Wash. Admin. Code ch. 182-550 – Hospital Services | Midpage

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Washington Administrative Code (WAC)

Chapter 550

Wash. Admin. Code ch. 182-550

Hospital Services

HEALTH CARE AUTHORITY

182-550-1000Applicability 182-550-1050Hospital services definitions 182-550-1100Hospital care—General 182-550-1200Restrictions on hospital coverage 182-550-1300Revenue code categories and subcategories 182-550-1350Revenue code categories and subcategories—CPT and HCPCS reporting requirements for outpatient hospitals 182-550-1400Covered and noncovered revenue code categories and subcategories for inpatient hospital services 182-550-1500Covered and noncovered revenue code categories and subcategories for outpatient hospital services 182-550-1600Specific items/services not covered 182-550-1650Adverse events, hospital-acquired conditions, and present on admission indicators 182-550-1700Authorization and utilization review (UR) of inpatient and outpatient hospital services 182-550-1800Hospital specialty services not requiring prior authorization 182-550-1900Transplant coverage 182-550-2100Requirements—Transplant facilities 182-550-2301Hospital and medical criteria requirements for bariatric surgery 182-550-2400Inpatient chronic pain management services 182-550-2431Hospice services—Inpatient payments 182-550-2500Inpatient hospice services 182-550-2501Acute physical medicine and rehabilitation (acute PM&R) program—General 182-550-2521Client eligibility requirements for acute PM&R services 182-550-2531Requirements for becoming an acute PM&R provider 182-550-2541Quality of care—Agency-approved acute PM&R hospital 182-550-2551When the medicaid agency authorizes acute PM&R services 182-550-2561The agency's prior authorization requirements for acute PM&R services 182-550-2565The long-term acute care (LTAC) program—General 182-550-2575Client eligibility requirements for LTAC services 182-550-2580Requirements for becoming an LTAC hospital 182-550-2585LTAC hospitals—Quality of care 182-550-2590Agency prior authorization requirements for Level 1 and Level 2 LTAC services 182-550-2595Identification of and payment methodology for services and equipment included in the LTAC fixed per diem rate 182-550-2596Services and equipment covered by the agency but not included in the LTAC fixed per diem rate 182-550-2598Critical access hospitals (CAHs)182-550-2600Inpatient psychiatric services 182-550-2650Base community psychiatric hospitalization payment method for medicaid and CHIP clients and nonmedicaid and non-CHIP clients 182-550-2750Hospital discharge planning services 182-550-2900Payment limits—Inpatient hospital services 182-550-2950Payment limits—Provider preventable fourteen-day readmissions 182-550-3000Payment method 182-550-3381Payment method for acute PM&R services and administrative day services 182-550-3400Case-mix index 182-550-3470Payment method—Bariatric surgery—Per case rate 182-550-3600Diagnosis-related group (DRG) payment—Hospital transfers 182-550-3700DRG high outliers 182-550-3800Rebasing 182-550-3830Adjustments to inpatient rates 182-550-3850Budget neutrality adjustment and measurement 182-550-3900Payment method—Bordering city hospitals and critical border hospitals 182-550-4000Payment method—Out-of-state hospitals 182-550-4100Payment method—New hospitals 182-550-4200Change in hospital ownership 182-550-4300Hospitals and units exempt from the DRG payment method 182-550-4400Services—Exempt from DRG payment 182-550-4500Payment method—Ratio of costs-to-charges (RCC)182-550-4550Administrative day rate and swing bed day rate 182-550-4650"Full cost" public hospital certified public expenditure (CPE) payment program 182-550-4670CPE payment program—"Hold harmless" provision 182-550-4690Authorization requirements and utilization review for hospitals eligible for CPE payments 182-550-4800Hospital payment methods—State-administered programs 182-550-4900Disproportionate share hospital (DSH) payments—General provisions 182-550-4925Eligibility for DSH programs—New hospital providers 182-550-4935DSH eligibility—Change in hospital ownership 182-550-4940Disproportionate share hospital independent audit findings and recoupment process 182-550-5000Payment method—Low income disproportionate share hospital (LIDSH)182-550-5130Payment method—Institution for mental diseases disproportionate share hospital (IMDDSH) and institution for mental diseases (IMD) state grants 182-550-5150Payment method—Medical care services disproportionate share hospital (MCSDSH)182-550-5200Payment method—Small rural disproportionate share hospital (SRDSH)182-550-5300Payment method—Children's health program disproportionate share hospital (CHPDSH)182-550-5400Payment method—Public hospital disproportionate share hospital (PHDSH)182-550-5410CPE medicaid cost report and settlements 182-550-5450Supplemental distributions to approved trauma service centers 182-550-5500Payment—Hospital-based RHCs 182-550-5550Public notice for changes in medicaid payment rates for hospital services 182-550-5600Dispute resolution process for hospital rate reimbursement 182-550-5700Hospital reports and audits 182-550-5800Outpatient and emergency hospital services 182-550-6000Outpatient hospital services—Conditions of payment and payment methods 182-550-6100Outpatient hospital physical therapy 182-550-6150Outpatient hospital occupational therapy 182-550-6200Outpatient hospital speech therapy services 182-550-6250Pregnancy—Enhanced outpatient benefits 182-550-6300Outpatient nutritional counseling 182-550-6450Outpatient hospital weight loss program 182-550-6500Blood and blood components 182-550-6600Hospital-based physician services 182-550-6700Hospital services provided out-of-state 182-550-7000Outpatient prospective payment system (OPPS)—General 182-550-7200OPPS—Billing requirements and payment method 182-550-7300OPPS—Payment limitations 182-550-7400OPPS EAPG relative weights 182-550-7450OPPS budget target adjustor 182-550-7500OPPS rate 182-550-7550OPPS payment enhancements 182-550-7600OPPS payment calculation 182-550-8000Hospital safety net program (HSNP)—Purpose 182-550-8100Assessment notices—Process and timelines