WSR 01-14-056

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

(Office of Rates Management)

[ Filed June 29, 2001, 3:55 p.m. ]

     Date of Adoption: June 27, 2001.

     Purpose: To adopt policy for adult family homes (AFH), adult residential care (ARC), and expanded adult residential care (EARC) Medicaid payment rates.

     Statutory Authority for Adoption: Chapter 74.39A RCW.

      Adopted under notice filed as WSR 01-10-103 on May 1, 2001.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 5, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 5, Amended 0, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

June 27, 2001

Brian 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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