WSR 09-12-062

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed May 28, 2009, 2:48 p.m. , effective July 1, 2009 ]


Effective Date of Rule: July 1, 2009.

Purpose: In accordance with sections 201 and 209 of the operating budget for fiscal years 2010 and 2011, the department will be adjusting its payment rates for inpatient and outpatient hospital services. The department is amending language in sections in chapter 388-550 WAC and adding a new section in order to meet the legislature's targeted budget expenditure levels. Changes include: Adding language that the department may change the method for calculating the outpatient prospective payment system (OPPS) payments to achieve the legislature's targeted expenditure levels; adding language that incorporates into rule which hospitals are no longer exempted from the OPPS payment method and that the department pays all covered outpatient hospital services, except for those provided in critical access hospitals (CAHs), under the OPPS methodology; and implementing a prorated inpatient payment policy when a facility transfers a client to another facility under certain circumstances. The rules also remove "neonatal" from the list of diagnostic related group (DRG) service categories for claims that group to a medical, surgical, or burn DRG category, remove "prepay" from "retrospective prepay utilization review," and clarify that the department may perform these reviews. In addition, the rules eliminate outdated information, and update and clarify language, including removing language for "administrative day rate and swing bed rate" from WAC 388-550-4500 and placing it into a new section.

Citation of Existing Rules Affected by this Order: Amending WAC 388-550-3600, 388-550-3700, 388-550-4500, 388-550-4550, 388-550-7050, 388-550-7100, 388-550-7450, 388-550-7500, and 388-550-7600.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500.

Other Authority: 2009-11 Omnibus Operating Budget (ESHB 1244).

Adopted under notice filed as WSR 09-08-118 on March 31, 2009.

A final cost-benefit analysis is available by contacting Carolyn Adams, P.O. Box 45510, Olympia, WA 98504-5510, phone (360) 725-1854, fax (360) 753-9152, e-mail adamscr@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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 7, Repealed 0.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 1, 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 2, Amended 7, Repealed 0.

Date Adopted: May 28, 2009.

Susan N. Dreyfus

Secretary

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 09-13 issue of the Register.

Washington State Code Reviser's Office