WSR 01-10-103

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed May 1, 2001, 3:36 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 00-07-074.

Title of Rule: Medicaid rates for contracted home and community residential care services, WAC 388-105-0005, 388-105-0010, 388-105-0015, 388-105-0020, and 388-105-0025.

Purpose: Establishes in rule Medicaid payment rates for contracted home and community residential care services.

Statutory Authority for Adoption: RCW 74.39A.030(3).

Statute Being Implemented: Chapter 74.39A RCW.

Summary: Implements Medicaid four level payment rates for contracted adult family home (AFH), adult residential care (ARC), and enhanced adult residential care (EARC).

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: Implements Medicaid payment rates four level payment system for contracted adult family home (AFH), adult residential care (ARC), and enhanced adult residential care (EARC). The effect of the four level payment system will increase the number of payment levels from three to four resulting in rate increases for some residents and decreases for others.

Proposal does not change existing rules.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed new sections of chapter 388-105 WAC are exempt from a small business economic impact statement under RCW 19.85.025(2) and 34.05.310 (4)(f), rules that set or adjust fees or rates pursuant to legislative standards.

RCW 34.05.328 does not apply 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. The new sections of chapter 388-105 WAC set Medicaid payment rates for residential care facilities pursuant to chapter 74.39A RCW. (1) To the extent of available funding, the department shall expand cost-effective options for home and community services for consumers for whom the state participates in the cost of their care... and (3)(a). The department shall by rule establish payment rates for home and community services that support the provision of cost-effective care.

Hearing Location: Blake Office Park, 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on June 5, 2001, at 10:00 a.m.

Assistance for Persons with Disabilities: 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, by June 5, 2001.

Date of Intended Adoption: June 8, 2001.

April 26, 2001

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

2934.4
Chapter 388-105 WAC

MEDICAID RATES FOR CONTRACTED HOME AND COMMUNITY RESIDENTIAL CARE SERVICE RATES


NEW SECTION
WAC 388-105-0005   What are the daily Medicaid payment rates for contracted adult family home (AFH), adult residential care (ARC), and enhanced adult residential care (EARC) services?   For contracted AFH, ARC, and EARC services, the department pays the following daily rates for care of a Medicaid resident:


Four level payment system rates for AFHs, ARCs, & EARCs
Care Levels Non-

metropolitan

Metropolitan*

King Co.
Level 1 $42.41 $41.19 $41.19
Level 2 $45.06 $47.24 $52.49
Level 3 $52.26 $54.64 $60.65
Level 4 $63.09 $66.89 $72.90

*Benton, Clark, Franklin, Kitsap, Pierce, Snohomish, Spokane, Thurston, Whatcom, and Yakima Counties.

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NEW SECTION
WAC 388-105-0010   What are care levels?   The care levels correspond to the amount of assistance a Medicaid resident needs in performing unmet activities of daily living (ADL) and to meet additional unmet care needs. Level 1 represents minimal assistance with level 4 representing maximum assistance.

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NEW SECTION
WAC 388-105-0015   How does the department determine whether the Medicaid resident needs assistance in completing ADLs and/or has unmet care needs?   The department completes a comprehensive assessment (CA) to identify the assistance needed with unmet ADLs and other care needs of a Medicaid resident.

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NEW SECTION
WAC 388-105-0020   How does the department determine at which care level the Medicaid resident will be placed?   (1) The department assigns:

     (a) Values from zero to three to any of the following unmet activities of daily living (ADL) that the Medicaid resident needs either minimal, substantial, or total assistance to complete: eating, toileting, ambulation, transfer, positioning, and bathing; and

     (b) Points to the resident's health, psychological, social, behavioral and/or cognitive status.

     (2) A Medicaid resident's total:

     (a) ADL values can range from zero to sixteen; and

     (b) Points can range from zero to three hundred fifty.

     (3) The department determines the Medicaid resident's care level by combining his/her total ADL values and total points.

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NEW SECTION
WAC 388-105-0025   How many ADL values and unmet care need points correspond to the four care levels?   The following table illustrates the number of ADL values and points that the Medicaid resident's assessment must demonstrate to be assigned to one of the four levels of care:


Level

ADL values

 Unmet care needs points
1 0 0-59
1 1 0-59
1 2 0-49
1 3 0-39
1 4 0-29
2 0 60-109
2 1 60-109
2 2 50-109
2 3 40-109
2 4 30-99
2 5-10 no points required
3 0-3 110+
3 4 100+
3 5 90+
3 6 80+
3 7 70+
3 8 60+
3 9 50-99
3 10 40-89
3 11-16 no points required
4 9 100+
4 10 90+
4 11 80+
4 12 70+
4 13 60+
4 14 50+
4 15 40+
4 16 30+

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