The Health Care Authority (HCA) recently completed changes to WAC 182-550-2900 and 182-550-3000 to support the change to readmissions payment policy that went into effect January 1, 2018. Last fall, WSHA successfully advocated for a reasonable new policy that includes exclusion criteria and parameters to be used by the managed care organizations. HCA also repealed WAC 182-550-3840, which previously allowed HCA to apply an inpatient payment rate penalty to hospitals that had a higher than expected readmissions based on a 3M software program. The rate penalties were rescinded as of January 1, 2018 and replaced by a policy involving review and possible denial of individual readmission claims.
Please contact WSHA if you believe claims are being denied inconsistent with the policy. There will be additional rulemaking activity to reference the policy in HCA’s rules regarding utilization review. For more information, see our previous Bulletin and an informational webcast recording. (Andrew Busz, email@example.com).