Regulatory Issues

The following is a list of state and/or federal regulatory issues WSHA is actively monitoring. 

September 2, 2015 - Department of Health rulemaking regarding ambulatory surgical facilities

The Washington State Department of Health Certificate of Need program is in the beginning stages of rulemaking on two important issues affecting ambulatory surgical facilities. First, the Department is considering when the expansion of a Certificate of Need-approved ambulatory surgery facility results in a new healthcare facility needing a new certificate of need. Second, the Department proposes to update the need forecasting methodology and standards for these facilities. Both rules could have substantial impacts on the way the Department regulates these facilities and could result in regulations that disadvantage hospital-based versus free-standing facilities. One suggestion under discussion is whether hospital facilities should be included in the bed need methodology for independent facilities, under the notion that hospital-based facilities are more expensive and may not be direct equivalents. WSHA would strongly oppose such a consideration. WSHA is actively engaged with the Department on this issue and strongly encourages hospital participation. The next meeting on the Ambulatory Surgical Facilities rulemaking is scheduled for Wednesday, September 16. Information on the Department’s rulemaking activities and meeting locations can be found here. (Zosia Stanley, zosias@wsha.org

August 31, 2015 - WSHA Comments on Calendar Year 2016 Outpatient Medicare Rule, Short Inpatient Hospital Stays

WSHA submitted comments to the Center for Medicare & Medicaid Services’s (CMS) proposed rule for Medicare outpatient prospective payment hospital services for calendar year 2016. In its comments, WSHA opposed CMS’s proposal to cut to outpatient conversion factors by 2 percent to compensate for alleged duplicate lab payments, and also opposed the continuing 0.2 percent reduction to inpatient rates due to transition to the Two-Midnight rule.

WSHA supported CMS’s proposal for short stay inpatient reviews to be performed by quality improvement organizations (QIOs) rather than the recovery audit contractors (RACs). Under the proposal, hospitals with high denial rates can be referred by the QIOs to the RACs for recoupment. WSHA voiced concerns that the QIOs need to be given sufficient flexibility to approve exceptions to the Two-Midnight rule and that CMS needs to provide protections to hospitals during the transition period. (Andrew Busz, andrewb@wsha.org)

August 21, 2015 – WSHA submits comments on the Bree Collaborative heart surgery bundle and warranty

The Bree Collaborative — a group appointed by the governor representing clinical leaders from purchasers, providers and state agencies — released a draft report on July 22 on heart surgery and the companion warranty. WSHA fully supports efforts to improve patient safety and recovery while reducing costs associated with heart surgery. Potentially unnecessary overuse of heart surgery is a serious issue. While the recommendations may improve care across the state, we have some concerns with how the recommendations are calibrated.

We submitted comments and surfaced our concerns to the Bree Collaborative on Aug 21. Our comments centered on the need to identify quality measures which need to be reported to a registry, but that providers should be allowed to choose where they report to, maintain access to care, especially in rural areas, and decrease barriers to care. We appreciate the Collaborative’s attention to this very important issue and look forward to continued dialogue on how to improve heart surgery in Washington State.

August 17, 2015 - WSHA Comments on Draft Readmissions Policy Rules

WSHA submitted a comment letter on a Health Care Authority (HCA) stakeholder draft of rule changes to its readmissions policy. The new readmissions policy will replace HCA current policy of review and denial of individual readmission claims. Instead, HCA will use 3M Corporation software to compare each hospital’s readmission rates with an expected rate based upon its mix and severity of cases, and will apply a prospective adjustment factor to prospective payment hospitals’ inpatient payment rates. Under the draft rule, the adjustment factors would be applied to inpatient services as of January 1, 2016. Hospitals will also receive periodic reports from HCA regarding their readmission rates to enable care improvements and improved coordination of post discharge services. Critical Access Hospitals will also receive data regarding their readmission cases but will not be subject to payment penalties. 

HCA and Navigant staff have met with and received input from a WSHA task force of finance and quality leaders from member hospitals.  In its comments, WSHA requested that HCA include in the rule specific details and protections discussed with the task force.  More information is available in our recent Fiscal Watch article. (Andrew Busz, andrewb@wsha.org)

July 30, 2015 – Bree Collaborative makes recommendations for cardiac artery bypass graft

The Bree Collaborative — a group appointed by the governor representing clinical leaders from purchasers, providers and state agencies — met July 22 to consider new recommendations for cardiac artery bypass graft (CABG). Once adopted, the collaborative will submit the final report to the Washington State Health Care Authority, which can elect to use the report’s recommendations to inform contracting and purchasing for Medicaid and state employee programs. We anticipate future Health Care Authority contracts will contain more recommendations and practice guidelines from the Bree Collaborative.

