," and amend WAC 388-502-0020 by removing a requirement that providers include a signed statement each time they bill MAA. This is no longer required and is not possible to do with MAA's electronic billing system.

Reasons Supporting Proposal: These amendments were requested by MAA providers.

Name of Agency Personnel Responsible for Drafting: Leslie Saeger, P.O. Box 45533, Olympia, WA 98504, (360) 725-1347; Implementation and Enforcement: Ann Lawrence, P.O. Box 45533, Olympia, WA 98504, (360) 725-1347.

Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: WAC 388-501-0010 inaccurately refers to osteopathic physicians as osteopaths, and is being corrected.

     WAC 388-502-0020 currently requires providers (people who provide services, equipment, and/or supplies to MAA clients) to submit a signed statement with every bill. This requirement is being deleted because it is no longer necessary and cannot be done with MAA's electronic billing system.

Proposal Changes the Following Existing Rules: Amending WAC 388-502-0010 by changing the term "osteopaths" to "osteopathic physicians"; and WAC 388-502-0020 by deleting subsection (1)(e).

August 23, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

The department reimburses enrolled providers for covered medical services, equipment and supplies they provide to eligible clients.

     (1) To be eligible for enrollment, a provider must:

     (a) Be licensed, certified, accredited, or registered according to Washington state laws and rules; and

     (b) Meet the conditions in this chapter and chapters regulating the specific type of provider, program, and/or service.

     (2) To enroll, an eligible provider must sign a core provider agreement or a contract with the department and receive a unique provider number.

     (3) Eligible providers listed in this subsection may request enrollment.      Out-of-state providers listed in this subsection are subject to conditions in WAC 388-502-0120.

     (a) Professionals:

     (i) Advanced registered nurse practitioners;

     (ii) Anesthesiologists;

     (iii) Audiologists;

     (iv) Chiropractors;

     (v) Dentists;

     (vi) Dental hygienists;

     (vii) Denturists;

     (viii) Dietitians or nutritionists;

     (xiv) Maternity case managers;

     (x) Midwives;

     (xi) Occupational therapists;

     (xii) Ophthalmologists;

     (xiii) Opticians;

     (xiv) Optometrists;

     (xv) Orthodontists;

     (xvi) ((Osteopaths)) Osteopathic physicians;

     (xvii) Podiatric physicians;

     (xviii) Physicians;

     (xix) Physical therapists;

     (xx) Psychiatrists;

     (xxi) Psychologists;

     (xxii) Registered nurse delegators;

     (xxiii) Registered nurse first assistants;

     (xxiv) Respiratory therapists;

     (xxv) Speech/language pathologists;

     (xxvi) Radiologists; and

     (xvii) Radiology technicians (technical only);

     (b) Agencies, centers and facilities:

     (i) Adult day health centers;

     (ii) Ambulatory services (ground and air);

     (iii) Ambulatory surgery centers (Medicare-certified);

     (iv) Birthing centers (licensed by the department of health);

     (v) Blood banks;

     (vi) Chemical dependency treatment facilities certified by the department of social and health services (DSHS) division of alcohol and substance abuse (DASA), and contracted through either:

     (A) A county under chapter 388-810 WAC; or

     (B) DASA to provide chemical dependency treatment services;

     (vii) Centers for the detoxification of acute alcohol or other drug intoxication conditions (certified by DASA);

     (viii) Community AIDS services alternative agencies;

     (ix) Community mental health centers;

     (x) Early and periodic screening, diagnosis, and treatment (EPSDT) clinics;

     (xi) Family planning clinics;

     (xii) Federally qualified health care centers (designated by the Federal Health Care Financing Administration);

     (xiii) Genetic counseling agencies;

     (xiv) Health departments;

     (xv) HIV/AIDS case management;

     (xvi) Home health agencies;

     (xvii) Hospice agencies;

     (xviii) Hospitals;

     (xix) Indian Health Service;

     (xx) Tribal or urban Indian clinics;

     (xxi) Inpatient psychiatric facilities;

     (xxii) Intermediate care facilities for the mentally retarded (ICF-MR);

     (xxiii) Kidney centers;

     (xxiv) Laboratories (CLIA certified);

     (xxv) Maternity support services agencies;

     (xxvi) Neuromuscular and neurodevelopmental centers;

     (xxvii) Nursing facilities (approved by DSHS Aging and Adult Services);

     (xxviii) Pharmacies;

     (xxix) Private duty nursing agencies;

     (xxx) Rural health clinics (Medicare-certified);

     (xxxi) Tribal mental health services (contracted through the DSHS mental health division); and

     (xxxii) Washington state school districts and educational service districts.

