EMERGENCY RULES
SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Effective Date of Rule: November 1, 2006.
Purpose: To comply with the requirements of the 2005 legislature, the department is adding new section WAC 388-550-2650, to adopt two separate base community psychiatric hospital payments. One is for Medicaid clients and the other is for non-Medicaid clients. The new rule also clarifies that both Involuntary Treatment Act (ITA)-certified hospitals and hospitals that have ITA-certified beds that have been used to treat ITA patients are included in the base community psychiatric hospitalization payment method for Medicaid and non-Medicaid clients.
This emergency rule replaces the emergency filing for WAC 388-550-2650, under WSR 06-14-086.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.500.
Other Authority: Section 204, chapter 518, Laws of 2005 (ESSB 6090), Part II.
Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: The legislature appropriated funds for fiscal year 2006 and 2007 to establish a separate based community psychiatric hospitalization payment rate for Medicaid and non-Medicaid clients at hospitals that accept commitments under the ITA and free-standing psychiatric hospitals that accept commitments under the ITA and also hospitals that have ITA-certified beds that have been used to treat ITA patients. This rule replaces the emergency rule filed under WSR 06-14-086. The new rule carries out the legislature's directive while the department completes the permanent rule-making process begun under WSR 05-14-145 and filed on July 5, 2005.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.
Date Adopted: October 23, 2006.
Andy Fernando, Manager
Rules and Policies Assistance Unit
3646.2(a) The Medicaid base community psychiatric hospitalization payment rate is a minimum per diem allowable calculated for claims for psychiatric services provided to Medicaid covered patients, to pay hospitals that accept commitments under the involuntary treatment act (ITA).
(b) The non-Medicaid base community psychiatric hospitalization payment rate is a minimum per diem allowable calculated for claims for psychiatric services provided to indigent patients to pay hospitals that accept commitments under the ITA.
(2) A client's inpatient psychiatric hospitalization must have a root cause that is psychiatric in nature. The department:
(a) Defines "root cause" as the reason the client was admitted based on the principal diagnosis and the department's review of the client's medical record; and
(b) Does not consider detoxification to be psychiatric in nature.
(3) All inpatient hospital psychiatric admissions require regional support network (RSN) prior authorization. The RSN-approved length of stay (LOS) is based on a client's discharge diagnosis.
(a) The number of department-covered days that are linked to claims paid under the DRG payment method becomes the RSN-approved LOS for those claims. If the case is a transfer case, the DRG average LOS becomes the LOS that is used to determine the allowable on the claim. See WAC 388-550-3600.
(b) The RSN-approved LOS for claims paid using a non-DRG payment method is established by the RSN in conjunction with the mental health division.
(4) Payment for claims is based on covered days within a client's approved LOS, subject to client eligibility and department-covered services.
(5) The Medicaid base community psychiatric hospitalization payment rate applies only to a Medicaid client admitted to a nonstate-owned free-standing psychiatric hospital located in Washington state.
(6) The non-Medicaid base community psychiatric hospitalization payment rate applies only to a non-Medicaid client admitted to a hospital:
(a) Designated by the department as an Involuntary Treatment Act (ITA)-certified hospital; or
(b) That has a department certified ITA bed that has been used to provide ITA services at the time of the non-Medicaid admission.
(7) For inpatient hospital psychiatric services provided to eligible clients on and after July 1, 2005, the department pays:
(a) A hospital's DOH-certified distinct psychiatric unit, as follows:
(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using the department-specific non-DRG payment method.
(ii) For non-Medicaid clients, the department uses as the allowable for inpatient hospital psychiatric claims, the greater of:
(A) The state-only diagnostic-related group (DRG) allowable (including the high cost outlier allowable, of applicable), or the department-specified non-DRG payment method if no relative weight exists for the DRG in the department's payment system; or
(B) The non-Medicaid base community psychiatric hospitalization payment rate multiplied by the covered days.
(b) A hospital without a DOH-certified distinct psychiatric unit, as follows:
(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using:
(A) The DRG payment method; or
(B) The department-specified non-DRG payment method if no relative weight exists for the DRG in the department's payment system.
(ii) For non-Medicaid clients, the department uses as the allowable for inpatient hospital psychiatric claims, the greater of:
(A) The state-only diagnostic-related group (DRG) allowable (including the high cost outlier allowable, if applicable), or the department-specified non-DRG payment method if no relative weight exists for the DRG in the department's payment system; or
(B) The non-Medicaid base community psychiatric hospitalization payment rate multiplied by the covered days.
(c) A non-state-owned free-standing psychiatric hospital, as follows:
(i) For Medicaid clients, the department uses as the allowable for inpatient hospital psychiatric claims, the greater of:
(A) The RCC allowable; or
(B) The Medicaid base community psychiatric hospitalization payment rate multiplied by covered days.
(ii) For non-Medicaid clients, the department pays inpatient hospital psychiatric claims the same as for Medicaid clients, except the base community psychiatric hospitalization payment rate is the non-Medicaid rate, and the RCC allowable is the state-only RCC allowable.
(d) A hospital, or a distinct psychiatric unit of a hospital, that is participating in the CPE payment program, as follows:
(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using the methods identified in WAC 388-550-4650.
(ii) For non-Medicaid clients, the department pays inpatient hospital psychiatric claims using the methods identified in WAC 388-550-4650, except that the allowable to which the federal financial participation (FFP) percentage is applied is the greater of:
(A) The RCC allowable; or
(B) The non-Medicaid base community psychiatric hospitalization payment rate multiplied by covered days.
(e) A hospital, or a distinct psychiatric unit of a hospital that is participating in the CAH program, as follows:
(i) For Medicaid clients, the department pays inpatient hospital psychiatric claims using the department-specified non-DRG payment method.
(ii) For non-Medicaid clients, the department pays inpatient hospital psychiatric claims using the department-specified non-DRG payment method.
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