06-19-099

WSR 06-19-099

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed September 19, 2006, 4:04 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 05-17-140.

     Title of Rule and Other Identifying Information: Sections in Title 388 WAC regarding covered and noncovered services - Part 2 of 3.

     WAC Sections Proposed in Part 2: Amending WAC 388-416-0015 Certification periods for CN and SCHIP medical programs, 388-475-1000 Healthcare for workers with disabilities (HWD) -- Program description, 388-501-0180 Out-of-state medical care, 388-519-0110 Spenddown of excess income for the medically needy program, 388-530-1000 Drug program, 388-530-1150 Noncovered drugs and pharmaceutical supplies and reimbursement limitations, 388-531-1600 Bariatric surgery, 388-533-0340 Maternity support services -- Noncovered services, 388-533-0385 Infant case management -- Noncovered services, 388-535-1265 Dental-related services not covered -- Adults, 388-535A-0040 Covered and noncovered orthodontic services and limitations to coverage, 388-538-063 Mandatory enrollment in managed care for GAU clients, 388-538-095 Scope of care for managed care enrollees, 388-540-130 Covered services, 388-540-140 Noncovered services and 388-540-150 Reimbursement -- General; and repealing WAC 388-501-0300 Limits on scope of medical program services, 388-529-0100 Scope of covered medical services by program, and 388-529-0200 Medical services available to eligible clients.

     Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling [phone]), on November 7, 2006, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than November 8, 2006.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail [e-mail], fax [phone], by 5:00 p.m. on November 7, 2006.

     Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by November 3, 2006, TTY [phone] or [phone] or by e-mail at [e-mail].

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of the proposal is to:

?	Improve the quality of care received by DSHS clients by using a consistent, evidence-based approach to making benefit coverage decisions.
?	Make HRSA benefit coverage rules clearer, more transparent, and consistent.
?	Establish a clear, transparent process by which HRSA determines what services are included under its benefit coverage.
?	Maximize program resources through prudent use of cost-effective practices.

     Changes to Rule in Parts 1, 2, and 3: In this proposal, the department has:

?	Replaced "medical assistance administration" and "MAA" with "the department" or "HRSA."
?	Substituted WAC 388-501-0160 cross reference in place of WAC 388-501-0165 where noncovered services are addressed.
?	Replaced all references to chapter 388-529 WAC with new WAC 388-501-0060 and 388-501-0065.
?	Added reference to new WAC 388-501-0169 in rules where limitations on covered services are addressed.
?	Repealed chapter 388-529 WAC which is being replaced with WAC 388-501-0060 and 388-501-0065.
?	Repealed WAC 388-501-0300 because it was incorporated into WAC 388-501-0050 and 388-501-0070.
?	Removed gender reassignment surgery from covered service status.
?	More clearly defined what is covered and not covered in the way of cosmetic and reconstructive surgery, treatment, and procedures in WAC 388-531-0100 and new WAC 388-501-0070.
?	Added more detail to WAC 388-501-0160 regarding the criteria and steps in the exception to rule (ETR) process.
?	In new WAC 388-501-0065, added brief descriptions of services available under each category of service listed in the table in new WAC 388-501-0060.
?	Included cross references (in new WAC 388-501-0065 and 388-501-0070) to other program WACs where the reader can find more specific detail of the covered or noncovered service.
?	Codified the evaluation criteria HRSA will use when evaluating requests for covered services beyond the maximum allowed.

     Reasons Supporting Proposal: It will make HRSA's rules regarding covered and noncovered medical services clearer and easier to understand for our clients and medical providers.

     Statutory Authority for Adoption: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700.

     Statute Being Implemented: RCW 74.04.050, 74.08.090, 74.09.530, and 74.09.700.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting: Kevin Sullivan, 626 8th Avenue, Olympia, WA 98504-5504, [phone]; Implementation and Enforcement: Gail Kreiger, 626 8th Avenue, Olympia, WA 98504-5504, [phone].

     No small business economic impact statement has been prepared under chapter 19.85 RCW. This amendment does not create more than minor costs to small businesses.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Kevin Sullivan, HRSA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-4405, phone [phone], fax [phone], e-mail [e-mail], TYY/TDD 1-800-848-5429.

September 15, 2006

Andy Fernando, Manager

Rules and Policies Assistance Unit

     Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 06-20 issue of the Register.