Fiscal Watch – February 21, 2024

The Senate released its proposed 2024 budget Sunday evening, Feb. 18, and the House released its proposed 2024 budget Monday, Feb. 19 at noon. Over the next couple of weeks, the two chambers will work together to craft a final budget. The legislative session adjourns March 7. 

In last year’s 2023-2025 biennial budget, we saw unprecedented investments in important areas for hospital and health care, such as the hospital Safety Net Assessment Program and investments to help with complex discharge patients. Given the supplemental session and the previous historic funding, we expected to have a much smaller budget this year. That said, WSHA is disappointed some of our important priorities were not funded in these budgets. These priorities included long-term care slots for complex discharge patients who are undocumented, rural labor and delivery sustainability, and Medicaid coverage of partial hospitalization/intensive outpatient treatment programs for adults.  

We are pleased that both budgets funded the Washington Reproductive Access Alliance for public hospital districts and a new residential treatment facility for children/youth with developmental disabilities and complex behaviors, and the House provides some funding for distressed hospital grants. 

For more information and link to a side-by-side comparison of the proposed House and Senate budgets, see our recent Inside Olympia. (Andrew Busz, andrewb@wsha.org)

The Health Care Authority (HCA) is currently accepting applications for $10 million in distressed hospital grant (DHG) funds as outlined in RCW 74.60.100 for calendar year 2024. Completed applications must be submitted to HCA by March 8, 2024. The email address for submission is in the application.

The grant funds will be made available once CMS approves the new Safety Net Assessment proposal, which will likely be in March or April of 2024. HCA is proactively moving forward with the application process to not delay processing of the application and disbursement of funds once conditions are met.
 
How to apply:

• Download the application and review the qualifying criteria;
• Complete the application, including all requested attachments; and
• Return the electronically signed application to the email listed in the application.

(Andrew Busz, andrewb@wsha.org)

The Washington State Health Care Authority’s February update to the Medicaid Inpatient Hospital Billing Guide includes instructions for billing covered ancillary services that are paid separately and in addition to the per diem administrative day payment. The separate payment applies to services provided on or after January 1, 2024. The billing guide lists the services and revenue codes that are eligible for separate payment, beginning on page 86.

The separate payment from the HCA and Medicaid MCOs is required by Senate Bill 5103, passed during the 2023 Legislative Session. This bill was one of WSHA’s legislative priorities for the 2023 legislative session. (Andrew Busz, andrewb@wsha.org)

In 2023, the Legislature enacted E2SHB 1357 to modernize prior authorization processes. The law shortens prior authorization determination timelines, adds standards for clinical review criteria, and requires carriers to use certain Application Programming Interfaces (APIs) for prior authorization processes. Over time, the changes are expected to significantly reduce delays in care that occur because of prior authorization processes.

The Office of the Insurance Commissioner (OIC) has provided an implementation update and is soliciting comments to inform its upcoming report to legislators. Any comments must be submitted to Policy and Legislative Affairs on or before February 28, 2024. WSHA plans to submit comments supporting current implementation and efforts to align state and federal requirements.

The changes to prior authorization timelines and clinical review criteria apply to health plans issued on or after January 1, 2024. However, E2SHB 1357 was passed in anticipation of and prior to finalization of federal rules regarding APIs. As a result, there are some differences between the state law and federal rules to be resolved. These differences are identified in the implementation update. (Andrew Busz, andrewb@wsha.org).

The Washington Vaccine Association (WVA) has developed and announced a notification process for hospitals to report WVA supplied vaccines provided during an inpatient stay. The new process was developed by a Hospital Billing Workgroup comprised of hospitals, payers, WA Department of Health staff, and WVA staff. Hospitals should be compliant with the new process by July 1, 2024.

The new process is intended to address the issue of allocating Dosage-Based Assessments (DBAs) among carriers for WVA funded vaccines provided on an inpatient basis. The assessments fund bulk purchasing of pediatric vaccines and immunotherapies distributed to and provided by hospitals and providers that participate in the WVA program. Under the new process, hospitals will issue an 837 or CMS-1500 type transaction to the appropriate carrier or third-party administrator, but it will be for reporting of DBAs rather than claims payment.

Details are in the WVA Inpatient Billing Guide. (Andrew Busz, andrewb@wsha.org).