09-09-080

WSR 09-09-080

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)

[ Filed April 15, 2009, 2:02 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 07-12-061.

     Title of Rule and Other Identifying Information: The department is creating WAC 388-501-0055 Healthcare coverage -- How the department determines coverage of services for its healthcare programs using health technology assessments.

     Hearing Location(s): Office Building 2, Auditorium, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html or by calling [phone]), on May 26, 2009, at 10:00 a.m.

     Date of Intended Adoption: Not sooner than May 27, 2009.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail [e-mail], fax [phone], by 5 p.m. on May 26, 2009.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by May 12, 2009, 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: To codify how health technology assessments are used in HRSA's determinations of what services are included in the benefit design of its medical assistance programs.

     Reasons Supporting Proposal: It makes HRSA's determination process more transparent to the public.

     Statutory Authority for Adoption: RCW 70.14.090 and 74.08.090.

     Statute Being Implemented: RCW 70.14.090 and 74.08.090.

     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, P.O. Box 45504, Olympia, WA 98504-5504, [phone]; Implementation and Enforcement: Gail Kreiger, P.O. Box 45506, Olympia, WA 98504-5506, [phone].

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule does not impose any new costs on 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, P.O. Box 45504, Olympia, WA 98504-5504, phone [phone], fax [phone], e-mail [e-mail].

April 13, 2009

Stephanie E. Schiller

Rules Coordinator

4047.3
NEW SECTION
WAC 388-501-0055   Healthcare coverage--How the department determines coverage of services for its healthcare programs using health technology assessments.   (1) The department uses health technology assessments in determining whether a new technology, new indication, or existing technology approved by the Food and Drug Administration (FDA) is a covered service under department healthcare programs. The department only uses health technology assessments when coverage is not mandated by federal or state law. A health technology assessment may be conducted by or on behalf of:

     (a) The department; or

     (b) The health technology assessment clinical committee (HTACC) according to RCW 70.14.080 through 70.14.140.

     (2) The department reviews available evidence relevant to a medical or dental service or healthcare-related equipment and uses a technology evaluation matrix, in order to:

     (a) Determine its efficacy, effectiveness, and safety;

     (b) Determine its impact on health outcomes;

     (c) Identify indications for use;

     (d) Identify potential for client misuse or abuse; and

     (e) Compare to alternative technologies to assess benefit vs. harm and cost effectiveness.

     (3) The department may determine the technology, device, or technology-related supply is:

     (a) Covered (refer to WAC 388-501-0060);

     (b) Covered with authorization (refer to WAC 388-501-0165);

     (c) Covered with limitations (refer to WAC 388-501-0169); or

     (d) Noncovered (refer to WAC 388-501-0070).

     (4) The department may periodically review existing technologies, devices, or technology-related supplies and reassign authorization requirements as necessary according to the same provisions as outlined above for new technologies, devices, or technology-related supplies.

     (5) The department evaluates the evidence and criteria presented by HTACC to determine whether a service is covered in accordance with WAC 388-501-0050 (6) and (7) and this section.

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