296-30-090 - What are the maximum allowable fees?

296-30-090. What are the maximum allowable fees?

(1) Maximum allowable fees for medical and mental health services are published in the medical aid rules and fee schedules and the crime victims' compensation program mental health fee schedule and billing guidelines less any available benefits of public or private insurance.

(2) The percent of allowed charges for authorized hospital inpatient and outpatient services billed by revenue codes are those rates established by the department.

(3)If sufficient funding is not provided to continue payments equal to the medical aid rules and fee schedules and the crime victims' compensation program mental health fee schedule and billing guidelines, payments will be reduced based on caseload estimates and available funding. The reduced payments will not be less than seventy percent of payments provided under the fee schedules.

(4) If an unforeseeable catastrophic event results in insufficient funding to continue payments equal to the medical aid rules and fee schedules and the crime victims' compensation program mental health fee schedule and billing guidelines, payments will be reduced to not less than seventy percent of payments provided under the fee schedules to the extent the reduction in payments is necessary to fund benefits.

(Amended by WSR 18-10-083, Filed 5/1/2018, effective 6/1/2018)

Statutory Authority: Chapter 7.68 RCW. 11-22-054, § 296-30-090, filed 10/31/11, effective 12/1/11. Statutory Authority: RCW 7.68.030. 05-16-096, § 296-30-090, filed 8/2/05, effective 9/2/05. Statutory Authority: RCW 7.68.030, 7.68.080, 7.68.130. 00-03-056, § 296-30-090, filed 1/14/00, effective 2/14/00.

The following state regulations pages link to this page.