Washington Administrative Code
Title 182 - Health Care Authority
ALL PAYER HEALTH CARE CLAIMS DATABASE
Chapter 182-70 - All payer health care claims database
FEE SCHEDULES
Section 182-70-570 - Process to modify fee schedules

(1) Fee schedules shall be reissued no less frequently than on an annual basis. The reissuance of the fee schedule can include maintaining the fee schedule without modification, modifying the fee schedule, or a combination of these two actions.

(2) The lead organization shall review fee schedules at least once every year. Annual period shall be from the date upon which the fee schedule is adopted. The review shall include whether any fee should be changed, removed from the schedule, or new fees added. The lead organization must maintain documentation that supports the recommended changes from the review of the fee schedule.

(3) The lead organization must present the changes, supporting documentation, and proposed modifications to the fee schedule to the data policy committee for review and feedback. The lead organization must provide any other available data requested by the DPC that supports the proposed modifications to the fee schedule.

(4) The DPC must review the changes, supporting documentation, and proposed modifications to the fee schedule and adopt recommendations, including the basis for each recommendation, as to whether the changes should be accepted and the modified fee schedule approved by the authority. The DPC must provide the recommendations to the lead organization for its consideration.

(5) The lead organization must review the DPC recommendations and make any changes to the recommendations and proposed modifications to the fee schedule based on the recommendations. The lead organization must document which recommendations it implemented into the fee schedule. For those recommendations that the lead organization did not act upon, the lead organization must document the reasons why each recommendation was not accepted.

(6) The lead organization must provide the authority the proposed modifications to the fee schedule, as modified, with supporting documentation, the DPC recommendations, and the reasoning for why the lead organization did not make changes for any recommendation not accepted. The lead organization must provide any other available data requested by the authority that supports the changes and proposed modified fee schedule provided to the authority.

(7) The authority shall post on the agency website the recommendations and proposed modifications to the fee schedule, and solicit public comment for thirty days. The authority may also convene a stakeholder meeting to provide an opportunity for interested parties another avenue to give feedback on the draft fee schedule. If the authority decides to hold a stakeholder meeting, the meeting may be in person, by telephone or other electronic means, as determined by the authority.

(8) After the comment period, the authority will review all the stakeholder feedback, recommendations of the DPC, and any data received from the lead organization and make a final determination regarding the fee schedule. The authority shall provide the final determination to the lead organization, publish the final determination on the agency website, and send notification through the authority listserv or other electronic means.