The collaborative is interested in hearing your feedback on the latest draft report and recommendations. Please read the documents and provide feedback via the online survey here. Feedback to the Bree Collaborative must be received by 5 p.m. Friday, Aug 21. (Ian Corbridge)

July 27, 2015 – WSHA Urges CMS to Pay for Mental Health Services
In a comment letter, WSHA urged Centers for Medicare & Medicaid Services (CMS) to adopt federal payment for hospitalizations at large, freestanding standing psychiatric hospitals (known as Institutions for Mental Disease) in its final managed care rule. Since the creation of Medicaid, the federal government has not paid for services at these hospitals. If adopted, the federal government would pay for Medicaid managed care enrollee hospitalizations for up to 15 days.

July 7, 2015 – WSHA Comments on Telemedicine for Fee-for-Service Medicaid
In response to a proposed rule on telemedicine fee-for-service Medicaid client coverage, WSHA provided a comment letter to the Health Care Authority seeking clarity on the billing of facility fees, and urging the recognition of services provided through store and forward technology. The department revised its rule in mid-August to incorporate WSHA’s comments. WSHA believes the changes to recognize the fee-for-service Medicaid clients will eventually impact the Medicaid managed care contract. Most of the Medicaid clients in the state are enrolled in managed care. (Chelene Whiteaker, chelenew@wsha.org)

June 25, 2015 – Preliminary statewide imaging rules

The Washington State Department of Health recently released a draft rule for Computed Tomography. The rule aims to improve the appropriate and safe use of imaging systems. We encourage hospitals, specifically quality leaders or imaging specialists to provide feedback on this draft rule. Comments will be accepted through July 17, 2015 and should be submitted to dohephctrulemaking@doh.wa.gov.

WSHA participated on the Department’s CT Advisory Committee which developed this draft rule. We appreciate the Departments aim to improve quality while acknowledging existing quality improvement efforts and being sensitive to reporting challenges. (Ian Corbridge).

May 19, 2015 - DOH Issues Proposed Rules to Protect Patient Information in CHARS Database

The Department of Health has issued proposed rules implementing ESSB6265, legislation WSHA supported to increase standards for protecting shared patient information in the Comprehensive Hospital Abstract Reporting System (CHARS). The proposed rules establish types of data files based on content and access, create a methodology for determining when indirect patient identifiers may become direct identifiers, and allow options for creating a public data file.  The Department will hold a formal hearing on the proposed regulations on June 10, 2015 at 9:30 a.m. at Town Center 2, Room 158, 111 Israel Rd. SE, Tumwater, WA 98501.  (Zosia Stanley, zosias@wsha.org)

April 15, 2015 -DOH Final Public Meeting on Proposed Changes to Hospital Construction Standards Rules

The Department of Health (DOH) has published a CR-102 with proposed changes to hospital licensing construction standards in Chapter 246-320 WAC. This proposed final rule changes have been in the works since July 2014.  More information on the rule development process can be found here

 A public meeting to discuss the proposed changes is scheduled for May 7, 2015 from 10 am to 12 pm at 243 Israel Rd. S.E., Town Center 3, Room 224, Tumwater, WA 98501.  (Zosia Stanley, ZosiaS@wsha.org)

March 24, 2015 – WSHA Continues Work with OIC on Network Adequacy Rulemaking

Beginning in 2013, WSHA members expressed significant concern regarding state rulemaking on network adequacy requirements for commercial insurers. These rules were developed by the Washington State Office of the Insurance Commissioner (OIC) based on changes in health care delivery and access as part of health care reform. In response to member concerns especially with the change in mileage access standards for rural areas, WSHA made network adequacy a priority. WSHA has worked closely with the OIC to provide input on hospital concerns and to encourage increased transparency in the rulemaking process. WHSA has regular meetings with key OIC staff to discuss concerns and upcoming work. WSHA is pleased that OIC’s most recent exposure drafts on network adequacy have shown increased efforts to add transparency and responsiveness to the rulemaking process. 

WSHA will continue to monitor the insurance networks carefully, and we strongly encourage our members to provide any examples of reduced access to both OIC and WSHA. If you encounter an insured person having difficulty with getting needed care, please help them file a complaint. The OIC’s complaint system is available here. Feedback to WSHA can be emailed to Zosia Stanley, Policy Director, Access at ZosiaS@wsha.org.  

March 12, 2015 - OIC Begins Next Round of Network Adequacy Rulemaking

The Office of the Insurance Commissioner (OIC) has issued an exposure draft seeking stakeholder input regarding a new round of network adequacy rulemaking. The OIC completed two rounds of network adequacy rulemaking in 2014. This new exposure draft, including provisions delayed from the 2014 rulemaking process, concerns network maintenance requirements and requirements for issuers to monitor networks and report information to the OIC. Comments on the exposure draft are due to the OIC by Friday, March 20, 2015.

