Washington Administrative Code › Title 182 - Health Care Authority › ALL PAYER HEALTH CARE CLAIMS DATABASE › Chapter 182-70 - All payer health care claims database › FEE SCHEDULES › Section 182-70-570 - Process to modify fee schedules

Current through Register Vol. 24-14, July 15, 2024
(1)
				  Fee schedules shall be reissued no less frequently than on an annual basis. The
				  reissuance of the fee schedule can include maintaining the fee schedule without
				  modification, modifying the fee schedule, or a combination of these two
				  actions.
(2) The lead organization
				  shall review fee schedules at least once every year. Annual period shall be
				  from the date upon which the fee schedule is adopted. The review shall include
				  whether any fee should be changed, removed from the schedule, or new fees
				  added. The lead organization must maintain documentation that supports the
				  recommended changes from the review of the fee schedule.
(3) The lead organization must present the
				  changes, supporting documentation, and proposed modifications to the fee
				  schedule to the data policy committee for review and feedback. The lead
				  organization must provide any other available data requested by the DPC that
				  supports the proposed modifications to the fee schedule.
(4) The DPC must review the changes,
				  supporting documentation, and proposed modifications to the fee schedule and
				  adopt recommendations, including the basis for each recommendation, as to
				  whether the changes should be accepted and the modified fee schedule approved
				  by the authority. The DPC must provide the recommendations to the lead
				  organization for its consideration.
(5) The lead organization must review the DPC
				  recommendations and make any changes to the recommendations and proposed
				  modifications to the fee schedule based on the recommendations. The lead
				  organization must document which recommendations it implemented into the fee
				  schedule. For those recommendations that the lead organization did not act
				  upon, the lead organization must document the reasons why each recommendation
				  was not accepted.
(6) The lead
				  organization must provide the authority the proposed modifications to the fee
				  schedule, as modified, with supporting documentation, the DPC recommendations,
				  and the reasoning for why the lead organization did not make changes for any
				  recommendation not accepted. The lead organization must provide any other
				  available data requested by the authority that supports the changes and
				  proposed modified fee schedule provided to the authority.
(7) The authority shall post on the agency
				  website the recommendations and proposed modifications to the fee schedule, and
				  solicit public comment for thirty days. The authority may also convene a
				  stakeholder meeting to provide an opportunity for interested parties another
				  avenue to give feedback on the draft fee schedule. If the authority decides to
				  hold a stakeholder meeting, the meeting may be in person, by telephone or other
				  electronic means, as determined by the authority.
(8) After the comment period, the authority
				  will review all the stakeholder feedback, recommendations of the DPC, and any
				  data received from the lead organization and make a final determination
				  regarding the fee schedule. The authority shall provide the final determination
				  to the lead organization, publish the final determination on the agency
				  website, and send notification through the authority listserv or other
				  electronic means.
Statutory Authority:
						RCW
						43.371.070(1)(f). WSR
						18-10-074, §
												82-75-570,
						filed 5/1/18, effective 6/1/18.