Preproposal statement of inquiry was filed as WSR 13-05-065.
Title of Rule and Other Identifying Information: WAC 182-530-7700 Reimbursement -- Dual eligible clients/medicare.
Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at http://maa.dshs.wa.gov/pdf/CherryStreetDirectionsNMap.pdf or directions can be obtained by calling (360) 725-1000), on June 25, 2013, at 10:00 a.m.
Date of Intended Adoption: Not sooner than June 26, 2013.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail firstname.lastname@example.org, fax (360) 586-9727, by 5:00 p.m. on June 25, 2013.
Assistance for Persons with Disabilities: Contact Kelly Richters by June 17, 2013, TTY (800) 848-5429 or (360) 725-1307 or e-mail email@example.com.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The following revisions to this rule are necessary:
|•||Clarify payment criteria for Medicare Part B deductible and coinsurance amounts; and|
|•||Eliminate reference to Medicare Part D copay.|
Reasons Supporting Proposal: See Purpose above.
Statutory Authority for Adoption: RCW 41.05.021; chapter 5, Laws of 2011 (ESHB 1086, 2010 2nd sp.s. c 1 s 208(25)); and Section 1902 (n)(3)(B) of the Social Security Act, as modified by Section 4714 of the Balanced Budget Act of 1997.
Statute Being Implemented: Chapter 5, Laws of 2011 (ESHB 1086, 2010 2nd sp.s. c 1 s 208(25)); and Section 1902 (n)(3)(B) of the Social Security Act, as modified by Section 4714 of the Balanced Budget Act of 1997.
Rule is necessary because of federal law, Section 1902 (n)(3)(B) of the Social Security Act, as modified by Section 4714 of the Balanced Budget Act of 1997.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Wendy L. Boedigheimer, Legal and Administrative Services, Rules and Publications, (360) 725-1306; Implementation and Enforcement: Myra Davis, Financial Services-Rates, Pharmacy Unit, (360) 725-1847.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has analyzed the proposed rules and concludes they do not impose more than minor costs for affected small businesses.
A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
May 22, 2013
Kevin M. Sullivan
AMENDATORY SECTION(Amending WSR 11-14-075, filed 6/30/11, effective 7/1/11)
WAC 182-530-7700 Reimbursement--Dual eligible clients/medicare. For clients who are dually eligible for medical assistance and medicare benefits, the following applies:
(1) Medicare Part B, the ((
department)) agency pays
(a) An amount up to the ((
department's)) agency's maximum
allowable fee for drugs medicare does not cover, but the
(( department)) agency covers; or
(b) Deductible and/or coinsurance amounts up to
medicare's or the ((
department's)) agency's maximum allowable
fee, whichever is less, for drugs medicare and the
(( department)) agency cover(( ; or
(c) Deductible and/or coinsurance amounts for clients under the qualified medicare beneficiary (QMB) program for drugs medicare covers but the department does not cover)).
(2) Medicare Part D:
For payment of medicare Part D drugs:
(i))) Medicare is the ((
primary)) payer for drugs covered
under the medicare Part D (( drugs;
(b) The ((
department)) agency does not pay(( s only the
copayment up to a maximum amount set by the Centers for
Medicare and Medicaid Services (CMS); and
(iii) The client is responsible for copayments above the maximum amount)) for Part D drugs or Part D copayments.
(b))) (c) For drugs excluded from the basic medicare
Part D benefit(( s)):
(i) The ((
department)) agency offers the same drug
benefit as a nondual eligible client has within those same
(ii) If the client has another third party insurer, that insurer is the primary payer; and
(iii) The ((
department)) agency is the payer of last
[11-14-075, recodified as § 182-530-7700, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700. 07-20-049, § 388-530-7700, filed 9/26/07, effective 11/1/07.]