WSHA Responds to HCA Hospital-Based Clinic Cut Proposal

November 12, 2014

As part of the process to develop a budget proposal for the upcoming biennium (State Fiscal Years 2016 and 2017), the Health Care Authority’s (HCA’s) recommendations to the Governor included a cut to the Medicaid payment rates for hospital-based clinics of $42 million over the two-year period. (See a hospital-specific estimate of the impact of this cut.) While we do not know if the Governor will include these in his budget, the agency’s recommendations mean they are likely to be discussed seriously during the upcoming session.

The Washington State Hospital Association (WSHA) has sent hospital leaders an Inside Olympia encouraging them to contact their legislators.  It urges them to tell the Governor not to include this cut in his budget proposal, and let them know how important these payments are to our hospitals’ ability to provide care in their communities.

WSHA will be engaged with political leaders to support adequate payment for hospital clinic services to protect access to services for Medicaid patients. To help us in this effort, WSHA will collect information from hospitals to show the impact to care in your community. Hospitals will see a survey from us shortly. (Andrew Busz,

Are You Ready? WSHA Hosts Exchange Outreach and Enrollment Web Conference on Friday, November 14, 2014 12:00-1:00 p.m.

The second open enrollment period for the Washington Healthplanfinder runs from November 15, 2014 through February 15, 2015. Hospitals have a significant role in assisting their patients to enroll in affordable coverage. Please join us for a webcast 12:00-1:00 p.m. on November 14 to learn from the success of the first open enrollment period in 2013-2014, and also to hear about some important changes for this next open enrollment period, such as the ability to make appointments with the call center, hospital presumptive eligibility, and premium sponsorship.
To join the training session
1. Go to
2. Enter your name and email address.
3. Enter the session password: healthplans
4. Click “Join Now”.
5. Follow the instructions that appear on your screen.

For more information, contact Barbara Gorham at

State Announces New RSAs as Backbone for Reform 

On November 4, HCA and the Department of Social and Health Services announced its designation of 10 Regional Service Areas (RSAs) as the new structures for an integrated physical and behavioral health delivery system. These areas will be used for managed care purchasing, starting with some early adopter areas in SFY 2016 and moving to a full adoption by the state in 2020. Most of the areas’ boundaries follow the recommendations stemming from the Adult Behavioral Health Task Force, except for the creation of a new North Central Washington area. 

The new North Central area was originally part of the Spokane designation but is now recognized as a separate area, served by the Spokane Regional Service Network for mental health needs under a transitional arrangement. The Association of Washington Public Hospital Districts working with community hospitals and state officials played a significant role in creating this new region – which more fully reflects the organization of the acute care health structure in the region.

The new regions will also serve as the service areas for the state’s creation of Accountable Communities of Health – regional collaborative that the state sees as playing an important role in transforming health care at the local level. (Claudia Sanders,

HCA Identifies Medicaid Outpatient Hospital Payment Issues, More Information to Come

HCA has identified a number of issues related to the new outpatient Enhanced Ambulatory Payment Group (EAPGs) methodology put in place for prospective payment hospitals on July 1, 2014. The issues are related to pricing configuration in the ProviderOne system and are causing some outpatient hospital Medicaid services to underpay or pay zero. WSHA is working with HCA on a communication detailing the issues and timelines for correction and adjustment of incorrectly processed claims. Since Medicaid managed care plans may be using vendor software or programming their own systems to implement EAPGs, it is important to identify any technical or HCA payment policy interpretation issues as soon as possible so they can be communicated and addressed by HCA. Please let us know if you believe you are experiencing payment errors. (Andrew Busz,


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