WSR 97-15-084

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

[Filed July 17, 1997, 10:47 a.m., effective July 24, 1997]

Date of Adoption: July 16, 1997.

Purpose: To implement federal requirements allowing longer time frames for Medicaid to be continued upon termination of SSI.

Citation of Existing Rules Affected by this Order: Amending WAC 388-522-2205 and 388-524-2405.

Statutory Authority for Adoption: RCW 74.08.090 and 74.09.530.

Other Authority: 42 CFR 435 and 42 U.S.C. 1302.

Adopted under notice filed as WSR 97-12-081 on June 4, 1997.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 2, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, amended 0, repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 2, repealed 0.

Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: A July 24, 1997, effective date is needed to implement federal regulation. This rule change will extend the period of time a person can receive Medicaid if Social Security benefits are terminated.

Effective Date of Rule: July 24, 1997.

July 16, 1997

Merry A. Kogut, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending Order 3732, filed 5/3/94, effective 6/3/94)

WAC 388-524-2405 SSI/state supplement termination. ((When SSA terminates an SSI/state supplemental client because of failure to meet blindness and disability criteria under Title XVI,)) (1) The department shall ((terminate)) provide uninterrupted medical assistance ((at the end of the second month following the month in which eligibility based on disability or blindness criteria ceases)) for a period of up to one hundred twenty days:

(a) For a person whose SSI/state supplemental is terminated; and

(b) While the department redetermines the person's eligibility for other financial or medical programs.

(((1) If the client has)) (2) The department shall continue medical assistance for a person:

(a) Who has filed a timely request for a hearing under SSA jurisdiction; and ((SSA continues benefits, the department shall continue medical assistance concurrently))

(b) Until SSA makes a final decision on the hearing request and any subsequent timely appeals.

(((2))) (3) The department shall ((not authorize the CSO to resubmit)) only submit a request for a redetermination of blindness or disability ((for consideration of the categorically needy or medically needy program.

(3) If the client)) if:

(a) The person presents new medical evidence ((to the CSO or the client's));

(b) The person's medical condition ((worsens, the department shall require a referral to SSA)) changes significantly; or

(c) The termination of SSI/state supplement or Social Security Disability Insurance was not based on a review of current medical evidence.

[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-524-2405, filed 5/3/94, effective 6/3/94. Formerly WAC 388-85-110 (part).]

AMENDATORY SECTION (Amending Order 3732, filed 5/3/94, effective 6/3/94)

WAC 388-522-2205 Redetermination of medical assistance. (1) Before termination of a client's medical assistance, the department shall redetermine the client's eligibility for other medical assistance programs or the medically indigent program.

(a) When additional information is necessary to redetermine eligibility, the department shall give the client ten days notice and an opportunity to provide such information.

(b) The department shall give the client advance and adequate notice of the redetermination decision before termination of medical assistance as described under WAC 388-245-1700.

(c) ((Until the department redetermines a client's eligibility in conformity with the requirements of this section,)) The client shall remain eligible for categorically needy medical benefits until the department redetermines a client's eligibility according to the requirements of this section.

(2) ((The department shall redetermine the client's eligibility for other financial and medical programs within thirty calendar days)) When SSA terminates the client's SSI/SSP financial benefits, refer to WAC 388-524-2405.