Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-549 - Rural health clinics › Section 182-549-1100 - Rural health clinics-Definitions

Current through Register Vol. 24-14, July 15, 2024
This section contains definitions of words and phrases that
				  apply to this chapter. Unless defined in this chapter, the definitions found in
				  chapter 182-500 WAC apply.
"APM index"
- The agency uses the alternative
				  payment methodology (APM) to update APM encounter payment rates on an annual
				  basis. The APM index is a measure of input price changes experienced by
				  Washington's federally qualified health center (FQHC) and rural health clinic
				  (RHC) providers. The index is derived from the federal medicare economic index
				  (MEI).
"Base year"
- The year that is used as the
				  benchmark in measuring an RHC's total reasonable costs for establishing base
				  encounter rates.
"Cost center"
- A category of service approved
				  to be provided by the RHC under WAC
				  182-549-1200
				  and reported in the medicare cost report and supplemental documentation. The
				  categories of services to be provided by the RHC may include medical and
				  dental.
"Encounter"
- A face-to-face or telemedicine
				  (including audio-only telemedicine) visit between an encounter-eligible client
				  and an RHC provider who exercises independent judgment when providing services
				  that qualify for encounter rate reimbursement.
"Encounter-eligible client"
- A client who
				  receives benefits under Title XIX (medicaid) or Title XXI (CHIP).
"Encounter rate"
- A cost-based,
				  facility-specific rate for covered RHC services.
"Enhancements (also called managed care enhancements or
				  supplemental payments)"
- A monthly amount the agency pays to RHCs
				  through a managed care organization (MCO) that has contracted with the RHC to
				  provide services to clients enrolled with the MCO. The enhancement is in
				  addition to the negotiated payment that RHCs receive from the MCO. RHCs
				  participating in the payment method described in WAC
				  182-549-1450(7)(b)
				  do not receive enhancements.
"Fee-for-service"
- A payment method the agency
				  uses to pay providers for covered medical services provided to Washington apple
				  health clients, which excludes services provided by the agency's contracted
				  managed care organizations and services that qualify for an encounter
				  payment.
"Interim rate"
- The rate the agency establishes
				  to pay an RHC for covered RHC services prior to the establishment of a
				  permanent rate for that RHC.
"Medicare cost report"
- The cost report is a
				  statement of costs and provider utilization that occurred during the time
				  period covered by the cost report. RHCs must complete and submit a report
				  annually to medicare.
"Medicare economic index (MEI)"
- An index
				  published in the Federal Register used in the calculation of changes to
				  determine allowed charges for physician services. The agency adjusts RHC
				  encounter rates and enhancement rates by the MEI each year on January
				  1st.
"Mobile unit"
- The objects, equipment, and
				  supplies necessary for provision of the services furnished directly by the RHC
				  are housed in a mobile structure.
"Permanent unit"
- The objects, equipment, and
				  supplies necessary for the provision of the services furnished directly by the
				  RHC are housed in a permanent structure.
"Rebasing"
- The process of recalculating
				  encounter rates using actual cost report data.
"Rural area"
- An area that is not delineated as
				  an urbanized area by the U.S. Census Bureau.
"Rural health clinic (RHC)"
- A clinic, as
				  defined in
				  42 C.F.R.
				  405.2401(b), that is
				  primarily engaged in providing RHC services and is:
* Located in a rural area designated as a shortage area as
				  defined under
				  42
				  C.F.R. 491.2;
* Certified by medicare as an RHC in accordance with
				  applicable federal requirements; and
* Not a rehabilitation agency or a facility primarily for the
				  care and treatment of mental diseases.
"Rural health clinic (RHC) services"
-
				  Outpatient or ambulatory care of the nature typically provided in a physician's
				  office or outpatient clinic or similar setting, including specified types of
				  diagnostic examination, laboratory services, and emergency treatments. The
				  specific list of services which must be made available by the clinic can be
				  found under 42 C.F.R. Part 491.9.
11-14-075, recodified as §
											182-549-1100, filed 6/30/11,
					 effective 7/1/11. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.510,
					 74.09.522,
					 42 U.S.C.
					 1396 a(bb),
					 42 C.F.R.
					 405.2472, and 42 C.F.R. 491. 10-09-030,
					 § 388-549-1100, filed 4/13/10, effective 5/14/10. Statutory Authority:
					 RCW
					 74.08.090,
					 74.09.510,
					 74.09.522,
					 42 C.F.R.
					 405.2472, 42 C.F.R. 491. 08-05-011, §
					 388-549-1100, filed 2/7/08, effective
					 3/9/08.