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Chapter 246-319 WAC

Last Update: 6/23/10


WAC Sections




Purpose: This chapter implements RCW 43.70.125 allowing the department to assess a fee for the department to conduct an initial medicare survey. An applicant for medicare certification must pay the fee whenever the department has not received sufficient funding from the Centers for Medicare and Medicaid Services.
(1) Definitions. The definitions in this section apply throughout this section unless the context clearly requires otherwise.
(a) "Initial medicare certification survey" means an on-site visit conducted by department staff for the purpose of determining compliance with medicare regulations. This survey is required before a health care provider can receive medicare or medicaid reimbursement.
(b) "Insufficient funding" means the department has spent or encumbered eighty percent of the total available Title XVIII medicare grant award to complete required certification activities.
(c) "Sufficient funding" means the department has received, through the Title XVIII medicare grant, funds intended to fully reimburse the department for all required certification activities in the annual grant.
(d) "Title XVIII grant priority" means the four tier system established by the Centers for Medicare and Medicaid Services that guides state agencies to complete certification activities in accordance with statutory mandates and Centers for Medicare and Medicaid Services policy.
(e) "Title XVIII medicare grant" means the grant authorized in Section 1864(a) of the Federal Social Security Act and administered by the Centers for Medicare and Medicaid Services to the department to fund the annual certification activity requirements.
(2) The department will not charge a fee to conduct initial medicare certification surveys as long as sufficient funding exists.
(3) Notice of insufficient funding. When insufficient funding exists to complete the Title XVIII grant priority, the department will:
(a) Issue a notice to all potentially affected health care providers and provider associations known by the department; and
(b) Charge a fee according to the fee schedule in subsection (4) of this section to all applicants who apply for initial medicare certification surveys after the notice is issued.
(4) Fees. The following fees will be charged to an applicant to conduct an initial medicare certification survey when there is insufficient funding:
Ambulatory surgery center
Critical access hospital
End stage renal disease facility
Home health agency
Hospice agency
Rehabilitation facility
Rural health clinic
Transplant hospital
[Statutory Authority: RCW 40.70.125. WSR 10-13-169, ยง 246-319-990, filed 6/23/10, effective 7/24/10.]