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WACs > Title 182 > Chapter 182-550
Last Update: 8/27/15
Chapter 182-550 WAC
HOSPITAL SERVICES
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WAC Sections
182-550-1000
Applicability.
182-550-1050
Hospital services definitions.
182-550-1100
Hospital careâGeneral.
182-550-1200
Restrictions on hospital coverage.
182-550-1300
Revenue code categories and subcategories.
182-550-1350
Revenue code categories and subcategoriesâCPT and HCPCS reporting requirements for outpatient hospitals.
182-550-1400
Covered and noncovered revenue codes categories and subcategories for inpatient hospital services.
182-550-1500
Covered and noncovered revenue code categories and subcategories for outpatient hospital services.
182-550-1600
Specific items/services not covered.
182-550-1650
Adverse events, hospital-acquired conditions, and present on admission indicators.
182-550-1700
Authorization and utilization review (UR) of inpatient and outpatient hospital services.
182-550-1800
Hospital specialty services not requiring prior authorization.
182-550-1900
Transplant coverage.
182-550-2100
RequirementsâTransplant hospitals.
182-550-2200
Transplant requirementsâCOE.
182-550-2301
Hospital and medical criteria requirements for bariatric surgery.
182-550-2400
Inpatient chronic pain management services.
182-550-2431
Hospice servicesâInpatient payments.
182-550-2500
Inpatient hospice services.
182-550-2501
Acute physical medicine and rehabilitation (acute PM&R) programâGeneral.
182-550-2521
Client eligibility requirements for acute PM&R services.
182-550-2531
Requirements for becoming an acute PM&R provider.
182-550-2541
Quality of careâAgency-approved acute PM&R hospital.
182-550-2551
How a client qualifies for acute PM&R services.
182-550-2561
The agency's prior authorization requirements for acute PM&R services.
182-550-2565
The long-term acute care (LTAC) programâGeneral.
182-550-2575
Client eligibility requirements for LTAC services.
182-550-2580
Requirements for becoming an LTAC hospital.
182-550-2585
LTAC hospitalsâQuality of care.
182-550-2590
Agency prior authorization requirements for Level 1 and Level 2 LTAC services.
182-550-2595
Identification of and payment methodology for services and equipment included in the LTAC fixed per diem rate.
182-550-2596
Services and equipment covered by the agency but not included in the LTAC fixed per diem rate.
182-550-2598
Critical access hospitals (CAHs).
182-550-2600
Inpatient psychiatric services.
182-550-2650
Base community psychiatric hospitalization payment method for medicaid and CHIP clients and nonmedicaid and non-CHIP clients.
182-550-2750
Hospital discharge planning services.
182-550-2900
Payment limitsâInpatient hospital services.
182-550-3000
Payment method.
182-550-3381
Payment method for acute PM&R services and administrative day services.
182-550-3400
Case-mix index.
182-550-3470
Payment methodâBariatric surgeryâPer case rate.
182-550-3600
Diagnosis-related group (DRG) paymentâHospital transfers.
182-550-3700
DRG high outliers.
182-550-3800
Rebasing.
182-550-3830
Adjustments to inpatient rates.
182-550-3850
Budget neutrality adjustment and measurement.
182-550-3900
Payment methodâBordering city hospitals and critical border hospitals.
182-550-4000
Payment methodâOut-of-state hospitals.
182-550-4100
Payment methodâNew hospitals.
182-550-4200
Change in hospital ownership.
182-550-4300
Hospitals and units exempt from the DRG payment method.
182-550-4400
ServicesâExempt from DRG payment.
182-550-4500
Payment methodâRatio of costs-to-charges (RCC).
182-550-4550
Administrative day rate and swing bed day rate.
182-550-4650
"Full cost" public hospital certified public expenditure (CPE) payment program.
182-550-4670
CPE payment programâ"Hold harmless" provision.
182-550-4690
Authorization requirements and utilization review for hospitals eligible for CPE payments.
182-550-4700
PaymentâNon-SCA participating hospitals.
182-550-4800
Hospital payment methodsâState-administered programs.
182-550-4900
Disproportionate share hospital (DSH) paymentsâGeneral provisions.
182-550-4925
Eligibility for DSH programsâNew hospital providers.
