WSR 04-01-043



(Medical Assistance Administration)

[ Filed December 11, 2003, 8:07 a.m. ]

Continuance of WSR 03-22-089.

Preproposal statement of inquiry was filed as WSR 02-24-010.

Title of Rule: Chapter 388-500 WAC, Medical definitions.

Purpose: The department is extending the written comment deadline for this proposed rule to 5:00 p.m., January 16, 2004. Written comments may be sent to the fax number or e-mail address, or delivered to the location listed below. Comments sent by postal mail must be postmarked by January 16, 2004. A public hearing was held on December 9, 2003.

The proposed rule updates the definition of "medical necessity" in order: To incorporate the use of medical information that is supported by scientific evidence in its determination of services; to include definitions for new or existing terms that may be necessary to clearly define "medically necessary"; to ensure consistency with the medical definitions and WAC 388-501-0165; and to carry out the directives of ESHB 1299 (chapter 273, Laws of 2003), an act relating to evidence-based health services purchasing by state purchased health care programs.

Statutory Authority for Adoption: RCW 74.08.090, ESHB 1299 (chapter 276, Laws of 2003).

Statute Being Implemented: RCW 74.08.090, ESHB 1299 (chapter 276, Laws of 2003).

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: Bill Hagens, P.O. Box 45500, Olympia, WA 98504, (360) 725-1237.

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

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

Explanation of Rule, its Purpose, and Anticipated Effects: The rule amends the definition of "medical necessity" and related rules.

The rule is being amended to include the use of scientific evidence in the department's coverage and service determinations; to help ensure the department's clients will not be harmed or injured by inappropriate service utilization in view of the robust development and availability of new drugs, treatments, and therapies; to help ensure that available resources be spent in the most effective manner to improve the health of clients; and to help expedite service determinations.

The anticipated effects are as stated above.

Proposal Changes the Following Existing Rules: The rule described in Title of Rule and Purpose above is being amended to include a reference to scientific evidence, include definitions related to the new definition of "medical necessity."

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rule and concludes that it will not have a more than minor impact on the small businesses affected by it.

RCW 34.05.328 applies to this rule adoption. The department has analyzed the proposed rule and concludes that it meets the definition of a "significant legislative rule" as defined by the legislature. An analysis of the probable costs and probable benefits is available from the person listed above.

Hearing Location: A public hearing was held December 9, 2003, in Lacey, Washington. See Purpose above.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue, Lacey, WA, fax (360) 664-6185, e-mail, by 5:00 p.m., January 16, 2004.

Date of Intended Adoption: Not sooner than January 17, 2004.

December 10, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

Legislature Code Reviser 


Washington State Code Reviser's Office