PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 00-12-077.
Title of Rule: Chapter 388-96 WAC, Nursing home accounting and reimbursement system. WAC 388-96-010 Definitions, 388-96-218 Proposed, preliminary, and final settlements, 388-96-310 Interest on other excess, 388-96-369 The nursing facility shall maintain a subsidiary ledger with an account for each resident for whom the facility holds money, 388-96-384 Liquidation or transfer of resident personal funds, 388-96-559 Cost basis of land and depreciation base, 388-96-708 Reinstatement of beds previously removed from service under chapter 70.38 RCW -- Effect on prospective payment rate, 388-96-709 Prospective rate revisions -- Reduction in licensed beds, 388-96-710 Prospective payment for new contractors, 388-96-713 Rate determination, 388-96-714 Nursing facility Medicaid rate allocations -- Economic trends and conditions adjustment factors, 388-96-723 How often will the department compare the statewide weighted average payment rate for the capital and noncapital portions of the rate for all nursing facilities with the statewide weighted average payment rate for the capital and noncapital portions of the rate identified in the Biennial Appropriations Act?, 388-96-732 How will the department determine whether its notice pursuant to WAC 388-96-724 was timely?, 388-96-740 What will the department use as the Medicaid case mix index when a facility does not meet the ninety percent minimum data set (MDS) threshold as identified in RCW 74.46.501?, 388-96-776 Add-ons to the payment rate -- Capital improvements, 388-96-777 Add-ons to the prospective rate -- Initiated by the department, 388-96-780 Exceptional therapy care -- Covered Medicaid residents, 388-96-802 May the nursing facility (NF) contractor bill the department for a Medicaid resident's day of death, discharge, or transfer for the NF?, 388-96-803 When a nursing facility (NF) contractor becomes aware of a change in the Medicaid resident's income and/or resources, must he or she report it?, and 388-96-901 Disputes.
Purpose: WAC 388-96-010, deletes definitions for "anticipated resident days" and "anticipated resident occupancy." Defines "nursing facility occupancy percentage." Amends the change of ownership definition.
WAC 388-96-218, clarifies that the department may issue preliminary settlements more than one hundred twenty days after receipt.
WAC 388-96-310, amends to agree with chapter 74.46 RCW on when interest begins accruing on money owed by either the department or contractor.
WAC 388-96-369 and 388-96-384, changes local office to home and community services office.
WAC 388-96-559, delete reference to WAC 388-96-567 that was repealed.
WAC 388-96-708, clarifies the recalculation of a prospective payment rate when a nursing facility reinstates licensed beds. Clarifies that the post-reinstatement number of licensed beds must be used in all rate setting.
WAC 388-96-709, clarifies the recalculation of a prospective payment rate when a nursing facility banks licensed beds. Clarifies that the post-banking number of licensed beds must be used in all rate setting.
WAC 388-96-710, clarifies dates used in setting a new contractor's rate.
WAC 388-96-713, clarifies that limits, lids and/or medians are only calculated once for any rebase period. Adds subsection clarifying that rates are set using actual days or days at 85% occupancy.
WAC 388-96-714, amends to limit an economic trends and conditions adjustment factor to rate setting before April 2000.
WAC 388-96-723, changes timelines for comparison of statewide weighted average payment rate from monthly to quarterly.
WAC 388-96-732, indicates how the department will determine timely notice made pursuant to WAC 388-96-724.
WAC 388-96-740, changes to "one" the case mix index that the department will use if a nursing facility does not meet the 90% MDS threshold.
WAC 388-96-776, clarifies the effective date of a rate add-on granted pursuant to this section.
WAC 388-96-777, edit to update reference.
WAC 388-96-780, clarifies the minimum required participation in a rehabilitation program. Clarifies length of coverage for an exceptional therapy rate.
WAC 388-96-802, clarifies that the department will not pay for the last day of a resident's stay.
WAC 388-96-803, reinstates the requirement that a nursing home must report resident income changes to the department within seventy-two hours.
WAC 388-96-901, makes the department's use of its discretion in setting the issuance date of preliminary settlements not subject to review under WAC 388-96-904.
Statutory Authority for Adoption: RCW 74.46.431 and [74.46.]800.
Statute Being Implemented: Chapter 74.46 RCW.
Reasons Supporting Proposal: See Purpose above.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Patricia Hague, 640 Woodland Square Loop S.E., Lacey, WA 98503, (360) 725-2447.
Name of Proponent: Department of Social and Health Services, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.
Proposal Changes the Following Existing Rules: See Purpose above.
No small business economic impact statement has been prepared under chapter 19.85 RCW. Under RCW 18.85.020(1) a small business is defined as one with fewer than fifty employees and whose purpose is to make a profit. The revisions to chapter 388-96 WAC only impact businesses with fifty or more employees and approximately one third the businesses are nonprofit. Also the proposed new sections and revisions to chapter 388-96 WAC are exempt from an SBEIS under RCW 19.85.025(2) and 34.05.310(4). (d) Rules that only correct typographical errors make address or name changes, or clarify language of a rule without changing its effect; (e) rules the content of which is explicitly and specifically dictated by statute; and (f) rules that set or adjust fees or rates pursuant to legislative standards.
RCW 34.05.328 applies to this rule adoption. Under RCW 34.05.328 (5)(b)(vi), rules that set or adjust fees or rates pursuant to legislative standards are exempt from RCW 34.05.328. Amendments to and new sections of chapter 388-96 WAC instruct and clarify how the department is to set Medicaid payment rates for nursing homes pursuant to chapter 74.46 RCW. RCW 74.46.010 reads as follows: This chapter may be known and cited as the "nursing facility Medicaid payment system." The purposes of this chapter are to specify the manner by which legislative appropriations for Medicaid nursing facility services are to be allocated as payment rates among nursing facilities, and to set forth auditing billing, and other administrative standards associated with payments to nursing home facilities.
Hearing Location: Blake Office Building East (behind Goodyear Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on May 8, 2001, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Kelly Cooper by May 1, 2001, phone (360) 664-6094, TTY (360) 664-6178, e-mail coopekd@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, coopekd@dshs.wa.gov, by May 8, 2001.
Date of Intended Adoption: No sooner than May 9, 2001.
March 7, 2001
Bonita H. Jacques, Chief
Office of Legal Affairs
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 01-08 issue of the Register.