     (c) Suppliers of:

     (i) Durable and nondurable medical equipment and supplies;

     (ii) Infusion therapy equipment and supplies;

     (iii) Prosthetics/orthotics;

     (iv) Hearing aids; and

     (v) Oxygen equipment and supplies;

     (d) Contractors of:

     (i) Transportation brokers;

     (ii) Interpreter services agencies; and

     (iii) Eyeglass and contact lens providers.

     (4) Nothing in this chapter precludes the department from entering into other forms of written agreements to provide services to eligible clients.

     (5) The department does not enroll licensed or unlicensed practitioners who are not specifically addressed in subsection (3) of this section, including, but not limited to:

     (a) Acupuncturists;

     (b) Counselors;

     (c) Sanipractors;

     (d) Naturopaths;

     (e) Homeopaths;

     (f) Herbalists;

     (g) Massage therapists;

     (h) Social workers; or

     (i) Christian Science practitioners or theological healers.

[Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.530.      00-15-050, § 388-502-0010, filed 7/17/00, effective 8/17/00.]

(1) Enrolled providers must:

     (a) Keep legible, accurate, and complete charts and records to justify the services provided to each client, including, but not limited to:

     (i) Patient's name and date of birth;

     (ii) Dates of services;

     (iii) Name and title of person performing the service, if other than the billing practitioner;

     (iv) Chief complaint or reason for each visit;

     (v) Pertinent medical history;

     (vi) Pertinent findings on examination;

     (vii) Medications, equipment, and/or supplies prescribed or provided;

     (viii) Description of treatment (when applicable);

     (ix) Recommendations for additional treatments, procedures, or consultations;

     (x) X-rays, tests, and results;

     (xi) Dental photographs and teeth models;

     (xii) Plan of treatment and/or care, and outcome; and

     (xiii) Specific claims and payments received for services.

     (b) Assure charts are authenticated by the person who gave the order, provided the care, or performed the observation, examination, assessment, treatment or other service to which the entry pertains;

     (c) Make charts and records available to DSHS, its contractors, and the US Department of Health and Human Services upon request, for six years from the date of service or longer if required specifically by federal or state law or regulation;

     (d) Bill the department according to department rules and billing instructions;

     (e) ((Include and sign the following statement with each bill submitted to the department for reimbursement: "I hereby certify under penalty of perjury, that the material furnished and service rendered is a correct charge against the state of Washington; the claim is just and due; that no part of the same has been paid and I am authorized to sign for the payee; and that all goods furnished and/or services rendered have been provided without discrimination on the grounds of race, creed, color, sex, religion, national origin, marital status, or the presence of any sensory, mental or physical handicap."

     (f))) Accept the payment from the department as payment in full;

     (((g))) (f) Follow the requirements in WAC 388-502-0160 and 388-538-095 about billing clients;

     (((h))) (g) Fully disclose ownership and control information requested by the department;

     (((i))) (h) Not pay a third party biller a percentage of amounts collected, or discount client accounts to a third party biller;

     (((j))) (i) Provide all services without discriminating on the grounds of race, creed, color, age, sex, religion, national origin, marital status, or the presence of any sensory, mental or physical handicap; and

     (((k))) (j) Provide all services according to federal and state laws and rules, and billing instructions issued by the department.

     (2) A provider may contact MAA with questions regarding its programs.      However, MAA's response is based solely on the information provided to MAA's representative at the time of inquiry, and in no way exempts a provider from following the laws and rules that govern the department's programs.

[Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.530.      00-15-050, § 388-502-0020, filed 7/17/00, effective 8/17/00.]

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