We are monitoring the 2015 networks carefully to see if access has deteriorated as a result of new OIC rules. We strongly encourage our members to send us any examples of reduced access so we can share these with the OIC. (Zosia Stanley, ZosiaS@wsha.org; 206-216-2511)


February 15, 2015 – WSHA and WSPA Submit Comments on the Draft Pharmacy Compounding Rule

WSHA and the Washington State Pharmacy Association (WSPA) submitted joint comments to the Washington State Department of Health (DOH) expressing concerns with the Pharmacy Quality Assurance Commission’s draft pharmacy “Compounding Practice Rule.”

We identified both high-level concerns and targeted comments. High-level concerns addressed the lack of alignment between the draft rule and national standards, the unnecessary increase in burden and cost to hospital pharmacies, and the potential impact of these draft rules on access to drug products in rural communities. Specific comments focused on adding clarity or addressing inconsistencies.

The two associations collaborated to convene members from across the state and submit joint comments reflecting our mutual interests and common concerns. Having identified preliminary concerns, WSHA and WSPA requested that the Commission provide a crosswalk between the draft rule and national standards governing the practice of pharmacy. The crosswalk was only released days before the comment period expired, which made it difficult for an in-depth analysis.  We look forward to convening another joint meeting of our members in June or July after the DOH releases its second draft. 

WSHA and WSPA are committed to advancing the practice of pharmacy and will continue to work collaboratively to address the concerns around pharmacy compounding practice rules in Washington State. Please have your pharmacy director contact Ian Corbridge if they are interested in participating in these discussions. (Ian Corbridge, IanC@wsha.org)

January 28, 2015 – DOH Seeking Comments on Hospital Patient Discharge Information Reporting Regulations by COB February 10

The Department of Health is seeking public comments on draft rules to amend Chapter 246-455 WAC regarding hospital patient discharge information. The rulemaking is in response to ESSB 6265, legislation WSHA supported to increase standards for protecting shared patient information in the Comprehensive Hospital Abstract Reporting System (CHARS). DOH held a stakeholder meeting on this subject October 1,  2014

Draft rules have been proposed by DOH. The rules seek to further define direct and indirect patient identifiers and public data sets, clarify restrictions on use of the data, add requirements for data sharing agreements, and update or add definitions. The rule will also include housekeeping changes, such as updating references. 

DOH is seeking public comment on the draft rule before filing the proposed rule and holding a formal hearing. If you would like to comment on the draft rule, please send your comments to vitalrecordsrules@doh.wa.gov by close of business on February 10, 2015

DOH will also hold a webinar workshop on February 9, 2015 to take comments on the draft. You may provide comments at the webinar or by emailing DOH at vitalrecordsrules@doh.wa.gov.

Please see the information below to register for the workshop. For questions about the workshop, contact Kris Reichl at Kristin.Reichl@doh.wa.gov or (360) 236-4311. For information about CHARS data, contact Ric Ordos at (360) 236-4216. (Zosia Stanley, zosias@wsha.org

CHARS Rule Workshop Registration information

CHARS Rule Workshop - Join us for a Webinar on February 9

Register Now

Space is limited. Reserve your Webinar seat now at:
https://www3.gotomeeting.com/register/388226750

The Department of Health is considering rulemaking to amend chapter 246-455 WAC regarding Hospital Patient Discharge Information. The rulemaking is in response to ESSB6265 (Chapter 220, Laws of 2014) which increased standards on sharing patient information from the Comprehensive Hospital Abstract Reporting System (CHARS) and authorized the Department of Health to adopt rules.

Title: CHARS Rule Workshop

Date: Monday, February 9, 2015

Time: 11:00 a.m.-12:30 p.m. PST

After registering, you will receive a confirmation email containing information about joining the Webinar. 

System Requirements

PC-based attendees - Required: Windows® 8, 7, Vista, XP or 2003 Server

Mac®-based attendees - Required: Mac OS®X 10.6 or newer

Mobile attendees - Required: iPhone®, iPad®, Android™ phone or Android tablet


January 14, 2015 - Certificate of Need for Tertiary Care

The Washington State Department of Health (the Department) Certificate of Need program has announced it is moving forward with review of tertiary health services that are subject to Certificate of Need. The Department will determine whether any changes are necessary to the tertiary health services list. Changes could include additions to or deletions from the list.  

