Original Notice.

     Preproposal statement of inquiry was filed as WSR 08-22-021.

     Title of Rule and Other Identifying Information: The department is amending WAC 388-543-1200 DME -- Providers who are eligible to provide services.

     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) 664-6094, on January 27, 2008 [2009], at 10:00 a.m.

     Date of Intended Adoption: Not sooner than January 28, 2009.

     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 DSHSRPAURULESCOORDINATOR@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on January 27, 2008 [2009].

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by January 13, 2009, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is removing the requirement for DME providers under WAC 388-543-1200 (1)(b) which states "Have appropriately trained, qualified staff." The department is also changing all references to "MAA" within this section to "the department."

     Reasons Supporting Proposal: This requirement sets up an expectation that the department will monitor the training the provider's staff receive and determine if they are "qualified." This is not the case. There are no standards for defining what is "qualified" for DME staff, nor is there a certification process, nor does the department have a system that monitors whether vendors are complying with this requirement.

     Statutory Authority for Adoption: RCW 74.08.090.

     Statute Being Implemented: RCW 74.08.090.

     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: Wendy Boedigheimer, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1306; Implementation and Enforcement: Erin Mayo, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-1729.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the rules and determined that no new costs will be imposed on small businesses or nonprofit organization.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Erin Mayo, DME Program Manager, DSHS, Health and Recovery Services Administration, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-1729, fax (360) 586-9727, e-mail mayoe@dshs.wa.gov.

December 19, 2008

Stephanie E. Schiller

Rules Coordinator

     (a) Have the proper business license; and

     (b) ((Have appropriately trained qualified staff; and

     (c))) Be certified, licensed and/or bonded if required, to perform the services billed to the department. Out-of-state prosthetic and orthotics providers must meet their state regulatory requirements.

     (2) ((MAA)) The department may reimburse qualified providers for DME and related supplies, prosthetics, orthotics, medical supplies, repairs, and related services on a fee-for-service (FFS) basis as follows:

     (a) DME providers for DME and related repair services;

     (b) Medical equipment dealers, pharmacies, and home health agencies under their medical vendor provider number for medical supplies, subject to the limitations in this section;

     (c) Licensed prosthetics and orthotics providers who are licensed by the Washington state department of health in prosthetics and orthotics. This does not apply to medical equipment dealers and pharmacies that do not require licensure to provide selected prosthetics and orthotics;

     (d) Physicians who provide medical equipment and supplies in the physician's office. ((MAA)) The department may pay separately for medical supplies, subject to the provisions in ((MAA's)) the department's resource based relative value scale (RBRVS) fee schedule; and

     (e) Out-of-state orthotics and prosthetics providers who meet their state regulations.

     (3) ((MAA)) The department terminates from medicaid participation any provider who violates program regulations and policies, as described in WAC 388-502-0020.

[Statutory Authority: RCW 74.08.090, 74.09.530. 01-01-078, § 388-543-1200, filed 12/13/00, effective 1/13/01.]

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