PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 05-17-140.
Title of Rule and Other Identifying Information: Sections in Title 388 WAC regarding covered and noncovered services - Part 3 of 3.
WAC Sections Proposed in Part 3: WAC 388-543-1100 Scope of coverage and limitations for DME, 388-543-1150 Limits and limitation extensions, 388-543-1300 Equipment, related supplies, or other nonmedical supplies, and devices not covered, 388-544-0010 Vision care -- General, 388-544-0450 Vision care -- Prior authorization, 388-544-1100 Hearing aid services -- General, 388-544-1400 Hearing aid services -- noncovered services, 388-545-900 Neurodevelopmental centers, 388-546-0200 Scope of coverage for ambulance transportation, 388-546-0250 Ambulance services the department does not cover, 388-550-2596 Services and equipment covered by the department but not included in LTAC fixed per diem rate, 388-551-2130 Noncovered home health services, 388-551-3000 Private duty nursing services for clients seventeen and younger, 388-553-500 Home infusion therapy/parenteral nutrition program -- Coverage, 388-554-500 Orally administered enteral nutrition products -- Coverage, 388-554-600 Tube-delivered enteral nutrition products and related equipment and supplies -- Coverage, 388-556-0500 Medical care services under state-administered cash programs, and 388-800-0045 What services are offered by ADATSA?
Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on November 7, 2006, at 10:00 a.m.
Date of Intended Adoption: Not earlier than November 8, 2006.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m. on November 7, 2006.
Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by November 3, 2006, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at schilse@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposal is to:
| • | Improve the quality of care received by DSHS clients by using a consistent, evidence-based approach to making benefit coverage decisions. |
| • | Make HRSA benefit coverage rules clearer, more transparent, and consistent. |
| • | Establish a clear, transparent process by which HRSA determines what services are included under its benefit coverage. |
| • | Maximize program resources through prudent use of cost-effective practices. |
| • | Replaced "medical assistance administration" and "MAA" with "the department" or "HRSA." |
| • | Substituted WAC 388-501-0160 cross reference in place of WAC 388-501-0165 where noncovered services are addressed. |
| • | Replaced all references to chapter 388-529 WAC with new WAC 388-501-0060 and 388-501-0065. |
| • | Added reference to new WAC 388-501-0169 in rules where limitations on covered services are addressed. |
| • | Repealed chapter 388-529 WAC which is being replaced with WAC 388-501-0060 and 388-501-0065. |
| • | Repealed WAC 388-501-0300 because it was incorporated into WAC 388-501-0050 and 388-501-0070. |
| • | Removed gender reassignment surgery from covered service status. |
| • | More clearly defined what is covered and not covered in the way of cosmetic and reconstructive surgery, treatment, and procedures in WAC 388-531-0100 and new WAC 388-501-0070. |
| • | Added more detail to WAC 388-501-0160 regarding the criteria and steps in the exception to rule (ETR) process. |
| • | In new WAC 388-501-0065, added brief descriptions of services available under each category of service listed in the table in new WAC 388-501-0060. |
| • | Included cross references (in new WAC 388-501-0065 and 388-501-0070) to other program WACs where the reader can find more specific detail of the covered or noncovered service. |
| • | Codified the evaluation criteria HRSA will use when evaluating requests for covered services beyond the maximum allowed. |
Reasons Supporting Proposal: It will make HRSA's rules regarding covered and noncovered medical services clearer and easier to understand for our clients and medical providers.
Statutory Authority for Adoption: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700.
Statute Being Implemented: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Department of social and health services, governmental.
Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, 626 8th Avenue, Olympia, WA 98504-5504, (360) 725-1344; Implementation and Enforcement: Gail Kreiger, 626 8th Avenue, Olympia, WA 98504-5504, (360) 725-1681.
No small business economic impact statement has been prepared under chapter 19.85 RCW. This amendment does not create more than minor costs to small businesses.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kevin Sullivan, HRSA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-4405, phone (360) 725-1344, fax (360) 586-9727, e-mail sullikm@dshs.wa.gov, TYY/TDD 1-800-848-5429.
September 15, 2006
Andy Fernando, Manager
Rules and Policies Assistance Unit
Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 06-20 issue of the Register.