SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Effective Date of Rule: Thirty-one days after filing.
Purpose: The department is creating WAC 388-501-0055 Healthcare coverage -- How the department determines coverage of services for its healthcare programs using health technology assessments.
Statutory Authority for Adoption: RCW 74.08.090 and 70.14.090.
Adopted under notice filed as WSR 09-09-080 on April 15, 2009.
Changes Other than Editing from Proposed to Adopted Version:
|•||Deleted the word "client" in subsection (2)(d).|
|•||Added more wording to subsection (3)(a), (b), (c), and (d) to better convey the purpose of the WAC cross references.|
A final cost-benefit analysis is available by contacting Kevin Sullivan, P.O. Box 45504, Olympia, WA 98504-5504, phone (360) 725-1344, fax (360) 586-9727, e-mail firstname.lastname@example.org.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.
Date Adopted: August 6, 2009.
Susan N. Dreyfus
(a) The department; or
(b) The health technology assessment clinical committee (HTACC) according to RCW 70.14.080 through 70.14.140.
(2) The department reviews available evidence relevant to a medical or dental service or healthcare-related equipment and uses a technology evaluation matrix, in order to:
(a) Determine its efficacy, effectiveness, and safety;
(b) Determine its impact on health outcomes;
(c) Identify indications for use;
(d) Identify potential for misuse or abuse; and
(e) Compare to alternative technologies to assess benefit vs. harm and cost effectiveness.
(3) The department may determine the technology, device, or technology-related supply is:
(a) Covered (See WAC 388-501-0060 for the scope of coverage for department medical assistance programs.);
(b) Covered with authorization (See WAC 388-501-0165 for the process on how authorization is determined.);
(c) Covered with limitations (See WAC 388-501-0169 for how limitations can be extended.); or
(d) Noncovered (See WAC 388-501-0070 for the services determined to be noncovered.).
(4) The department may periodically review existing technologies, devices, or technology-related supplies and reassign authorization requirements as necessary according to the same provisions as outlined above for new technologies, devices, or technology-related supplies.
(5) The department evaluates the evidence and criteria presented by HTACC to determine whether a service is covered in accordance with WAC 388-501-0050(6) and (7) and this section.