We want to make sure you are aware this process has started so you can participate as appropriate in the public comment period, the first phase of which is January 1, 2015 to February 28, 2015.  Read the entire WSHA bulletin here. (Zosia Stanley, zosias@wsha.org)

October 15, 2014 – DOH Seeks Comments on Rulemaking to Protect Patient Information

The Department of Health has begun rulemaking to implement ESSB 6265 – legislation supported by WSHA to protect the sharing of patient information in the Comprehensive Hospital Abstract Reporting System (CHARS). As noted in this announcement the rules will further define direct and indirect patient identifiers, define what is included in a public data set, clarify restrictions on the use of the data, and add requirements for data sharing agreements. At a CHARS Rules Workgroup on October 1, 2014, DOH staff shared a PowerPoint presentation outlining potential areas of regulation.

WSHA has engaged with DOH on this issue and is providing comments to the department on how to balance protecting the confidentiality of patient data while maintaining the usefulness of the dataset. WSHA comments on this first phase of the rule making process were sent to the DOH on October 15, 2014.  (Zosia Stanley, zosias@wsha.org

September 9, 2014 - WSHA and AWPHD Express Concern to State About Proposed Regional Service Area Boundaries.

WSHA and AWPHD sent a letter to the Washington State Health Care Authority this week expressing concerns about the state’s intent to designate proposed regional service areas (RSAs) for Medicaid purchasing.  WSHA and AWPHD are concerned that the boundaries of the RSAs do not support medical care referral patterns.  This is particularly worrisome in Cowlitz County and the Chelan-Douglas area.  WSHA and AWPHD asked the state to take care that the RSAs do not adversely affect the well-being of consumers or the effectiveness of future care delivery systems. (Zosia Stanley, zosias@wsha.org)

September 4, 2014 – DOH Releases Stakeholder Draft of New Hospital Construction Standards

The Department of Health (DOH) has released an initial draft of possible revisions to hospital licensing construction standards. Interested parties may submit comments by September 22, 2014.  The DOH asks that anyone proposing changes use the Rules Proposal Form from the department’s website.  You can click here for a link to this form, and for more information.  (Barbara Gorham, BarbaraG@wsha.org)

August 26, 2014 - DOH Begins Rulemaking to Protect Patient Information in CHARS

The Department of Health has begun rulemaking to implement ESSB 6265 – legislation proposed by WSHA to protect the sharing of patient information in the Comprehensive Hospital Abstract Reporting System (CHARS).  These rules will further define direct and indirect patient identifiers and public data sets, clarify restrictions on the use of the data, and add requirements for data sharing agreements.  WSHA is participating in the rulemaking process.  Interested parties wishing to participate can either send an e-mail to vitalrecordsrules@doh.wa.gov or call Kris Reichl at DOH at (360) 236-4311. 

August 18, 2014 - Health Care Authority Issues Rulemaking Notice on Administrative Days

The Health Care Authority (HCA) released notice of intent CR 101 to modify rules relating to administrative days.  The rulemaking will affect HCA’s standards for when administrative days are allowed in lieu of APRDRG payment, for example when a patient no longer meets inpatient criteria but placement in an appropriate skilled nursing facility cannot be arranged.  Hospitals that are interested in the rulemaking process should respond to the HCA contact indicated in the notice. (Andrew Busz, andrewb@wsha.org)

August 18, 2014 - Health Care Authority Issues Rulemaking Notice on Hospital Revenue Codes

The Health Care Authority (HCA) released notice of intent CR-101 to modify rules relating to Revenue Code Billing.  The rulemaking will affect HCA’s standards for billing and payment for revenue codes for inpatient and outpatient hospital services.   Hospitals that are interested in the rulemaking process should respond to the HCA contact indicated in the notice. (Andrew Busz, andrewb@wsha.org)

August 4, 2014 – WSHA Comments on Newborn Screening Regulations

WSHA has submitted a comment letter to the Department of Health regarding proposed rule making for newborn screening sample collection and health provider reporting.  WSHA supported the underlying legislation to ensure newborns are rapidly screened for disorders and that parents are given the result as soon as possible.  Overall, WSHA supports the proposed rule making.  However, WHSA suggests that the proposed rule be revised to more accurately reflect the data that will be published and recognize that different categories of abnormality may appropriately have different notification times. DOH staff has indicated they are receptive to our comments and will be proposing modifications in the proposed rule. (Zosia Stanley, zosias@wsha.org)

July 29, 2014 - OIC Begins Second Round of Network Adequacy Rulemaking

The Office of the Insurance Commissioner (OIC) has issued a preproposal statement of inquiry seeking stakeholder input regarding a second round of network adequacy rulemaking.  The OIC just completed the first round of network adequacy rulemaking in April. WSHA strongly objected to some of these new rules, including provisions requiring less access to health care in rural areas than what is required in urban areas. This new round of rulemaking, which concerns provisions not addressed by the rules adopted in April, will allow WSHA to continue our discussions with the OIC regarding access to care standards. 

