The Washington Office of the Insurance Commissioner (OIC) recently issued a new draft of what we anticipate will become a bill to restrict balance billing.... Read More >>
On April 1, 2017, the Health Care Authority (HCA) plans to update the outpatient weights used for payment under the Enhanced Ambulatory Payment Group (EAPG) system at prospective payment hospitals. ... Read More >>
Last week the Washington State Office of the Insurance Commissioner (OIC) issued a proposed rule on prior authorizations.... Read More >>
Last week, the Centers for Medicare & Medicaid Services (CMS) finalized and posted its Medicare Outpatient Observation Notification (MOON) form. ... Read More >>
Wednesday Governor Inslee released his state budget proposal, which includes more funding for mental health services but unfortunately also includes a cut of $42 million over the two year period for services to Medicaid enrollees at hospital-based clinics... Read More >>
Hospitals and other organizations are seeking ways to obtain needed capital equipment while retaining flexibility to adapt to changes in health care payment.... Read More >>
The Washington State Health Care Authority (HCA) is seeking rural health clinics interested in piloting a new alternative payment model (APM). The pilot will also include interested federally qualified health centers. Facilities interested in piloting the new model must sign a letter of intent by December 31, and work with HCA to finalize a memorandum of understanding in the following months. ... Read More >>
On November 15, the Office of the Insurance Commissioner (OIC) convened a second large stakeholder meeting regarding the intent of the Commissioner and legislators to introduce balance billing (“Surprise Billing”) legislation this session. Attendees included Insurance Commissioner Mike Kreidler, State Representative Eileen Cody, State Representative Michelle Caldier, representatives of health plans and representatives of WSHA, WSMA and physician groups. The main purpose of the meeting was to seek consensus on a methodology to determine default payment rate that plans would pay in absence of a contract. The discussion also sought stakeholder consensus for details of a dispute/arbitration process to appeal the fallback rate. Both a default rate and arbitration mechanism are expected to be components of the legislation. ... Read More >>
State and federal laws require hospitals to provide an array of notice and signage to patients, workforce members and the public. The Washington State Office of the Attorney General has in recent months stepped up its investigation of hospital compliance with these types of requirements. Hospitals could be subject to significant penalties if found to be out of compliance.... Read More >>
On November 8, the Bree Collaborative convened a special meeting of interested providers and health systems, health plans and others to discuss ways to improve proper authorizations. While WSHA was hopeful that the meeting would lead to a pathway to work with payers on a standardized approach across payers, it is unclear if there is traction for that concept.... Read More >>
