OLYMPIA – A massive recodification of Washington state’s Medicaid operational guidelines has won the approval of the federal government, and the rewrite may now be used by other states undertaking the same task at the direction of federal officials.

Washington and other states’ “Medicaid State Plan and Amendments” – known as “SPAs”- form the operational basis for the federal-state Medicaid partnership. But collectively, they also became an electronic amalgam over the years as changes, rewritten rules, pilot projects and waivers were added to previous guidelines. The federal government posts State Plans and Amendments on the Internet, but they have been out-of-date and difficult for providers, policymakers and stakeholders to read.

Washington’s rewrite project began in the Balanced Budget Act of 1997, in which Congress indicated that after August 2003 federal matching funds would only be available to each state for Medicaid services administered by them and that those services and related payment methods must be clearly identified in the State Plan.

The State of Washington Medical Assistance Administration (MAA) in the Department of Social and Health Services, which administers Washington’s Medicaid Program, were among the first staffs to undertake the review, revision and reformatting of its State Plan to meet those requirements – an Augean job that fell to Larry Linn, an analyst in the Hospital Rates Office of the Division of Business and Finance (DBF) in MAA.

Linn won his supervisors and federal officials praise for carrying through on the difficult assignment.

“I couldn’t have done this by myself,” Linn said. “I received superb help and guidance from a myriad of Medicaid program managers throughout MAA and the other DSHS administrations that coordinate federally funded Medicaid programs.”

Linn, with a background in rates and tracking hospital finances, began the project in the fall of 2002 by putting together contacts across DSHS and in federal health agencies to help collect the information he needed. Then he created a strategy for identifying all the covered services – reviewing the existing Medicaid State Plan script, and revising the descriptions, service limitations and payment methods when needed.

“Part of the project was to identify all of the categorically needy and medically needy services covered by the State of Washington; the other half was identifying and defining all of our payment methods”, Linn said. “And by services, we didn’t just mean MAA, but all of the different ways Medicaid funds are used in DSHS, to pay for covered services, including but not limited to those provided by physicians, hospitals, mental health, home health, hospice, children’s programs, pharmacies, long-term care, and more.”

The revisions were dubbed “the mega-SPA” by federal reviewers when they received Linn’s initial draft in the late summer of 2003. It required more than 114 additional pages to clarify, reorganize and redraft the original documents and all of their amendments over the years.

Finally, after more than a year of reviews – including conference calls, more Linn redrafts and corrections – MAA was notified by the federal Centers for Medicare and Medicaid Services (CMS) this month that the “mega-SPA” had been approved.

CMS expects to post the revised state plans on a federal site. MAA officials said that Linn’s revamp will assist in posting the state’s own up-to-date version in the future. That would be more convenient for state providers and stakeholders — and easier to keep up to date, something the state could not even attempt before.

“As the first state to get through this process, we owe Larry a great deal for sticking to the job in difficult, sometimes thankless times,” said Carolyn Adams, Chief of the Hospital and Managed Care Rates Office of the Division of Business and Finance. “He also worked unselfishly, coordinating a broad team of people from other units and the federal regional office of CMS. They all share the credit and deserve our thanks.”