(1) The resident has the right to choose to remain in the nursing facility and receive specialized services if:
(a) He or she has continuously resided in a nursing facility since October 1, 1987; and
(b) The department determined, in 1990, that the resident required specialized services for a serious mental illness or developmental disability but did not require nursing facility services.
(2) In the event that residents chose to remain in the nursing facility as outlined in subsection (1) above, the department, or designee, will clarify the effect on eligibility for medicaid services under the state plan if the resident chooses to leave the facility, including its effect on readmission to the facility.
(3) An individual applying for admission to a nursing facility or a nursing facility resident who has been adversely impacted by a PASRR determination may appeal the department's determination that the individual is:
(a) Not in need of nursing facility care as defined under WAC
388-106-0350 through
388-106-0360;
(b) Not in need of specialized services as defined under WAC
388-97-1960; or
(c) Need for specialized services as defined under WAC
388-97-1960.
(4) The nursing facility must assist the individual applying for admission or resident, as needed, in requesting a hearing to appeal the department's PASRR determination.
(5) If the department's PASRR determination requires that a resident be transferred or discharged, the department will:
(a) Provide the required notice of transfer or discharge to the resident, the resident's surrogate decision maker, and if appropriate, a family member or the resident's representative thirty days or more before the date of transfer or discharge;
(b) Attach a hearing request form to the transfer or discharge notice;
(c) Inform the resident, in writing in a language and manner the resident can understand, that:
(i) An appeal request may be made any time up to ninety days from the date the resident receives the notice of transfer or discharge;
(ii) Transfer or discharge will be suspended when an appeal request is received by the office of administrative hearings on or before the date of transfer or discharge set forth in the written transfer or discharge notice; and
(iii) The resident will be ineligible for medicaid nursing facility payment:
(A) Thirty days after the receipt of written notice of transfer or discharge; or
(B) If the resident appeals under subsection (1)(a) of this section, thirty days after the final order is entered upholding the department's decision to transfer or discharge a resident.
(6) The department's home and community services may pay for the resident's nursing facility services after the time specified in subsection (5)(c)(iii) of this section, if the department determines that a location appropriate to the resident's medical and other needs is not available.
(7) The department will:
(a) Send a copy of the transfer/discharge notice to the resident's attending physician, the nursing facility and, where appropriate, a family member or the resident's representative;
(b) Suspend transfer or discharge:
(i) If the office of administrative hearings receives an appeal on or before the date set for transfer or discharge or before the resident is actually transferred or discharged; and
(ii) Until the office of appeals makes a determination; and
(c) Provide assistance to the resident for relocation necessitated by the department's PASRR determination.
(8) Resident appeals of PASRR determinations will be in accordance with 42 C.F.R. § 431 Subpart E, chapter
388-02 WAC, and the procedures defined in this section. In the event of a conflict between a provision in this chapter and a provision in chapter
388-02 WAC, the provision in this chapter will prevail.
[Statutory Authority: Chapters 18.51 and 74.42 RCW and 42 C.F.R. 489.52. 08-20-062, § 388-97-2000, filed 9/24/08, effective 11/1/08.]