Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-23A - Hospitals › Part 2 - PAYMENT METHODS FOR HOSPITAL SERVICES › Section 296-23A-0220 - How does the department pay for hospital outpatient services?

Current through Register Vol. 24-14, July 15, 2024
The department will pay for hospital outpatient services
				  according to the following table:
Hospital Type or Service
								Location
Does the Ambulatory Payment Classification
								System apply?
Do percent of allowed charges (POAC)
								payment methods apply?
Do the department's Medical Aid Rules and
								Fee Schedules apply to hospital outpatient radiology, laboratory, pathology,
								occupational therapy, and physical therapy services?
Children's hospitals
No
Yes, paid 100% of allowed charges
Yes
Chronic Pain Management Program
No
Exempt, paid per department agreement
Exempt, paid per department agreement
Health Maintenance Organizations
Yes, paid statewide average per APC rate
Yes, applies to certain hospital outpatient
								services excluded from OPPS except radiology, laboratory, pathology,
								occupational therapy, and physical therapy
Yes
Military
No
Yes, paid 100% of allowed charges
No, paid 100% of allowed charges
Veterans Administration
No
Yes, paid 100% of allowed charges
No, paid 100% of allowed charges
State psychiatric facility
No
Yes, paid 100% of allowed charges
Yes
Other psychiatric hospitals
No
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
Rehabilitation hospitals
No
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
Cancer hospitals
No
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
Critical access hospitals
No
Yes, applies to hospital outpatient services except
								radiology, laboratory, pathology, occupational therapy, and physical
								therapy
Yes
All other Washington hospitals
Yes
Yes, applies to certain hospital outpatient
								services excluded from OPPS except radiology, laboratory, pathology,
								occupational therapy, and physical therapy
Yes
Hospitals are reimbursed only for the technical component of
				  rates listed in the fee schedules, for outpatient radiology, pathology and
				  laboratory services.
See chapter 296-23 WAC for rules on radiology,
				  pathology, laboratory, physical therapy, occupational therapy, and work
				  hardening services.
See WAC 296-23A-700 for rules on prospective payment
				  system for hospital outpatient services.
See WAC
				  296-20-132 and
				  296-20-135 for information on the
				  conversion factor used for certain hospital outpatient
				  services.
Statutory Authority:
					 RCW
					 51.04.030 and 51.12.330. 06-12-073, §
					 296-23A-0220, filed 6/6/06, effective 7/7/06. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030,
					 51.36.080,
					 51.36.085. 01-24-045, §
					 296-23A-0220, filed 11/29/01, effective 1/1/02. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030,
					 51.36.080. 00-06-027, §
					 296-23A-0220, filed 2/24/00, effective 3/26/00; 97-06-066, § 296-23A-0220,
					 filed 2/28/97, effective 4/1/97.