Health Care Authority to Adjust November 1 Rate Cut for PPS Hospitals

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 >>

Mental health capital grants announced

Recognizing the continuing need for involuntary inpatient mental health services, the state Legislature funded $32 million in the 2015-2017 budget for capital grants to assist with construction or renovation for inpatient and crisis mental health services.... Read More >>

Hospital financial assistance webinar recording available

WSHA hosted a webinar Nov. 23 on important information about development of a standard financial assistance application form and standard financial assistance communication plan for Washington State hospitals. Please contact Cliff Duggan if you are interested in receiving a copy of the recorded webinar. You can reach Cliff at or (206) 216-2517. WSHA recommends every hospital review this the application and communication plan. These documents are still in draft form, and WSHA welcomes feedback by Dec. 1.... Read More >>

Clinical experts needed for state Disaster Medical Advisory Committee

On Jan. 1, 2015 the Washington State Department of Health launched a planning effort to create a state-level structure for clinical engagement on issues related to Crisis Standards of Care during an emergency of state-level importance. The need for regional medical surge planning that incorporates the ability to implement regional crisis standards of care is recognized by many local, state and federal agencies.... Read More >>

CMS Announces Recovery Audit Contractor Program Improvements

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 >>

WSHA Provides Rate Appeals Guidance and Webinar Slides for November 1 Medicaid Cuts

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 >>

WSHA to Help Represent Clinic Interests in Payment Redesign

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 >>

CMS Implements Bundled Payments for Hip and Knee Replacements; WSHA Provides Resources

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 >>

Standardized Financial Assistance Application and Communication Plan

This bulletin provides information on two financial assistance documents that WSHA will recommend every hospital adopt. WSHA intends to recommend that all hospitals adopt the standard financial assistance application and communication plan once these documents are finalized and approved by the WSHA Board. These documents focus on the patient-facing portions of the financial assistance process and do not dictate the levels of financial assistance offered at individual hospitals.... Read More >>

Sample Language for Appeal of Medicaid PPS Rates Effective November 1

The purpose of this bulletin is to provide Prospective Payment System (PPS) hospitals with information should they wish to appeal changes to their Medicaid hospital payment rates effective November 1. WSHA recommends they file a rate appeal with the Health Care Authority (HCA) within 60 days of the date of their rate notice to protect their right to a rate correction if it is determined the new rates are in error.... Read More >>

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