182-550-4935
DSH eligibilityâChange in hospital ownership.
182-550-4940
Disproportionate share hospital independent audit findings and recoupment process.
182-550-5000
Payment methodâLow income disproportionate share hospital (LIDSH).
182-550-5130
Payment methodâInstitution for mental diseases disproportionate share hospital (IMDDSH) and institution for mental diseases (IMD) state grants.
182-550-5150
Payment methodâMedical care services disproportionate share hospital (MCSDSH).
182-550-5200
Payment methodâSmall rural disproportionate share hospital (SRDSH).
182-550-5210
Payment methodâSmall rural indigent assistance disproportionate share hospital (SRIADSH).
182-550-5220
Payment methodâNonrural indigent assistance disproportionate share hospital (NRIADSH).
182-550-5300
Payment methodâChildren's health program disproportionate share hospital (CHPDSH).
182-550-5380
Payment methodâSole community disproportionate share hospital (SCDSH).
182-550-5400
Payment methodâPublic hospital disproportionate share hospital (PHDSH).
182-550-5410
CPE medicaid cost report and settlements.
182-550-5425
Upper payment limit (UPL) payments for inpatient hospital services.
182-550-5450
Supplemental distributions to approved trauma service centers.
182-550-5500
PaymentâHospital-based RHCs.
182-550-5550
Public notice for changes in medicaid payment rates for hospital services.
182-550-5600
Dispute resolution process for hospital rate reimbursement.
182-550-5700
Hospital reports and audits.
182-550-5800
Outpatient and emergency hospital services.
182-550-6000
Outpatient hospital servicesâConditions of payment and payment methods.
182-550-6100
Outpatient hospital physical therapy.
182-550-6150
Outpatient hospital occupational therapy.
182-550-6200
Outpatient hospital speech therapy services.
182-550-6250
PregnancyâEnhanced outpatient benefits.
182-550-6300
Outpatient nutritional counseling.
182-550-6400
Outpatient hospital diabetes education.
182-550-6450
Outpatient hospital weight loss program.
182-550-6500
Blood and blood components.
182-550-6600
Hospital-based physician services.
182-550-6700
Hospital services provided out-of-state.
182-550-7000
Outpatient prospective payment system (OPPS)âGeneral.
182-550-7200
OPPSâBilling requirements and payment method.
182-550-7300
OPPSâPayment limitations.
182-550-7400
OPPS EAPG relative weights.
182-550-7450
OPPS budget target adjustor.
182-550-7500
OPPS rate.
182-550-7550
OPPS payment enhancements.
182-550-7600
OPPS payment calculation.
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS CHAPTER
182-550-2511
Acute PM&R definitions. [WSR 11-14-075, recodified as § 182-550-2511, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 07-12-039, § 388-550-2511, filed 5/30/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.520 and 42 C.F.R. 482.56. WSR 03-06-047, § 388-550-2511, filed 2/28/03, effective 3/31/03. Statutory Authority: RCW 74.08.090 and 74.09.520. WSR 99-17-111, § 388-550-2511, filed 8/18/99, effective 9/18/99.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-2570
LTAC program definitions. [WSR 11-14-075, recodified as § 182-550-2570, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 08-21-039, § 388-550-2570, filed 10/8/08, effective 11/8/08; WSR 07-11-129, § 388-550-2570, filed 5/22/07, effective 8/1/07. Statutory Authority: RCW 74.08.090. WSR 02-14-162, § 388-550-2570, filed 7/3/02, effective 8/3/02.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-2800
Payment methods and limitsâInpatient hospital services for medicaid and SCHIP clients. [WSR 11-14-075, recodified as § 182-550-2800, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 2009-11 Omnibus Operating Budget (ESHB 1244). WSR 09-12-063, § 388-550-2800, filed 5/28/09, effective 7/1/09. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-14-018, § 388-550-2800, filed 6/22/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.500, and 2005 c 518, § 204, Part II. WSR 07-06-043, § 388-550-2800, filed 3/1/07, effective 4/1/07. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-12-022, § 388-550-2800, filed 5/20/05, effective 6/20/05. