WSR 14-06-049 PERMANENT RULES HEALTH CARE AUTHORITY (Washington Apple Health) [Filed February 26, 2014, 4:00 p.m., effective March 29, 2014] Effective Date of Rule: Thirty-one days after filing.
Purpose: To comply with the legislature's directive to increase reimbursement rates to medicare's levels for independent ARNPs who provide qualified evaluation and management services and vaccine administration services to eligible clients for dates of service July 1, 2013, through December 31, 2014.
Citation of Existing Rules Affected by this Order: Amending WAC 182-53-2010.
Statutory Authority for Adoption: RCW 41.05.021.
Other Authority: 3ESSB 5034, section 213(26), chapter 4, Laws of 2013 2nd sp. sess., 63rd legislature.
Adopted under notice filed as WSR 14-03-072 on January 15, 2014.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: February 26, 2014.
Kevin M. Sullivan
Rules Coordinator
NEW SECTION
WAC 182-531-2010 Enhanced reimbursement—Independent advanced registered nurse practitioners (ARNPs).
(1) Effective for dates of service July 1, 2013, through December 31, 2014, the agency is authorized by the legislature to increase reimbursement rates to medicare levels for independent ARNPs who provide qualified primary care services to eligible medicaid clients.
(2) For the purpose of this section, the following definitions apply:
(a) Independent ARNP – Means a health care practitioner who is not supervised by an eligible primary care physician and not already receiving increased rates for evaluation and management services and vaccine administration services as provided under the Affordable Care Act, section 1202.
(b) Qualified primary care services – Means evaluation and management services and vaccine administration services provided to eligible medicaid clients.
(3) The agency calculates the enhanced rate for independent ARNPs using medicare's payment methodology.
(a) ARNP services are paid at eighty percent of the lesser of the actual charge or eighty-five percent of what a physician is paid under the medicare physician fee schedule.
(b) For the purpose of this enhanced rate calculation, the amount payable to a physician is determined by the Centers for Medicare and Medicaid Services (CMS) as authorized by C.F.R. 447.405 for qualified services in calendar years 2013 and 2014.
(4) If the enhanced rate is less than the agency's published fee schedule rate, the agency's payment will equal the published rate.
(5) This rate increase does not apply to either of the following:
(a) Federally qualified health center services and rural health clinic services reimbursed as part of the encounter rate.
(b) Services provided under state-only funded programs.
(c) Services paid at an enhanced or supplemental rate through a separate provision or regulation.
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