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PDFWAC 182-55-040

Health care authority's implementation of final coverage determinations.

This section applies to all final coverage determinations made after August 1, 2016.
(1) The health care authority reviews the final coverage determination for conflicts identified in RCW 70.14.120 (1)(a) and (b).
(2) The health care authority reviews whether the health technology review process meets the requirements in this subsection before compliance by the health care authority's state-purchased health care programs. The review includes whether the:
(a) Notification of the health technology selected for review was made on the centralized, internet-based communication tool as required by RCW 70.14.130 (1)(a);
(b) Health technology assessment provided to the committee met the requirements in RCW 70.14.100(4) and WAC 182-55-055;
(c) Health technology assessment was published on the centralized, internet-based communication tool at least fourteen calendar days before the committee's consideration of the health technology assessment;
(d) Health technology assessment was considered by the committee in an open and transparent process, as required by RCW 70.14.110 (2)(a);
(e) Committee provided an opportunity for public comment prior to the committee's final coverage determination decision;
(f) Committee acknowledged public comment timely received after publication of the committee's draft coverage determination and before the committee's final coverage determination decision;
(g) Committee's final coverage determination specifies the reason or reasons for a decision that is inconsistent with the identified decisions made under the federal medicare program and expert treatment guidelines, including those from specialty physician and patient advocacy organizations, for the reviewed health technology; and
(h) Committee meetings complied with the requirements of the Open Public Meetings Act as required by RCW 70.14.090(3).
(3) After the health care authority completes its reviews under subsections (1) and (2) of this section, it establishes an implementation date for each of the health care authority's state-purchased health care programs and publishes the implementation dates on the health care authority's website.
(4) The health care authority's implementation of a final coverage determination can be reviewed as other agency action under RCW 34.05.570(4). A petition for review must be filed in superior court and comply with all statutory requirements for judicial review of other agency action required in chapter 34.05 RCW.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-18-023, § 182-55-040, filed 8/26/16, effective 9/26/16. Statutory Authority: RCW 41.05.013, 41.05.160, and 70.14.090. WSR 06-23-083 (Order 06-10), § 182-55-040, filed 11/13/06, effective 12/14/06.]
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