Washington State Insurance Commissioner Mike Kreidler plans to submit proposed legislation in the upcoming 2016 session to limit balance billing of patients for out-of-network emergency services when a patient receives care at a facility contracted as in-network with their health plan.... Read More >>

The final rule for payment of early obstetrical deliveries adopted by the Washington State Health Care Authority (HCA) includes protections requested by WSHA for patients and providers. The rule is intended to deny Medicaid payment for early elective deliveries. The final rule allows payment for deliveries prior to 39 weeks if the early delivery is medically necessary.... Read More >>

On November 1, the Washington State Health Care Authority (HCA) reduced inpatient and outpatient hospital payments to prospective payment hospitals by 8 percent in order to apply budget neutrality adjustments due to the recent rebasing of the payment systems. In response to this significant change in Medicaid rates, WSHA requested HCA and its consultant, Navigant, review the calculations and provide WSHA with data sets to enable an independent analysis.... Read More >>

After several years of frustration and advocacy, hospitals should soon see meaningful reform to the Recover Audit Contractor (RAC) program. Effective January 1, the amount of audit requests RACs will be able to request for a hospital will be reduced by three-fourths, from 2.0 percent down to 0.5 percent of the hospital’s paid Medicare claims from the previous year.... Read More >>

The Health Care Authority recently sent Prospective Payment System (PPS) hospitals notices of new Medicaid inpatient and outpatient payment rates, effective November 1. These changes are due to state calculations to ensure budget neutrality. ... Read More >>

The Washington State Health Care Authority (HCA) is beginning the process of updating the Medicaid payment methodology for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics. HCA is in the final stages of contracting with a technical assistance consultant to work with stakeholders to develop a successor to the current alternative payment methodology (APM).... Read More >>

On November 16, the Centers for Medicare & Medicaid Services (CMS) finalized its rule concerning payment of hip and knee replacements for hospitals in selected regions. The new program goes into effect April 1, 2016 and will affect hospitals in the Seattle-Tacoma-Bellevue and Portland-Vancouver-Hillsboro metropolitan service areas that provide hip and knee replacement surgery.... Read More >>

The Health Care Authority (HCA) recently sent hospitals new agreements to provide protections from reductions to regular Medicaid payment for the period when hospitals are participating in the Hospital Safety Net Assessment program. The new safety net law, passed during the most recent legislative session, requires HCA to offer hospitals an agreement giving the hospital a remedy should the state reduce payments under the program.... Read More >>

It’s that time again! Open enrollment for the Exchange’s individual market runs November 1, 2015 to January 31, 2016. Washington’s hospitals play a key role in helping patients enroll in either the Health Benefit Exchange’s subsidized health plans or Apple Health, depending on the enrollee’s income. Individuals and families can access enrollment for either program through Washington’s Healthplanfinder portal. ... Read More >>

Please join the Washington State Hospital Association, the Washington Association of Sheriffs and Police Chiefs, and the Association of Washington Cities for a webinar about important changes in Washington State law as a result of enactment of Senate Bill 5593,which went into effect July 24, 2015. This webinar is for hospital staff and staff of law enforcement entities and governing units affected by the bill. (The webinar will be recorded.)... Read More >>