WSR 09-05-008

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed February 5, 2009, 1:39 p.m. , effective March 8, 2009 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The department is removing the requirement for durable medical equipment (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." 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 currently 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.

Citation of Existing Rules Affected by this Order: Amending WAC 388-543-1200.

Statutory Authority for Adoption: RCW 74.08.090.

Adopted under notice filed as WSR 09-01-174 on December 23, 2008.

A final cost-benefit analysis is available by contacting Erin Mayo, DME Program Manager, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-1729, fax (360) 586-9727, e-mail mayoe@dshs.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

Date Adopted: February 5, 2009.

Stan Marshburn

Secretary

4054.1
AMENDATORY SECTION(Amending WSR 01-01-078, filed 12/13/00, effective 1/13/01)

WAC 388-543-1200   Providers who are eligible to provide services.   (1) ((MAA)) The department requires a provider who supplies DME and related supplies, prosthetics, orthotics, medical supplies and related services to ((an MAA)) a client to meet all of the following. The provider must:

(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.]

Washington State Code Reviser's Office