HEALTH CARE AUTHORITY
[Filed May 16, 2022, 8:48 a.m.]
Preproposal statement of inquiry was filed as WSR 22-07-049.
Title of Rule and Other Identifying Information: WAC 182-550-6000 Outpatient hospital services—Conditions of payment and payment methods.
Hearing Location(s): On June 21, 2022, at 10:00 a.m. In response to the coronavirus disease 2019 (COVID-19) public health emergency, the health care authority (HCA) continues to hold public hearings virtually without a physical meeting place. This promotes social distancing and the safety of the residents of Washington state. To attend the virtual public hearing, you must register in advance https://us02web.zoom.us/webinar/register/WN_0MvAkvJuR-eiDkr-anVLwQ. If the link above opens with an error message, please try using a different browser. After registering, you will receive a confirmation email containing information about joining the public hearing.
Date of Intended Adoption: Not sooner than June 22, 2022.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email email@example.com, fax 360-586-9727, by June 21, 2022.
Assistance for Persons with Disabilities: Contact HCA rules coordinator, phone 360-725-1306, fax 360-586-9727, telecommunication[s] relay service 711, email firstname.lastname@example.org, by June 10, 2022.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is correcting subsection (3)(c) of this rule to align with the medicaid state plan.
Reasons Supporting Proposal: See purpose.
Rule is not necessitated by federal law, federal or state court decision.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Not applicable.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1408; Implementation and Enforcement: Tracy Huynh, P.O. Box 45500, Olympia, WA 98504-5500, 360-725-1311.
A school district fiscal impact statement is not required under RCW 28A.305.135
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.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. This rule does not impose more-than-minor costs on businesses.
May 16, 2022
AMENDATORY SECTION(Amending WSR 22-04-051, filed 1/27/22, effective 2/27/22)
WAC 182-550-6000Outpatient hospital services—Conditions of payment and payment methods.
(1) The medicaid agency pays hospitals for covered outpatient hospital services provided to eligible clients when the services meet the provisions in WAC 182-550-1700. All professional medical services must be billed according to chapter 182-531 WAC.
(2) To be paid for covered outpatient hospital services, a hospital provider must:
(a) Have a current core provider agreement with the agency;
(b) Bill the agency according to the conditions of payment under WAC 182-502-0100;
(c) Bill the agency according to the time limits under WAC 182-502-0150; and
(d) Meet program requirements in other applicable WAC and the agency's published issuances.
(3) The agency does not pay separately for any services:
(a) Included in a hospital's room charges;
(b) Included as covered under the agency's definition of room and board (e.g., nursing services). See WAC 182-550-1050; or
(c) Related to an inpatient hospital admission and provided within one calendar day of a client's inpatient admission ((or discharge)).
(4) The agency does not pay:
(a) A hospital for outpatient hospital services when a managed care plan is contracted with the agency to cover these services;
(b) More than the "acquisition cost" ("A.C.") for HCPCS (health care common procedure coding system) codes noted in the outpatient fee schedule; or
(c) For cast room, emergency room, labor room, observation room, treatment room, and other room charges in combination when billing periods for these charges overlap.
(5) The agency uses the outpatient weighted costs-to-charges (OWCC) rate to pay for covered outpatient services provided in a critical access hospital (CAH). See WAC 182-550-2598.
(6) Hospitals must provide documentation as required or requested by the agency.
(7) All hospital providers must present final charges to the agency within 365 days of the "statement covers period from date" shown on the claim. The state of Washington is not liable for payment based on billed charges received beyond 365 days from the "statement covers period from date" shown on the claim.