We are monitoring the 2015 networks carefully to see if access has deteriorated as a result of these new rules, and we strongly encourage our members to send us any examples of reduced access so we can share these with the OIC.  (Barbara Gorham, barbarag@wsha.org; 206-216-2512)

June 3, 2014 - Health Care Authority Issues Rulemaking Notice on DSH Overpayment Recoupment

The Health Care Authority released notice of intent (CR-101) to create rules relating to recoupment and redistribution of disproportionate share hospital (DSH) overpayments identified through federally required DSH audits. DSH payments for state fiscal year 2011 and following are subject to recoupment.  Drafting has not yet begun on the new rules.  Hospitals that are interested in the rulemaking process should respond to the HCA contact indicated in the notice.

June 3, 2014 - Health Care Authority Issues Final Rule on Hospital Rebasing

The Health Care Authority released final rules updating definitions and various provisions relating to Medicaid Hospital payment to support the planned rebasing of inpatient payment for prospective payment hospitals effective July 1, 2014. 

June 3, 2014 - Health Care Authority Issues Final Rule on Federally Qualified Health Center and Rural Health Clinic Enhancement Payments

The Health Care Authority released final rules related to Medicaid enhancement payments to federally qualified health centers and rural health clinics for services provided to Medicaid recipients enrolled with managed care plans. The rule change supports a legislative proviso in the 2013?2015 operating budget, which requires that the enhancement payments be made by the managed care plans. 

May 13 - WSHA Comments on Budget Neutrality Adjustment Stakeholder Draft

WSHA has submitted a comment letter in response to the Health Care Authority’s stakeholder draft rules outlining the budget neutrality adjustment process. WSHA strongly objects to the HCA’s proposed payment methodology, which would use an up-front reduction of rates. We propose, instead, that any necessary changes be made prospectively, and that the elimination of the up-front reduction will be incorporated into the CR-102 version of the rules. HCA staff has indicated they are receptive to our comments and will be proposing modifications in the proposed rule. (Andrew Busz, andrewb@wsha.org)

May 7, 2014 – Department of Health Files Notice of Proposed Rule-making for Mandatory Reporting of Clostridium difficile

The Department of Health (DOH) filed a proposed rule establishing new reporting requirements for healthcare associated infections in acute-care hospitals. Under the proposed rule, hospitals would be required to report cases of Clostridium difficile to the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN). This reporting mandate will align state and federal requirements while providing essential data to address the growing problem of Clostridium difficile infections across the state.

WSHA has been working closely with the DOH on the proposed rule and will serve on the advisory council that will provide guidance on the implementation of the final rule. This rule is expected to have minimal burden on hospitals as many already report data to the NHSN. The DOH has guaranteed technical assistance to those hospitals in need of additional support in complying with this rule.

A stakeholders meeting is set for Tuesday, May 27, 2014 at 9am. Comments on the proposed rule can be submitted here. For more detailed information on the proposed rule, contact Ian Corbridge, ianc@wsha.org or (206) 216-2514.  

May 6, 2014 – WSHA Testifies on Proposed Inpatient and Outpatient Payment Rules

WSHA submitted comments and testified at a May 6 rulemaking hearing regarding the Health Care Authority’s proposed rules pertaining to inpatient and outpatient payment as part of its planned transition to a new All Patient Refined DRG grouping system (APR-DRG), and Enhanced Ambulatory Payment Groups (EAPGs) scheduled for implementation on July 1, 2014.

WSHA’s comments focused specifically on language concerning the budget target adjuster and the lack of separate criteria to be used for setting base payment rates.  WSHA argued that in the absence of specific criteria to ensure rates consistent with economy and efficiency, the budget adjustor could be used to reduce rates to fit a specific and arbitrary budget target number, which may be insufficient to preserve access to services for Medicaid enrollees. (Andrew Busz, andrewb@wsha.org)

April 29, 2014 – WSHA Sends Letter to Pharmacy Quality Assurance Commission Outlining Concerns with Emergency Rule

 WSHA submitted a letter to the Pharmacy Quality Assurance Commission (Commission) outlining concerns with the emergency rule for WAC 246-873-060 – Emergency Outpatient Medications. The letter addresses:

  1. The Commission’s confusing methodology used to determine dispensing eligibility; and
  2. The lack of any validation effort on behalf of the Commission to ensure data accuracy.

The emergency rule greatly expands the number of Washington hospitals that can dispense pre-packs of controlled substances in their emergency department from 10 pre-packs to approximately 43. However, the emergency rule has unintended consequences for some hospitals, limiting their dispensing privileges. 

WSHA continues to work with the Commission to expand dispensing privileges and improve this WAC which has not been uniformly enforced or updated for decades. As of Tuesday, April 29, 2014 the Commission had not posted the emergency rule. For more detailed information on the emergency rule, contact Ian Corbridge, ianc@wsha.org or (206) 216-2514.