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 04-19-113, § 388-550-2800, filed 9/21/04, effective 10/22/04. Statutory Authority: RCW 74.08.090, 74.09.500, 74.09.035(1), and 43.88.290. WSR 02-21-019, § 388-550-2800, filed 10/8/02, effective 11/8/02. Statutory Authority: RCW 74.08.090 and 42 U.S.C. 1395x(v), 42 C.F.R. 447.271, .11303, and .2652. WSR 01-16-142, § 388-550-2800, filed 7/31/01, effective 8/31/01. Statutory Authority: RCW 74.09.090, 42 U.S.C. 1395x(v) and 1396r-4, 42 C.F.R. 447.271, 11303 and 2652. WSR 99-14-027, § 388-550-2800, filed 6/28/99, effective 7/1/99. Statutory Authority: RCW 74.08.090, 42 U.S.C. 1395 x(v), 42 C.F.R. 447.271, 447.11303, and 447.2652. WSR 99-06-046, § 388-550-2800, filed 2/26/99, effective 3/29/99. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-2800, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3010
Payment methodâPer diem payment. [WSR 11-14-075, recodified as § 182-550-3010, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 2009-11 Omnibus Operating Budget (ESHB 1244). WSR 09-12-063, § 388-550-3010, filed 5/28/09, effective 7/1/09. Statutory Authority: RCW 74.08.090, 74.09.500 and 2005 c 518. WSR 07-14-051, § 388-550-3010, filed 6/28/07, effective 8/1/07.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3020
Payment methodâBariatric surgeryâPer case payment. [WSR 11-14-075, recodified as § 182-550-3020, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 2009-11 Omnibus Operating Budget (ESHB 1244). WSR 09-12-063, § 388-550-3020, filed 5/28/09, effective 7/1/09. Statutory Authority: RCW 74.08.090, 74.09.500 and 2005 c 518. WSR 07-14-051, § 388-550-3020, filed 6/28/07, effective 8/1/07.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3100
Calculating DRG relative weights. [WSR 11-14-075, recodified as § 182-550-3100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500 and 2005 c 518. WSR 07-14-051, § 388-550-3100, filed 6/28/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.04.050. WSR 04-13-048, § 388-550-3100, filed 6/10/04, effective 7/11/04. Statutory Authority: RCW 74.08.090, 42 U.S.C. 1395 x(v), 42 C.F.R. 447.271, 447.11303, and 447.2652. WSR 99-06-046, § 388-550-3100, filed 2/26/99, effective 3/29/99. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3100, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3150
Base period costs and claims data. [WSR 11-14-075, recodified as § 182-550-3150, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500 and 2005 c 518. WSR 07-14-051, § 388-550-3150, filed 6/28/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3150, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3200
Medicaid cost proxies. [WSR 11-14-075, recodified as § 182-550-3200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 07-14-055, § 388-550-3200, filed 6/28/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3200, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3250
Indirect medical education costsâConversion factors, per diem rates, and per case rates. [WSR 11-14-075, recodified as § 182-550-3250, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500 and 2005 c 518. WSR 07-14-051, § 388-550-3250, filed 6/28/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3250, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3300
Hospital peer groups and cost caps. [WSR 11-14-075, recodified as § 182-550-3300, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 07-14-055, § 388-550-3300, filed 6/28/07, effective 8/1/07; WSR 06-08-046, § 388-550-3300, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 05-12-132, § 388-550-3300, filed 6/1/05, effective 7/1/05. Statutory Authority: RCW 74.08.090 and 42 U.S.C. 1395x(v), 42 C.F.R. 447.271, .11303, and .2652. WSR 01-16-142, § 388-550-3300, filed 7/31/01, effective 8/31/01. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3300, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3350
Outlier costs. [WSR 11-14-075, recodified as § 182-550-3350, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 07-14-055, § 388-550-3350, filed 6/28/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3350, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3450
