WAC 388-550-4650   "Full cost" public hospital certified public expenditure (CPE) payment program.  (1) The department's "full cost" public hospital certified public expenditure (CPE) payment program provides payments to participating hospitals based on the "full cost" of covered medically necessary services and requires the expenditure of local funds in lieu of state funds to qualify for federal matching funds. The department's payments to participating hospitals equal the federal matching amount for allowable costs. The department uses the ratio of costs-to-charges method described in WAC 388-550-4500 to determine "full cost."

     (2) Only the following facilities are reimbursed through the "full cost" public hospital CPE payment program:

     (a) Public hospitals located in the state of Washington that are:

     (i) Owned by public hospital districts; and

     (ii) Not certified by the department of health (DOH) as a critical access hospital;

     (b) Harborview Medical Center; and

     (c) University of Washington Medical Center.

     (3) Payments made under the CPE payment program are limited to medically necessary services provided to medical assistance clients eligible for inpatient hospital services.

     (4) Each hospital described in subsection (2) of this section is responsible to provide certified public expenditures as the required state match for claiming federal medicaid funds.

     (5) The department determines the actual payment for inpatient hospital services under the CPE payment program by:

     (a) Multiplying the hospital's medicaid RCC rate by the covered charges (to determine allowable costs), then;

     (b) Subtracting the client's responsibility and any third party liability (TPL) from the amount derived in (a) of this subsection, then;

     (c) Multiplying the state's federal matching assistance percentage (FMAP) by the amount derived in (b) of this subsection.



[Statutory Authority: RCW 74.08.090, 74.09.500. 06-08-046, § 388-550-4650, filed 3/30/06, effective 4/30/06. Statutory Authority: RCW 74.04.050, 74.08.090. 05-12-132, § 388-550-4650, filed 6/1/05, effective 7/1/05.]