April 28, 2014 – OIC Finalizes Network Adequacy Rules

Despite objections from insurers, providers, hospitals and others, the Office of the Insurance Commissioner has made final its draft network adequacy rule.  WHSA had asked the Commissioner in our official comments to withdraw the rule to allow for more stakeholder input.  We are concerned that access to health care, particularly in rural areas, could be diminished by these rules.  The rule requires hospital access within 30 minutes of enrollees in urban areas, but within 60 minutes of enrollees in rural areas.  We see no reason for this distinction, assuming there are available providers in rural areas willing to contract at reasonable rates. The rule also makes it very easy for carriers to be exempt from its network adequacy standards. This is because the rule says the OIC will not consider rates when determining whether a carrier made a good faith effort to contract.  It also says the carrier need only submit “substantial evidence” of a good faith effort, and not “clear and convincing evidence,” which the OIC had included in a previous version of the rule at WSHA’s request.  (Barbara Gorham, BarbaraG@wsha.org; 206-216-2512)

April 21, 2014 – WSHA Requests Insurance Commissioner to Withdraw Draft Network Adequacy Rules. 

WHSA has submitted comments on the Washington State Office of the Insurance Commissioner’s draft network adequacy rules, and has asked the Commissioner to withdraw the rule to allow for more stakeholder input.  We are concerned that access to health care, particularly in rural areas, could be diminished by these rules.  The draft rule requires hospital access within 30 minutes of enrollees in urban areas, but within 60 minutes of enrollees in rural areas.  We see no reason for there to be less access to care in rural areas, assuming there are providers available and willing to contract at reasonable rates. The draft rule also makes it very easy for carriers to be exempt from its network adequacy standards. This is because the draft rule says the OIC will not consider rates when determining whether a carrier made a good faith effort to contract. It also says the carrier need only submit “substantial evidence” of a good faith effort, and not “clear and convincing evidence,” which the OIC had included in a previous version of the rule at WSHA’s request. (Barbara Gorham, BarbaraG@wsha.org; 206-216-2512)

April 15, 2014 - Health Care Authority Releases Draft Hospital Medicaid Rates for July Rebasing

The Health Care Authority (HCA) has released draft payment rates as well as the All Payer Refined-DRG and Enhanced Ambulatory Payment Group weights to be used effective July 1, 2014. The move to new groupers and weights is a significant change to payment for prospective payment hospitals.

Here are the direct links to the rate documents that contain those weights:

HCA presented implementation and policy decisions during a February 24 webcast.

WSHA and a rebasing task force of WSHA members strongly objects to HCA’s decision to apply a three percent budget neutrality reduction to the inpatient and outpatient payment rates, particularly since it is unclear how this will be applied by the managed care plans. WSHA received this response from HCA to WSHA’s  comments to a stakeholder draft of proposed rules.  The WSHA Executive Committee has directed WSHA to work on a lobbying effort on this issue and to consider additional options, such as legal action, if necessary.  (Andrew Busz, andrewb@wsha.org)

April 9, 2014 - Health Care Authority Issues Stakeholder Drafts of Proposed Inpatient Payment Rules

The Health Care Authority recently issued two stakeholder exposure drafts of proposed rules pertaining to inpatient payment as part of its planned transition to a new All Patient Refined DRG grouping system (APR-DRG), scheduled for implementation on July 1, 2014.

WSHA has submitted comments on March 7 and April 7. We have questioned the distribution of the stakeholder drafts as well as the lack of specificity in the content of the proposed rules.  We have focused comments specifically on the budget neutrality adjuster and budget adjuster, which can be used to cut payment rates when rates exceed expected levels of payment. (Andrew Busz, andrewb@wsha.org)

March 31, 2014 - WSHA Requests a Meeting with Commissioner Kreidler to Discuss Network Adequacy Rules

WHSA has sent a letter to the Washington State Insurance Commissioner, Mike Kreidler, requesting an urgent meeting to discuss the official draft network adequacy rules issued by the Office of the Insurance Commissioner (OIC) on March 19. These draft rules are problematic for two major reasons. First, the draft rule requires hospital access within 30 minutes of enrollees in urban areas, but within 60 minutes of enrollees in rural areas.  We see no reason for there to be less access to care in rural areas, assuming there are providers available and willing to contract at reasonable rates. Second, the draft rule makes it very easy for carriers to be exempt from its network adequacy standards. This is because the draft rule says the OIC will not consider rates when determining whether a carrier made a good faith effort to contract. It also says the carrier need only submit “substantial evidence” of a good faith effort, and not “clear and convincing evidence,” which the OIC had included in a previous version of the rule at WSHA’s request. (Barbara Gorham, BarbaraG@wsha.org; 206-216-2512)

March 25, 2014 – WSHA Submits Revised Language for WAC 246-873-060 to the Pharmacy Commission

WSHA submitted revised language on the Washington Administrative Code (WAC) 246-873-060 – Emergency Outpatient Medications to the Pharmacy Quality Assurance Commission on March 24, 2014. WSHA’s revisions aim to allow hospitals to distribute emergency pharmaceuticals, including controlled substances, when normal pharmacy services are not available. These revisions will be considered by the Pharmacy Commission who has agreed to emergency rulemaking for this WAC.

