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 >>

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 >>