Safety Net Assessment Program Underway: WSHA Requested HCA Fix Agreements

September 2, 2015

At the very end of the 2015 legislative session and after an extraordinary amount of negotiation and fine-line review, both the House and the Senate passed, and the Governor signed, HB 2151, a new Hospital Safety Net Assessment bill that meets the parameters established by the WSHA Board of Trustees.

Operationally, the program will function in the same manner as the program for State Fiscal Years 2014 and 2015, with payments to hospitals through a combination of quarterly direct payments from HCA to hospitals, quarterly payments from managed care plans, small rural DSH payments, and access payments. HCA sent assessment invoices for the new program to hospitals August 31, with the first quarterly assessment payments from hospitals to HCA due the end of September. For State Fiscal Year 2016, the assessment rates are $344 per non-Medicare day for prospective payment hospitals, $67 per non-Medicare day for psychiatric and rehabilitation hospitals, and $10 per non-Medicare day for critical access hospitals. The timing of payments and the collection of assessments is timed under the program  to minimize cash flow issues, with the first of the quarterly direct HCA payments and payments from managed care plans due to be paid to hospitals by the end of each quarter, prior to the collection of the assessments for the period. WSHA staff are working with HCA to ensure the timing of the program functions as designed.

One of the protections in the Safety Net bill is a provision that requires HCA to offer hospitals an agreement giving them remedies should the state reduce payments under the program. HCA sent agreements for the 2015-2017 biennium to hospitals late last week. While the contract is consistent with the format of the contracts that were in place for the 2013-2015 biennium, WSHA legal staff identified some incorrect references to key provisions of the statutes in the new contracts. After further review, HCA determined that the contract language needs to be revised.

The HCA currently anticipates that it will provide a revised contract to your organization within the next couple of weeks. Please do not sign and return the contract that was recently provided. If you have already submitted a signed contract, the HCA will refrain from countersigning as a new contract will be issued. (Andrew Busz,

Exchange Sees More Plan Competition for 2016 Open Enrollment

Competition on the Health Benefits Exchange’s individual market will increase in 2016 as three new insurers participate. All 39 counties now have at least four insurers participating on the Exchange. New entries include Health Alliance Northwest Health Plan, Regence Blue Shield, and United Healthcare of Washington. A total of 12 health insurers selling 136 plans, 46 more than 2015, will be available to consumers purchasing individual health insurance through the Exchange. The companies requested an average rate change of 5.4 percent, but 4.2 percent was approved over 2015 premiums. The Office of the Insurance Commissioner is still reviewing filings for Coordinate Care. Open enrollment runs from November 1, 2015 to January 31, 2016 with coverage starting on January 1, 2016.

Starting this November under the Affordable Care Act, Washington Healthplanfinder Business will expand its coverage from businesses of up to 50 employees to larger businesses of up to 100 employees. Washington Healthplanfinder Business will expand its statewide coverage this year with two insurance carriers, Moda Health and UnitedHealthcare, and 47 plans available. Kaiser Permanente will continue to offer health plans to small businesses in Clark and Cowlitz Counties. To learn more about what is offered on the Exchange for individuals and businesses, click here. (Chelene Whiteaker,

Department of Health Considers Rule Changes Regarding Ambulatory Surgical Facilities

The Washington State Department of Health Certificate of Need program is in the beginning stages of rulemaking on two important issues affecting ambulatory surgical facilities. First, the Department is considering when the expansion of a Certificate of Need-approved ambulatory surgical facility results in a new healthcare facility needing a new certificate of need. Second, the Department proposes to update the need forecasting methodology and standards for these facilities. Both rules could have substantial impacts on the way the Department regulates these facilities and could result in regulations that disadvantage hospital-based versus free-standing facilities.

One suggestion under discussion is to exclude existing hospital facilities in the bed need methodology for independent facilities, under the notion that hospital-based facilities are more expensive and may not be direct equivalents. WSHA would strongly oppose such a consideration, as it ignores current capacity and could undermine hospital facilities that provide services to more complex patients than independent facilities. WSHA is actively engaged with the Department on this issue and strongly encourages hospital participation. The next meeting on the Ambulatory Surgical Facilities rulemaking is scheduled for Wednesday, September 16.  Information on the Department’s rulemaking activities and meeting locations can be found here.  (Zosia Stanley,

WSHA Comments on Calendar Year 2016 Outpatient Medicare Rule, Short Inpatient Hospital Stays

August 31, WSHA submitted comments to the Center for Medicare & Medicaid Services’s (CMS) proposed rule for Medicare outpatient prospective payment hospital services for calendar year 2016. In its comments, WSHA opposed CMS’s proposal to cut outpatient conversion factors by 2 percent to compensate for alleged duplicate lab payments, and also opposed the continuing 0.2 percent reduction to inpatient rates due to transition to the Two-Midnight rule.

WSHA supported CMS’s proposal for short stay inpatient reviews to be performed by quality improvement organizations (QIOs) rather than the recovery audit contractors (RACs). Under the proposal, hospitals with high denial rates can be referred by the QIOs to the RACs for recoupment. WSHA voiced concerns that the QIOs need to be given sufficient flexibility to approve exceptions to the Two-Midnight rule and that CMS needs to provide protections to hospitals during the transition period. (Andrew Busz,

Is Your Hospital’s Charity Care Policy Up to Date on the Department of Health Website?

State law require hospitals to submit charity care policies, procedures, and sliding fee schedules to the Department for review and approval no later than 30 days before adoption by the hospital. The Department posts current approved charity care policies on itshospitals policies page. Several hospitals have contacted WSHA to note that the charity care policies posted on the Department’s webpage do not reflect the most current versions the hospitals submitted to the Department. WSHA is working with the Department and hospital members to address this issue.  WSHA encourages hospitals to check whether their charity care policies are up-to-date and contact WSHA if they are not.  (Zosia Stanley,


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