WSHA worked with our membership to revise and update this WAC, which currently prohibits some hospitals from distributing controlled substances when normal pharmacy services are not available. This WAC has not been uniformly enforced or updated for decades and its enforcement severely limits a provider or hospital’s ability to deliver compassionate, evidence-based, and cost-effective care. For more information, contact Ian Corbridge, IanC@wsha.org or (206) 216-2514.

March 12, 2014 – Pharmacy Commission Approves Emergency Rulemaking

The Pharmacy Quality Assurance Commission approved emergency rulemaking for Washington Administrative Code (WAC) 246-873-060 – Emergency Outpatient Medications. The emergency rulemaking will allow hospitals to prescribe and distribute a limited supply of a controlled substance in an emergency setting when normal pharmacy services are not available. The approval for emergency rulemaking was in direct response to a formal request by the Washington State Hospital Association (WSHA), Island Hospital, and Skagit Valley Hospital.

WSHA is actively working with our membership to revise and update the WAC. Current revisions can be accessed here: (clean draft) (track changes draft). WSHA will submit edits to the Pharmacy Commission who has agreed to expedite the emergency rulemaking process. For more detailed information or to provide edits on this WAC, contact Ian Corbridge, IanC@wsha.org or (206) 216-2514.

March 11, 2014 -- WSHA Files Suit Against DOH Over Certificate of Need Rules

(Cassie Sauer, cassies@wsha.org)

March 11,  2014 – DOH Requires Hospitals to Submit Hospital Policies by March 25

Hospitals are required to submit policies to the Department of Health by March 25, 2014 on non-discrimination, admissions, reproductive health, and end-of-life care.  Policies should be submitted in PDF format to HospitalPolicies@doh.wa.gov and posted on the hospital’s own website.

  • WSHA’s bulletin about the requirements
  • DOH’s guidance about the requirements
  • WSHA’s bulletin on and model for non-discrimination policy

Cassie Sauer, cassies@wsha.org

February 26, 2014 – DOH Proposes New Rule to Require Statewide Reporting of Clostridium Difficile

The Washington State Department of Health (DOH) recently issued a proposed rule to require mandatory statewide reporting of Clostridium (C.) difficile. The proposed rule would align C. difficile reporting requirements with other healthcare-associated infection (HAI) reporting categories as established by the Centers for Medicare and Medicaid Services. Reporting of C. difficile would be through the National Healthcare Safety Network (NHSN), a federal tracking system for HAIs. The data reported to the NHSN will provide the DOH important information on frequency and severity of C. difficile trends. WSHA is in close communication with the DOH and is participating in the rulemaking process. More information on the proposed rule is available on the DOH website. For questions, please contact Ian Corbridge, IanC@wsha.org.

February 21, 2014 – WSHA Submits Comments to the OIC Regarding Draft Network Adequacy Rules

WSHA has submitted comments on a new version of draft network adequacy rules distributed to stakeholders by the Office of the Insurance Commissioner on February 14.  These regulations would make substantial changes to the state’s network adequacy requirements for commercial health insurers, including Exchange plans.  WSHA has strongly objected to a provision in the new draft rule that creates a different standard for access to acute care in rural areas.  The rule currently requires a hospital within 60 minutes of enrollees in rural areas and 30  minutes of enrollees in urban areas.  WSHA also strongly objects to a provision in the rule allowing insurers in counties with fewer than 50,000 people to automatically be exempt from the rule’s requirements. 

The OIC is expected to issue the official draft rule soon. The new regulations are expected to be finalized in March, and will apply to the 2015 plan approval process during the summer of 2014.  Barbara Gorham, BarbaraG@wsha.org

February 9, 2014 - DOH Finalizes Rule Changing Process for Appealing Administrative Orders

The Department of Health has finalized rulemaking to change the process for appealing an administrative order. The new rule specifies that if no request for administrative review of an initial order is received within 21 days, the order becomes final. The rule implements ESHB 1381, which was enacted in 2013, and which modified the DOH’s administrative adjudicative process.  Barbara Gorham, barbarag@wsha.org

January 6, 2014 - Department of Revenue Releases Excise Tax WAC Discussion Drafts for Review

 The Department of Revenue (DOR) recently released discussion drafts of revisions to two Washington administrative code (WAC) chapters pertaining to excise taxes for hospitals and other facilities, and  drugs, devices and supplies.  Both impact WSHA members.

