WSR 23-06-025
PERMANENT RULES
HEALTH CARE AUTHORITY
[Filed February 22, 2023, 10:31 a.m., effective March 25, 2023]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The agency is removing subsections (1) and (2) regarding payment for services covered by medicare. The revised rule replaces these subsections with a reference to the agency's general rules for medicare coinsurance, payments, and deductibles in WAC 182-502-0110, consistent with federal requirements.
Citation of Rules Affected by this Order: Amending WAC 182-543-8200.
Adopted under notice filed as WSR 23-03-097 on January 17, 2023.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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 22, 2023.
Wendy Barcus
Rules Coordinator
OTS-4209.1
AMENDATORY SECTION(Amending WSR 18-24-021, filed 11/27/18, effective 1/1/19)
WAC 182-543-8200Billing for clients eligible for medicare and medicaid.
If a client is eligible for both medicare and medicaid((:
(1) The medicaid agency requires a provider to accept medicare assignment before any medicaid reimbursement;
(2) In accordance with WAC 182-502-0110(3):
(a) If the service provided is covered by medicare and medicaid, the agency pays only the deductible or coinsurance up to medicare's or medicaid's allowed amount, whichever is less.
(b) If the service provided is covered by medicare but is not covered by the agency, the agency pays only the deductible or coinsurance up to medicare's allowed amount)), see WAC 182-502-0110 Conditions of payment and prior authorization requirements—Medicare coinsurance, copayments, and deductibles.