WAC 296-23A-0221. How does the self-insurer pay for hospital outpatient services?

The self-insurer will pay for hospital outpatient services according to the following table: Hospital Type or Service Location Do percent of allowed charges (POAC) payment methods apply? Do the department's Medical Aid Rules and Fee Schedules apply to hospital outpatient radiology, laboratory, pathology, occupational therapy, and physical therapy services? Children's hospitals Yes, paid 100% of allowed charges Yes Chronic Pain Management Program Not Applicable Not Applicable Health Maintenance Organizations Yes, paid 100% of allowed charges Yes Military Yes, paid 100% of allowed charges No, paid 100% of allowed charges Veterans Administration Yes, paid 100% of allowed charges No, paid 100% of allowed charges State psychiatric facility Yes, paid 100% of allowed charges Yes Other psychiatric hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Rehabilitation hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Cancer hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes All other Washington hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Hospital Type or Service Location Do percent of allowed charges (POAC) payment methods apply? Do the department's Medical Aid Rules and Fee Schedules apply to hospital outpatient radiology, laboratory, pathology, occupational therapy, and physical therapy services? Children's hospitals Yes, paid 100% of allowed charges Yes Chronic Pain Management Program Not Applicable Not Applicable Health Maintenance Organizations Yes, paid 100% of allowed charges Yes Military Yes, paid 100% of allowed charges No, paid 100% of allowed charges Veterans Administration Yes, paid 100% of allowed charges No, paid 100% of allowed charges State psychiatric facility Yes, paid 100% of allowed charges Yes Other psychiatric hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Rehabilitation hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Cancer hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes All other Washington hospitals Yes, applies to hospital outpatient services except radiology, laboratory, pathology, occupational therapy, and physical therapy Yes Hospitals are reimbursed only for the technical component of rates listed in the fee schedules, for outpatient radiology, pathology and laboratory services. See chapter 296-23 WAC for rules on radiology, pathology, laboratory, physical therapy, occupational therapy, and work hardening services. See WAC 296-23A-700 for rules on the prospective payment system for hospital outpatient services. See WAC 296-20-132 and 296-20-135 for information on the conversion factor used for certain hospital outpatient services.