WAC 182-550-7550. OPPS payment enhancements

(1) Pediatric adjustment. (a) The medicaid agency establishes a policy adjustor to be applied to all enhanced ambulatory patient group (EAPG) services for clients under age 18 years. (b) Effective July 1, 2014, this adjustor equals one point thirty-five (1.35). (2) Chemotherapy and combined chemotherapy/pharmacotherapy adjustment. (a) The agency establishes a policy adjustor to be applied to services grouped as chemotherapy drugs or combined chemotherapy and pharmacotherapy drugs. (b) Effective July 1, 2014, this adjustor equals one point one (1.1). (3) Sole community hospitals. (a) For sole community hospital's rate enhancements, the agency multiplies the in-state hospital's specific EAPG conversion factor by a multiplier if the hospital meets all of the following criteria per RCW 74.09.5225 : (i) Be certified by CMS as a sole community hospital as of January 1, 2013; (ii) Have a level III adult trauma service designation from the Washington state department of health (DOH) as of January 1, 2014; (iii) Have less than 150 acute care licensed beds in fiscal year 2011; and (iv) Be owned and operated by the state or a political subdivisions. (b) Effective July 1, 2024, the enhancement multiplier equals 1.25. This may be adjusted in future years to account for legislatively approved increases. (See RCW 74.09.5225 ) Enhancement Multiplier by Year Provider Category Effective For the Dates 07/01/2015 - 06/30/2020 07/01/2020 - 06/30/2021 07/01/2021 - 06/30/2022 07/01/2022 - 06/30/2023 07/01/2023 - 12/31/2023 01/01/2024 - 06/30/2024 07/01/2024 Sole community hospital 1.25 1.5 1.5 1.25 1.25 1.50 1.25 Sole community hospital accepting single bed certifications N/A N/A 1.5 1.5 N/A N/A N/A Enhancement Multiplier by Year Provider Category Effective For the Dates 07/01/2015 - 06/30/2020 07/01/2020 - 06/30/2021 07/01/2021 - 06/30/2022 07/01/2022 - 06/30/2023 07/01/2023 - 12/31/2023 01/01/2024 - 06/30/2024 07/01/2024 Sole community hospital 1.25 1.5 1.5 1.25 1.25 1.50 1.25 Sole community hospital accepting single bed certifications N/A N/A 1.5 1.5 N/A N/A N/A