On October 27th, the WSHA Medicaid Payment Task Force met with staff from the Health Care Authority to discuss the Authority’s proposal to update the method of payment for Medicaid hospital outpatient services for prospective payment system hospitals.... Read More >>

In July 2014, the Washington State Health Care Authority (HCA) rebased inpatient and outpatient rates and suggested a 3 percent cut to adjust for coding changes in the new system. WSHA pushed back and HCA agreed to make budget neutrality adjustments as needed. HCA recently completed its two-year analysis and determined no additional rate adjustments were needed.... Read More >>

Hospitals that submitted preliminary Disproportionate Share Hospital (DSH) applications for state fiscal year 2017 have until October 31 to provide the Health Care Authority with any remaining missing application information for their application to remain active.... Read More >>

On September 23, the Office of the Insurance Commissioner (OIC) released a third iteration of stakeholder draft rules concerning prior authorizations. We are pleased that the OIC has undertaken a rule making process on prior authorization and is trying to provide more transparency around some of the requirements.... Read More >>

The Office of the Insurance Commissioner (OIC) recently circulated a stakeholder draft bill related to out-of-network billing, sometimes referred to as “surprise bills." The bill is meant to address the situation where a patient receives services at a hospital or other facility that is part of their health plan’s network, but receive care from providers who are not contracted with the plan.... Read More >>

he federal Office of the Inspector General (OIG) recently released results of two separate audits where they claimed the Washington State Medicaid program made improper payments. In one audit, OIG claimed the state made $9.2 million in improper electronic health record incentive payments.... Read More >>

When the Washington State Health Care Authority rebased inpatient and outpatient rates in July 2014, they originally suggested a three percent cut to adjust for coding changes in the new system. WSHA and our hospitals pushed back and HCA agreed to measure changes for a two-year period, making budget neutrality adjustments as needed.... Read More >>

The Hospital Safety Net Assessment Program for State Fiscal 2017 went into effect July 1, 2016. Under the program, the state collects assessments from hospitals.... Read More >>

WSHA submitted a comment letter in response to the Health Care Authority’s proposed changes to the payment rules governing Medicaid payment to federally qualified health centers (FQHCs) and rural health clinics. In our letter, WSHA voices concerns that the proposed rule language does not enable clinics to support transformation of care delivery without taking on significant financial risk of reduced payments.... Read More >>

Despite strong interest from WSHA, WSMA and members of the two organizations, the Bree Collaborative voted last week to not address prior authorization as a major focus area for the upcoming year.... Read More >>