WSR 03-14-067



(Medical Assistance Administration)

[ Filed June 25, 2003, 4:37 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 03-10-086.

Title of Rule: Amending WAC 388-538-067 Managed care provided through managed care organizations (MCOs).

Purpose: Amending the rule to provide the potential for broader provider participation in managed care.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.522.

Statute Being Implemented: RCW 74.09.080, 74.09.510, 74.09.522, 74.09.450, 42 C.F.R. 438.400 through 420.

Summary: See Purpose above.

Reasons Supporting Proposal: See Purpose above.

Name of Agency Personnel Responsible for Drafting: Ann Myers, P.O. Box 45533, Olympia, WA 98504, (360) 725-1345; Implementation and Enforcement: Michael Paulson, P.O. Box 45530, Olympia, WA 98504, (360) 725-1641.

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: See Purpose above.

The purpose is to broaden the potential for greater provider participation in managed care.

The anticipated effect is increased provider participation in managed care, resulting in better access for medical assistance clients.

Proposal Changes the Following Existing Rules: The rules amend the criteria for contracting with the department to provide managed care services to eligible clients.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rules, and, to the best of the department's knowledge, the businesses affected by the rule employ more than fifty employees. The affected businesses therefore do not meet the definition of a small business in RCW 19.85.020, and a statement is not required.

RCW 34.05.328 does not apply to this rule adoption. WAC 388-538-067 is amended to clarify policy and does not make significant changes to that policy. The department has analyzed the proposed amendments and concludes that the probable benefits are greater than the probable costs. A copy of the cost/benefit analysis memo is available from the department representative named below.

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on August 5, 2003, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by July 29, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail

Submit Written Comments to: Identify WAC Numbers, Department of Social and Health Services, Rules Coordinator, Rules and Policies Assistance Unit, delivered to 4500 10th Avenue S.E., Lacey, WA, mail to P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, or e-mail, by 5:00 p.m., August 5, 2003.

Date of Intended Adoption: Not sooner than August 6, 2003.

June 25, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION(Amending WSR 02-01-075, filed 12/14/01, effective 1/14/02)

WAC 388-538-067   Managed care provided through managed care organizations (MCOs).   (1) Managed care organizations (MCOs) may contract with the department of social and health services (DSHS) to provide prepaid health care services to eligible medical assistance administration (MAA) clients ((under the healthy options (HO) managed care program)). The MCOs must meet the qualifications in this section to be eligible to contract with DSHS. The MCO must:

(a) Have a certificate of registration from the office of the insurance commissioner (OIC) ((as either a health maintenance organization (HMO) or a health care services contractor (HCSC).)) that allows the MCO to provide the services in subsection (1) of this section;

(b) Accept the terms and conditions of DSHS' HO contract;

(c) Be able to meet the network and quality standards established by DSHS; and

(d) Accept the prepaid rates published by DSHS.

(2) DSHS reserves the right not to contract with any otherwise qualified MCO.

[Statutory Authority: RCW 74.09.080, RCW 74.08.510, [74.08.]522, 74.09.450, 1115 Waiver, 42 U.S.C. 1396. 02-01-075, 388-538-067, filed 12/14/01, effective 1/14/02.]

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