WASHINGTON STATE REGISTER

WSR 12-09-010

INTERPRETIVE OR POLICY STATEMENT

HEALTH CARE AUTHORITY

[ Filed April 5, 2012, 10:32 a.m. ]

Notice of Interpretive or Policy Statement

аааа In accordance with RCW 34.05.230(12), following is a list of policy and interpretive statements issued by the department of social and health services.

Health Care Authority (HCA)
Legal and Administrative Services

аааа Document Title: Provider Notice #12-23.

аааа Subject: Outpatient hospitals.

аааа Effective Date: April 1, 2012.

аааа Description: Effective for dates of service on and after April 1, 2012, the medicaid program of the health care authority (the agency) will:

Х Update the Outpatient Hospital and Outpatient Prospective Payment System (OPPS) Fee Schedule with added codes and coverage changes;

Х Update changes in prior authorization requirements for certain current procedural terminology (CPTж) codes; and

Х Implement a utilization review program to determine the medical necessity of emergency room use for conditions that could be treated in a primary care office or urgent care clinic.

аааа Effective for dates of service on and after April 15, 2012, the medicaid program of the agency will require prior authorization for a select group of surgical procedure codes. Qualis Health or the agency will be conducting the medical necessity review as indicated on the fee schedule. Submitting requests for medically necessary reviews will begin April 1, 2012.

аааа For additional information, contact Amber Dassow, HCA, P.O. Box 45504, phone (360) 725-1349, TDD/TTY 1-800-848-5429, fax (360) 586-9727, e-mail dassoal@hca.wa.gov, web site http://www.hca.wa.gov/.

Х	Update the Outpatient Hospital and Outpatient Prospective Payment System (OPPS) Fee Schedule with added codes and coverage changes;
Х	Update changes in prior authorization requirements for certain current procedural terminology (CPTж) codes; and
Х	Implement a utilization review program to determine the medical necessity of emergency room use for conditions that could be treated in a primary care office or urgent care clinic.

й Washington State Code Reviser's Office