WSR 16-20-081
(Washington Apple Health)
[Filed October 4, 2016, 11:53 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-15-050.
Title of Rule and Other Identifying Information: WAC 182-551-1860 Concurrent care for hospice clients twenty years of age and younger.
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 or directions can be obtained by calling (360) 725-1000), on November 8, 2016, at 10:00 a.m.
Date of Intended Adoption: Not sooner than November 9, 2016.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail, fax (360) 586-9727, by 5:00 p.m. on November 8, 2016.
Assistance for Persons with Disabilities: Contact Amber Lougheed by November 4, 2016, e-mail, (360) 725-1349, or TTY (800) 848-5429 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is amending this rule to revise terms using the word "curative." The revised terms include: Life-prolonging treatment, life-prolonging service, and concurrent care benefit. The agency is removing services under subsection (4)(b) that are considered life-prolonging treatment, which are included in the concurrent care benefit and should not be listed under subsection (4).
Reasons Supporting Proposal: See Purpose above.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Statute Being Implemented: RCW 41.05.021, 41.05.160, Section 2302 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. 1396d (o)(1)(C).
Rule is necessary because of federal law, Section 2302 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C. 1396d (o)(1)(C).
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Chantelle Diaz, P.O. Box 42716, Olympia, WA 98504-2716, (360) 725-1842; Implementation and Enforcement: Nancy Hite, P.O. Box 75506, Olympia, WA 98504-5506, (360) 725-1611.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has determined that the proposed filing does not impose a disproportionate cost impact on small businesses or nonprofits.
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.
October 4, 2016
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 12-09-079, filed 4/17/12, effective 5/18/12)
WAC 182-551-1860 Concurrent care for hospice clients age twenty ((years of age)) and younger.
(1) In accordance with ((Section 2302 of the Patient Protection and Affordable Care Act of 2010 and Section 1814(a)(7) of the Social Security Act)) 42 U.S.C. 1396 (d)(o)(1)(C), hospice palliative services are available to clients age twenty ((years of age)) and younger without forgoing ((curative)) life-prolonging services ((which)) that the client is entitled to under Title XIX Medicaid and Title XXI Children's Health Insurance Program (CHIP) for treatment of the terminal condition.
(2) Unless otherwise specified within this section, ((curative)) life-prolonging treatment including related services and medications requested for clients age twenty ((years of age)) and younger are subject to the medicaid agency's specific program rules governing those services or medications.
(3) The following services ((aimed at achieving a disease-free state)) are included under the ((curative)) concurrent care benefit:
(a) Radiation;
(b) Chemotherapy;
(c) Diagnostics, including laboratory and imaging;
(d) Licensed health care professional services;
(e) Inpatient and outpatient hospital care;
(f) Surgery;
(g) Medication;
(h) Equipment and related supplies, for example, wheelchairs, walkers, and wound care supplies; and
(i) Ancillary services, such as medical transportation.
(4) The following are not included under the ((curative)) concurrent care benefit:
(a) Hospice covered services as described in WAC 182-551-1210;
(b) Private duty nursing, massage therapy, physical therapy, occupational therapy, or acupuncture;
(c) Services related to symptom management such as:
(((I) Radiation;
(II) Chemotherapy;
(III) Surgery;
(IV))) (i) Medication for pain, nausea, and anxiety; and
(((V))) (ii) Equipment and related supplies((; and
(d) Ancillary services, such as medical transportation.
(5) Health care professionals must request prior authorization from the agency in accordance with WAC 182-501-0163 for enrollment in a concurrent care plan. Prior authorization requests are subject to medical necessity review under WAC 182-501-0165.
(6) If the ((curative)) life-prolonging treatment includes noncovered services in accordance with WAC 182-501-0070, the provider must request an exception to rule in accordance with WAC 182-501-0160.
(7) If the ((medicaid)) agency denies a request for a covered service, refer to WAC 182-502-0160, Billing a client, for when a client may be responsible to pay for a covered service.