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PDFWAC 388-835-0585

What requirements apply to prospective reimbursement rates for new providers?

(1) A prospective reimbursement rate for a new provider must be established within sixty days after DSHS receives a properly completed projected budget from the provider. The effective date of the reimbursement rate must be the same as the effective date of the contract.
(2) The prospective reimbursement rate must be based on the:
(a) Provider's projected cost of operation;
(b) Costs and payment rates of the prior provider, if any; and/or
(c) Costs and payment rates, taking into account applicable lids or maximums, of other providers in comparable circumstances.
(3) If DSHS does not receive a properly completed projected budget at least sixty days before the contract's effective date, a preliminary rate, based on information from former and/or comparable providers, will be prepared by DSHS. This preliminary rate must remain in effect until an initial prospective rate can be set.
(4) If a change of ownership takes place that does not result from an arm's length transaction, the new provider's prospective rates for administration, operations and property costs cannot exceed the former provider's rates. The former provider's rates can be adjusted, if necessary, to reflect changes in economic trends.
[Statutory Authority: RCW 71A.20.140. WSR 01-10-013, ยง 388-835-0585, filed 4/20/01, effective 5/21/01.]
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