WSR 11-23-089



(Medicaid Program)

[ Filed November 17, 2011, 11:21 a.m. ]

Subject of Possible Rule Making: WAC 182-502-0005 Core provider agreement.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 41.05.021, section 6401 (b)(7) of the Patient Protection and Affordable Care Act, Section 1902 (kk)(7) of the Social Security Act, 42 C.F.R. 455.410.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Revisions to this rule are necessary in order to:

(1) Implement 42 C.F.R. 455.410 which mandates states to require all ordering, prescribing, or referring providers to be enrolled as participating providers under the billing providers' core provider agreement in order to receive payment.

(2) Clarify language regarding the core provider agreement effective date, when a provider may ask for an effective date earlier than the agency's approval of the provider application, and how far back the agency's chief medical officer may authorize an effective date under the exceptions. This clarification is necessary to allow medicaid provider entities that are subject to survey and certification by the Centers for Medicare and Medicaid Services or the state survey agency, a reasonable amount of time to submit their medicare certification letters to the agency.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: Centers for Medicare and Medicaid Services.

Process for Developing New Rule: The health care authority (HCA) welcomes the public to take part in developing the rules. Anyone interested should contact the staff person identified below. At a later date, HCA will file a notice of proposed rule making (CR-102) with the office of the code reviser. A copy of the proposal will be sent to everyone on the mailing list and to anyone who requests a copy.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Wendy L. Boedigheimer, P.O. Box 45504, Olympia, WA 98504-5504, fax (360) 586-9727, TTY 1-800-848-5429, e-mail

November 17, 2011

Kevin M. Sullivan

Rules Coordinator

Washington State Code Reviser's Office