Weekly Report Details

Vol. 36, No. 36: September 23, 2011

New Medicaid Emergency Room Benefit Limit Resources Available


The Health Care Authority, the state agency administering Medicaid, has posted materials about the emergency room visit limit on its website. The information available includes links to the HCA "non-emergency" diagnosis list, the exclusions list, and the expedited prior authorization criteria. In the coming days the HCA plans to also post billing instructions.

Despite claims made in an HCA press release, WSHA and its partners during the negotiations, the Washington State Medical Association and the Washington Chapter of the American College of Emergency Physicians do not agree that the list represents non-emergency diagnoses.

Additional information about the emergency room benefit limit is also available on the WSHA website. This includes a link to the WSHA webcast on the benefit limit and links to state documents and other helpful information. (Ed Phippen, edp@wsha.org)

Charity Care Laws Remain in Place

Hospitals should be aware that there is an incorrect statement in an HCA press release about the benefit limit. The press release states, "The fourth and subsequent non-emergency visits will not be covered by Medicaid, and hospitals will be permitted to bill clients for those services" (emphasis added). The state has not changed its charity care laws. Most patients who qualify for Medicaid will also qualify for charity care under state law. As you develop billing procedures related to this benefit limit, please consult your hospital charity care policies and internal experts regarding charity care. Additional information about charity care is available on the WSHA website. (Claudia Sanders, claudias@wsha.org)

State's FY2011-13 Budget Changes Access to Dental Services for Some Clients

Effective October 1, 2011, the dental benefit for developmentally disabled clients will change. To be eligible for services a developmentally disabled client must fall into one of the following categories:

  • Women who are pregnant or who are in their 60-day postpartum period;
  • Adults enrolled in 1915 (c) Home and Community Based waiver programs;
  • Enrollees in the "Roads to Community Living" (RCL) grant;
  • Residents in either Intermediate Care Facility/Intellectually Disabled facility, Residential Habilitation Center, Nursing Home or State Veteran's home.

The agency has developed a decision-making tool for providers to use to determine if a Medicaid-covered adult client meets one of these criteria and is eligible to receive the restored set of dental services. More details are available. (Jean Engler, jeane@wsha.org)

Proposed Rules on Medication Administration for Health Care Assistants

The 2011 legislature passed Substitute House Bill 1304 which amended the scope of practice for health care assistants so that only health care assistants certified in categories C or E may administer certain over-the-counter drugs (e.g., Benadryl, acetaminophen, ibuprofen, aspirin, Neosporin) and certain legend drugs (e.g., kenalog, hydrocortisone cream, raglan, compazine). The administration of these drugs is limited to oral, topical, rectal, otic, ophthalmic, or inhaled routes and must be pursuant to a written order of a supervising health care practitioner.

As required by the legislation, the Department of Health, Health Care Assistant Program has filed a rule to specify that no other categories but those health care assistants certified in C or E can administer the drug. The formal adoption hearing is scheduled for October 14, 2011 at 9:00 a.m. at the Department of Health offices in Tumwater. Comments may be submitted by e-mail, fax or on the website until close of business on October 14, 2011.

Licensed health practitioners, such as physicians, nurses, and naturopaths, may delegate certain functions to health care assistants such as administering skin tests, injections, and performing blood withdrawals. Health care assistants are divided into seven different categories, A through G, based on educational, training, and experiential requirements. (Brenda Suiter, brendas@wsha.org)

Resources & Opportunities

PAC Campaign Underway: Appreciation Dinner Approaches

The Washington Hospital Political Action Committee's (PAC) 2011 campaign is underway with a goal of raising $150,000. As in past years, contributors of $350 or more will be thanked with an invitation to attend the PAC Appreciation Dinner at the Seattle Aquarium. This fantastic networking event is held the first evening of the WSHA Annual Meeting on October 12. This year we will have tours of the aquarium available after dinner. To reserve your spot, please contact your PAC liaison or Maria Harwood at mariah@wsha.org or (206) 577-1840. (Brenda Suiter, brendas@wsha.org)

