WSR 09-17-004

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed August 6, 2009, 8:59 a.m. , effective September 6, 2009 ]


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     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 0.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

Secretary

4047.4
NEW SECTION
WAC 388-501-0055   Healthcare coverage--How the department determines coverage of services for its healthcare programs using health technology assessments.   (1) The department uses health technology assessments in determining whether a new technology, new indication, or existing technology approved by the Food and Drug Administration (FDA) is a covered service under department healthcare programs. The department only uses health technology assessments when coverage is not mandated by federal or state law. A health technology assessment may be conducted by or on behalf of:

     (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.

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