DOR is revising the WACs to update and present complex information in a more usable format.  Both WACs include examples showing how various provisions would be interpreted and applied by the DOR.  DOR has asked WSHA to let them know of any concerns we have with the scope, format, or content of the draft language so corrections could be reflected in proposed rule.  If you have concerns you want WSHA to include in our comments, please contact Andrew Busz, andrewb@wsha.org.

December 20, 2013 – WSHA Submits Comments to the OIC Regarding Draft Network Adequacy Rules

WSHA has submitted comments on an 80-page stakeholder draft of new network adequacy rules. On December 4, 2013, the Office of the Insurance Commissioner distributed to stakeholders a draft of proposed regulations making substantial changes to the state’s network adequacy requirements for commercial health insurers, including Exchange plans.  The stakeholder draft contains specific access standards for the Insurance Commissioner to consider when determining network adequacy, including requirements for access to both primary care and specialty care.  Unfortunately, the draft does not have a similar requirement for hospitals, so we have requested there be a hospital within 25 miles of 90% of enrollees in both rural and urban areas.  In addition to these access standards, the stakeholder draft addresses a number of other issues, including spot contracting, prior authorization, tiered networks, access to mental health services, and access to essential community providers.

The OIC is expected to issue the official draft rule soon. The new regulations are expected to be finalized in February, and will apply to the 2015 plan approval process during the summer of 2014.  Barbara Gorham, BarbaraG@wsha.org

November 26, 2013 – WSHA Files Final Comments on Certificate of Need and Hospital Licensing Rulemaking

The Department of Health’s final hearing on its Certificate of Need and Hospital Licensing rulemaking is being held on November 26, 2013. In addition to prior comments filed, WSHA is submitting further comments on the proposed rules. WSHA continues to object to the proposed requirement for CON review of many more transactions as contrary to law and decades of precedent, and has serious concerns about the intersection of these proposed rules with conscience clauses. WSHA also continues to have major questions about the effectiveness of the Certificate of Need program and the plan to collect hospital policies as ways to achieve the Department’s goals, and asks the Department a number of questions about its plans. Read the comments here.

November 25, 2013 - HCA Finalizes Rules Requiring Hospitals to Report Adverse Events to the Agency

The Washington State Health Care Authority (HCA) finalized rules that require hospitals and providers to report preventable provider conditions and health care-acquired conditions to the agency.  In August 2012, WSHA raised concerns in its initial comments since hospitals are already required to report adverse events to the Washington State Department of Health. WSHA also commented on the January 2013 draft rules, asking the HCA to streamline how hospitals report to the agency.  Vergil Cabasco, vergilc@wsha.org

November 25, 2013 - DOH Updates Draft Rules to Reduce Radiation Exposure from Computed Tomography Scanners

The Washington State Department of Health updated its proposed draft rules to regulate Computed Tomography (CT) scanners and reduce radiation overexposure.  The proposed rules establish radiation dosage limits, and require facilities using CT scanners to establish scanning protocols.  In addition, the proposed rules could potentially alter operating procedures, impose new reporting requirements, and change staffing requirements.  An advisory committee, comprised of stakeholders, will review the proposed rules and provide comments to the department.  WSHA plans to comment on the draft rules and is participating in the rulemaking process.  More information on the CT advisory committee and the proposed rules are available on the department’s website. (For more background information, please see the entry from August 23, 2013.) Vergil Cabasco, vergilc@wsha.org

October 22, 2013 - WSHA Submits Comments to the OIC Regarding Network Adequacy Rules

Along with the Washington State Medical Association and seven other organizations, WSHA has submitted comments to the Office of the Insurance Commissioner regarding rulemaking for new network adequacy standards governing commercial health plans.   These new rules will be in effect for Qualified Health Plans participating in the Exchange in 2015.   The Office of the Insurance Commissioner filed its Preproposal Statement of Inquiry on September 18, 2013.  The text of the proposed rule is expected to be released soon.  Barbara Gorham, barbarag@wsha.org

September 10, 2013 – WSHA Files Further Comments on Certificate of Need and Hospital Licensing Rulemaking

WSHA has filed further, extensive comments on the Department of Health’s Certificate of Need/Hospital Licensing concept rule addressing hospital mergers and affiliations.  The comments describe why mergers and affiliations are happening, object to the proposed requirement for CON review of many more transactions as contrary to law and decades of precedent, describe the intersection of these proposed rules with conscience clauses and religious freedom, raise questions about the workability and usefulness of policy collection, and stress the role of other branches of government.  Read the comments here.

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