SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: December 8, 1999.
Purpose: To comply with the Governor's Executive Order 97-02 by rewriting the long term care (LTC) eligibility rules in a simpler, clearer, and more effective style for the regulated audience; to streamline and consolidate rules as much as possible; and to repeal rules no longer needed to manage the LTC medical assistance programs.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-513-1300 and 388-513-1310; and amending WAC 388-513-1305, 388-513-1315, 388-513-1320, 388-513-1330, 388-513-388-513-1350, 388-513-1360, 388-513-1365, 388-513-1395, 388-513-1396, 388-515-1510, and 388-315-1530.
Statutory Authority for Adoption: RCW 11.92.180, 43.20B.460, 48.85.020, 74.04.050, 74.04.057, 74.08.090, 74.09.500, 74.09.530, 74.[09.]575, 74.09.585; 20 C.F.R. 416.1110-1112, 1123 and 1160; 42 C.F.R. 435.403 (j)(2) and 1005; and Sections 17, 1915(c), and 1924 (42 U.S.C. 1396) of the Social Security Act.
Adopted under notice filed as WSR 99-16-067 on August 2, 1999.
Changes Other than Editing from Proposed to Adopted Version: WAC 388-513-1301 Definitions related to long-term care (LTC) services.
1. The definition of an adult family home in subsection (1) under "Alternate living facility (AFH)" is changed in the following way: "Adult family home (AFH) is a licensed family home that provides its residents with personal care and board and room for two to six adults unrelated to the person(s) providing the care."
2. The definition of a residential habilitation center in subsection (5) under "Medical facility" is changed in the following way: "Residential habilitation center (RHC), which is a state-operated facility certified to provide ICF/MR and/or nursing facility level of care for persons with developmental disabilities."
3. The definition of "Waivered programs/services" is changed in the following way: "Waivered programs/services" means programs for which the federal government authorizes exceptions to Medicaid rules. Such programs provide to an eligible client a variety of services not normally covered under Medicaid. In Washington state, waivered programs are CAP, CASA, COPES, MIC, and OBRA."
WAC 388-513-1315 Eligibility for long-term care (institutional, waivered, and hospice) services.
4. The text of subsection (5) is changed in the following way: "To be eligible for institutional or hospice services under the MN program, a client must be:
(a) Be eligible for the MN children's medical program as described in WAC 388-505-0210(1); and
(b) Relate to the SSI program as described in WAC 388-503-0510(1) and meet all requirements described in WAC 388-513-1395."
WAC 388-513-1325 Determining available income for a single client for long-term care (LTC) services.
5. The following text was added as subsection (2)(f): "WAC 388-513-1315 (15) and (16), Eligibility for long-term care (institutional, waivered, and hospice) services."
WAC 388-513-1330 Determining available income for legally married couples for long-term care (LTC) services.
6. The following text was added as subsection (1)(f): "WAC 388-513-1315 (15) and (16), Eligibility for long-term care (institutional, waivered, and hospice) services."
WAC 388-513-1350 Defining the resource standard and determining available resources for long-term care (LTC) services.
7. The following text is inserted as subsection (3)(d): "WAC 388-470-0060(6), Resources of an alien sponsor."
8. The maximum allocation amount and effective date described in subsection (6) is changed to "eighty-four thousand, one hundred and twenty dollars effective January 1, 2000."
WAC 388-513-1360 Determining excluded resources for long-term care (LTC) services.
9. The cross reference to WAC 388-470-0070 in subsection (3) is changed to: "WAC 388-470-0040(7)."
10. A cross reference to WAC 388-470-0020 is inserted in subsection (4).
WAC 388-513-1395 Determining eligibility for institutional or hospice services and for facility care only under the medically needy (MN) program.
11. The following text is inserted in subsection (4)(a): "as described in WAC 388-513-1325 and 388-513-1330."
WAC 388-515-1510 Community alternatives program (CAP) and outward bound residential alternatives (OBRA).
12. The following text is inserted into subsection (2)(b): "not allocated to participation in a prior month."
13. The text in subsection (5)(b)(i) is changed in the following way: "(i) A personal needs allowance (PNA) of thirty-eight dollars and eighty-four cents; plus"
Upon further review the originator realized that an inclusion of the language now deleted would have resulted in a change of policy. This adoption process precludes any such action.
WAC 388-515-1530 Coordinated community AIDS services alternatives (CASA) program.
14. The following text is inserted into subsection (2)(b): "not allocated to participation in a prior month."
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 3, Amended 11, Repealed 2.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 3, Amended 11, Repealed 2.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 3, Amended 11, Repealed 2. Effective Date of Rule: Thirty-one days after filing.
December 8, 1999
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit
Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 00-02 issue of the Register.