11-15-029

WSR 11-15-029

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medicaid Purchasing Administration)

[ Filed July 12, 2011, 8:29 a.m. , effective August 12, 2011 ]

     Effective Date of Rule: Thirty-one days after filing.

     Purpose: These amendments reorganize the sections for nonemergency medical transportation; add/remove/update definitions; update client eligibility and responsibility; include a section on "covered trips"; add a new section for "exclusions and limitations"; include a section for "intermediate stops or delays"; add new section regarding local provider and trips outside the client's local community; update the section regarding meals/lodging/escort/guardian; expand the reimbursement section to clarify when reimbursement for preauthorized expenditures for trips, meals, and lodging must be requested, what documentation is required for reimbursement of mileage, fuel/gas, parking, bridge tolls, etc., and when the broker may retroactively authorize and reimburse transportation costs (including meals and lodging).

     Citation of Existing Rules Affected by this Order: Amending WAC 388-546-5000, 388-546-5100, 388-546-5200, 388-546-5300, 388-546-5400, and 388-546-5500.

     Statutory Authority for Adoption: RCW 74.04.057, 74.08.090, 74.09.500.

     Other Authority: RCW 74.08.090.

      Adopted under notice filed as WSR 11-10-070 on May 3, 2011.

     Changes Other than Editing from Proposed to Adopted Version: WAC 388-546-5100 Definitions, added the following text to the proposed definition of "noncompliance or noncompliant":

     "Noncompliance or noncompliant" - When a client:

?	Fails to appear at the pick-up point of the trip at the scheduled pick-up time without good cause or without reasonable notification to the broker;
?	Fails without good cause to comply with the rules, procedures, and/or policies of the department and/or those of the department's transportation brokers, the brokers' subcontracted transportation providers, and healthcare service providers;

     WAC 388-546-5500 Covered trips.

     Subsection (1)(a), changed "services is" to "services are."

     Subsection (1)(d), changed "the" to "a."

     Subsection (1)(g), corrected the reference to "WAC 388-546-6200(7) not (6)."

     WAC 388-546-5700 Local provider and trips outside client's local community.

     Subsection (3)(a)(ii), changed "locally" to "in the client's local community" for consistency.

     Subsection (3)(b)(iii), the text was changed as follows:

     Ongoing treatment of the following medical conditions that may qualify for transportation based on continuity of care, include but are not limited to:

     (A) Active cancer treatment;

     (B) Recent transplant (within the last twelve months);

     (C) Scheduled surgery (within the next sixty days);

     (D) Major surgery (within the previous sixty days); or

     (E) Third trimester of pregnancy.

     WAC 388-546-6200 Reimbursement.

     Subsection (7)(b), the department added subsection (iii) with the following language which:

     The trip involves an area that the department's broker considers to be unsafe for the client, other riders, or the driver.

     A final cost-benefit analysis is available by contacting Walter Neal, P.O. Box 45530, Olympia, WA 98504-5530, phone [phone], fax [phone], e-mail [e-mail].

     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 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 8, Amended 6, 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 8, Amended 6, Repealed 0.

     Date Adopted: July 12, 2011.

Susan N. Dreyfus

Secretary

     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 11-16 issue of the Register.