WSHA Annual Meeting Highlights for Members of Governing Boards

Annual mtg imageWSHA's upcoming Annual Meeting on October 12-13 features several special elements specifically for members of hospital and health system governing boards:

  • A concurrent session for board members will focus on "The Nuts and Bolts of Building Relationships with Your Legislators." With more dire forecasts for Washington State revenue in the coming year, it is even more important that board members are comfortable explaining the value of their organization to their local legislators.
  • The Trustee Breakfast topic, "From Stigma to Hope," features a panel of experts sharing insights and experiences on how the stigma of mental health is a pervasive phenomenon. One in four people struggles with a mental health issue at some point in their lives. This could include patients, co-workers and hospital leaders, with major implications for our hospitals and health systems.
  • Three tables will be set aside at the Opening Luncheon to allow board members to get to know other board members from around the state.

Governing Board Members are encouraged to attend the WSHA member meeting on Wednesday morning, October 12 as well. Please register online or use the registration form in your Annual Meeting brochure!

The WSHA room block at the Edgewater Hotel has been extended to Monday, September 26. To obtain WSHA's reduced rate, you must ask for the "Washington State Hospital Association Room Block" and make your reservation by Monday, September 26. Contact The Edgewater Hotel - Hotel Direct: (206) 728-7000 or Reservations: (800) 624-0670. (Deborah Swets, deborahs@wsha.org)

Member News & Awards

MultiCare Tacoma General Hospital and Mary Bridge Hospital Receive Award

Today Washington State Department of Health Secretary Mary Selecky presented the Warren Featherstone Reid Award to MultiCare Tacoma General Hospital and Mary Bridge Pediatric Heart Center in Tacoma for their pioneering work screening newborns for heart defects.

Since 2008, Tacoma General has screened more than 7,000 day-old babies with a painless test that measures oxygen in the blood. Called pulse oximetry, the test diagnoses heart defects so they can be treated early at the Mary Bridge Pediatric Heart Center. Undetected heart defects are a leading cause of infant deaths.

The award honors health care providers and facilities for exceptional quality and value in the delivery of health services. It is named for a longtime Senate staff member, Featherstone Reid, who worked for U.S. Senator Warren Magnuson, promoting better health policies. Among many other policies and projects, he helped start the Medicare and Medicaid programs. The award in his name was established by the 1994 Legislature. (Brenda Suiter, brendas@wsha.org)

Swedish Enters Agreement with Microsoft Corporation

Swedish Health Systems plans to implement Microsoft Amalga, a health intelligence platform, to improve care coordination across organizational boundaries and help manage population health as patients move among care settings. The adoption of Amalga is designed to strengthen the health system's relationships with patients and providers across the community, help improve patient transitions and care quality, and position Swedish for growth in the era of accountable care.

"Health-care reform requires health systems to do more with less," said Swedish President and CEO Rod Hochman, M.D. "Amalga is a key technology enabler that will allow us to efficiently combine data stored in disparate IT systems across multiple facilities and use it to uncover opportunities to improve performance and the quality of patient care across the care continuum."

Microsoft Amalga is used at other renowned health-care institutions in the United States including New York-Presbyterian Hospital, Johns Hopkins Health System, Norton Healthcare, Providence Health & Services and St. Joseph Health System. (Beth Zborowski, bethz@wsha.org)    

Let's Hear It For Our Disaster Readiness Rep's!!!

For the better part of nine years, every hospital has participated in the regional preparedness planning. Each has provided one representative who attends at least one monthly meeting, attends and coordinates training(s), submits cumbersome, detailed reimbursement information to take advantage of the federal funds available, and, in many -- if not most -- cases, spends at least some of their own personal time to get the job done in the best way possible. If you are reading this, and you haven't connected with that person in your facility doing this incredible work or you're not sure exactly who's standing in the weeds getting it done, please take a moment to look at the list and let that person know the hospital appreciates what they are doing!!! Thanks! (Peggi Shapiro, peggis@wsha.org)


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