Payment method for calculating medicaid DRG conversion factor rates. [WSR 11-14-075, recodified as § 182-550-3450, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500 and 2005 c 518. WSR 07-14-051, § 388-550-3450, filed 6/28/07, effective 8/1/07. Statutory Authority: RCW 74.09.090, 42 U.S.C. 1395x(v) and 1396r-4, 42 C.F.R. 447.271, 11303 and 2652. WSR 99-14-027, § 388-550-3450, filed 6/28/99, effective 7/1/99. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3450, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3460
Payment methodâPer diem rate. [WSR 11-14-075, recodified as § 182-550-3460, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 2009-11 Omnibus Operating Budget (ESHB 1244). WSR 09-12-063, § 388-550-3460, filed 5/28/09, effective 7/1/09. Statutory Authority: RCW 74.08.090, 74.09.500 and 2005 c 518. WSR 07-14-051, § 388-550-3460, filed 6/28/07, effective 8/1/07.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-3500
Hospital annual inflation adjustment determinations. [WSR 11-14-075, recodified as § 182-550-3500, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090 and 74.09.500. WSR 07-14-055, § 388-550-3500, filed 6/28/07, effective 8/1/07. Statutory Authority: RCW 74.09.090, 42 U.S.C. 1395x(v) and 1396r-4, 42 C.F.R. 447.271, 11303 and 2652. WSR 99-14-027, § 388-550-3500, filed 6/28/99, effective 7/1/99. Statutory Authority: RCW 74.08.090, 42 U.S.C. 1395 x(v), 42 C.F.R. 447.271, 447.11303, and 447.2652. WSR 99-06-046, § 388-550-3500, filed 2/26/99, effective 3/29/99. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-3500, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-4600
Hospital selective contracting program. [WSR 11-14-075, recodified as § 182-550-4600, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-12-040, § 388-550-4600, filed 5/30/07, effective 7/1/07; WSR 06-08-046, § 388-550-4600, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050, 74.08.090. WSR 05-12-132, § 388-550-4600, filed 6/1/05, effective 7/1/05. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-4600, filed 12/18/97, effective 1/18/98.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-5125
Payment methodâPsychiatric indigent inpatient disproportionate share hospital (PIIDSH). [WSR 11-14-075, recodified as § 182-550-5125, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-14-090, § 388-550-5125, filed 6/29/07, effective 8/1/07; WSR 06-08-046, § 388-550-5125, filed 3/30/06, effective 4/30/06.] Repealed by WSR 14-16-019, filed 7/24/14, effective 8/24/14. Statutory Authority: RCW 41.05.021, 41.05.160, Public Law 111-148, 42 C.F.R. § 431, 435, and 457, and 45 C.F.R. § 155.
182-550-6350
Outpatient sleep apnea/sleep study programs. [WSR 11-14-075, recodified as § 182-550-6350, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-13-100, § 388-550-6350, filed 6/20/07, effective 8/1/07. Statutory Authority: RCW 74.08.090, 74.09.730, 74.04.050, 70.01.010, 74.09.200, [74.09.]500, [74.09.]530 and 43.20B.020. WSR 98-01-124, § 388-550-6350, filed 12/18/97, effective 1/18/98.] Repealed by WSR 13-07-029, filed 3/13/13, effective 4/13/13. Statutory Authority: RCW 41.05.021.
182-550-7050
OPPSâDefinitions. [WSR 11-14-075, recodified as § 182-550-7050, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.09.500, and 74.09.530. WSR 10-08-023, § 388-550-7050, filed 3/30/10, effective 4/30/10. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 2009-11 Omnibus Operating Budget (ESHB 1244). WSR 09-12-062, § 388-550-7050, filed 5/28/09, effective 7/1/09. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-13-100, § 388-550-7050, filed 6/20/07, effective 8/1/07; WSR 04-20-061, § 388-550-7050, filed 10/1/04, effective 11/1/04.] Repealed by WSR 14-12-047, filed 5/29/14, effective 7/1/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.
182-550-7100
OPPSâExempt hospitals. [WSR 11-14-075, recodified as § 182-550-7100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 2009-11 Omnibus Operating Budget (ESHB 1244). WSR 09-12-062, § 388-550-7100, filed 5/28/09, effective 7/1/09. Statutory Authority: RCW 74.08.090, 74.09.500. WSR 07-13-100, § 388-550-7100, filed 6/20/07, effective 8/1/07; WSR 04-20-061, § 388-550-7100, filed 10/1/04, effective 11/1/04.] Repealed by WSR 14-14-049, filed 6/25/14, effective 7/26/14. Statutory Authority: RCW 41.05.021 and chapter 74.60 RCW.