WSR 04-04-044

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed January 29, 2004, 11:50 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 03-15-050.

Title of Rule: WAC 388-105-0005 Daily Medicaid payment rates for contracted adult family home (AFH), adult residential care (ARC) and enhanced adult residential care (EARC) services, 388-105-0030 Daily Medicaid payment rates for contracted assisted living facilities (ALF) not receiving a capital rate add-on and 388-105-0040 Capital add-on rates for ALF and the ALF daily payment rates with a capital add-on rate, and new WAC 388-105-0045 Medicaid payment rates for bed or unit holds - Medicaid resident discharged for a hospital or nursing home stay from an AFH or a boarding home with an ARC, EARC, or AL contract.

Purpose: To adopt permanently July 1, 2003, rate increase and to implement SSB 5579 (chapter 231, Laws of 2003) granting of payments to providers to hold a bed or unit when a Medicaid resident temporarily leaves the facility for a hospital or nursing home stay.

Statutory Authority for Adoption: RCW 74.39A.030 Medicaid payment rate increases.

Statute Being Implemented: RCW 18.20.290 Bed or unit hold payments.

Summary: Proposed rules permanently adopt rate increases adopted into WAC by emergency adoption effective July 1, 2003, and permanently adopt the bed or unit hold policy adopted into WAC by emergency adoption effective July 1, 2003.

Reasons Supporting Proposal: RCW 74.39A.030 and 18.20.290.

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: WAC 388-105-0005 Permanent adoption of daily Medicaid payment rates for contracted adult family home (AFH), adult residential care (ARC), and enhanced adult residential care (EARC) services that were emergency adopted effective July 1, 2003.

WAC 388-105-0030 Permanent adoption of the daily Medicaid payment rates for contracted assisted living facilities (ALF) not receiving a capital rate add-on that were emergency adopted effective July 1, 2003.

WAC 388-105-0040 Permanent adoption of the capital add-on rates for assisted living facilities (ALF) and the ALF daily payment rates with a capital add-on rate that were emergency adopted effective July 1, 2003.

New WAC 388-105-0045 Permanent adoption of the bed or unit hold payment policy for Medicaid resident discharged for a hospital or nursing home stay from an adult family home (AFH) or a boarding home with an adult residential care services (ARC), enhanced adult residential care services (EARC), or assisted living services (AL) contract that were emergency adopted effective July 1, 2003.

Proposal Changes the Following Existing Rules: Proposed rules: Increase the Medicaid payment rates for AFHs, ARCs, EARCs, and AL facilities effective July 1, 2003; and implement a bed or unit hold payment policy for Medicaid resident discharged for a hospital or nursing home stay from an adult family home (AFH) or a boarding home with an adult residential care services (ARC), enhanced adult residential care services (EARC), or assisted living services (AL) contract.

No small business economic impact statement has been prepared under chapter 19.85 RCW. Under RCW 19.85.025(3), this chapter does not apply to the adoption of a rule described in RCW 34.05.310(4). The unit or bed hold rule in WAC 388-105-0045 is exempted by RCW 34.05.310 (4)(e) (rules the content of which is explicitly and specifically dictated by statute). The rate rules in WAC 388-105-0005, 388-105-0030, and 388-105-0040 are exempted by RCW 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)(v) and (vi), rules that the content of which is explicitly and specifically dictated by statute; or set or adjust fees or rates pursuant to legislative standards are exempt from RCW 34.05.328. The proposed rules were specifically dictated by statute and set or adjust rates in accordance with legislative standards.

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on March 9, 2004, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by March 5, 2004, phone (360) 664-6097, TTY (360) 664-6178, e-mail swensFH@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., March 9, 2004.

Date of Intended Adoption: Not earlier than March 10, 2004.

January 28, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3263.5
AMENDATORY SECTION(Amending WSR 02-22-058, filed 10/31/02, effective 12/1/02)

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 $ ((46.06)) 45.70 $ ((44.79)) 44.43 $ ((44.79)) 44.43
Level 2 $ ((49.28)) 48.65 $ ((51.52)) 50.89 $ ((56.97)) 56.34
Level 3 $ ((57.07)) 56.32 $ ((59.51)) 58.76 $ ((65.76)) 65.01
Level 4 $ ((68.15)) 67.75 $ ((72.07)) 71.67 $ ((78.31)) 77.91

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

[Statutory Authority: 2002 c 371. 02-22-058, 388-105-0005, filed 10/31/02, effective 12/1/02. Statutory Authority: 2001 c 7 206. 01-21-077, 388-105-0005, filed 10/18/01, effective 11/18/01. Statutory Authority: Chapter 74.39A RCW. 01-14-056, 388-105-0005, filed 6/29/01, effective 7/30/01.]


AMENDATORY SECTION(Amending WSR 02-22-058, filed 10/31/02, effective 12/1/02)

WAC 388-105-0030   What are the daily Medicaid payment rates for contracted assisted living facilities (((ALF))) (AL) not receiving a capital rate add-on?   For contracted ALF services for care of a Medicaid resident, the department pays the following daily rates:


COPES ((ALF)) AL Daily Payment Rates w/o

Capital Add-on Rate

Care Levels Non-

metropolitan

Metropolitan*

King Co.

Level 1 $ ((54.84)) 54.48 $ ((56.35)) 55.99 $ ((61.03)) 60.67
Level 2 $ ((61.14)) 60.51 $ ((62.92)) 62.29 $ ((68.52)) 67.89
Level 3 $ ((67.54)) 66.79 $ ((69.90)) 69.15 $ ((76.46)) 75.71

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

[Statutory Authority: 2002 c 371. 02-22-058, 388-105-0030, filed 10/31/02, effective 12/1/02.]


AMENDATORY SECTION(Amending WSR 02-22-058, filed 10/31/02, effective 12/1/02)

WAC 388-105-0040   What are the daily capital add-on rates for assisted living facilities (((ALF))) (AL) and the ((ALF)) AL daily payment rates with a capital add-on rate?   For an ((ALF)) AL that qualifies for a capital add-on rate, the department will add the following amount to the per resident day payment rates in WAC 388-105-0030:


COPES ((ALF)) AL Add-on Rate July 1, 2002
Non-

metropolitan

Metropolitan*

King Co.

$ 4.68 $ 4.39 $ 4.84


COPES ((ALF)) AL Daily Payment Rates with a

Capital Add-on Rate

Care Levels Non-

metropolitan

Metropolitan*

King Co.

Level 1 $ ((59.52)) 59.16 $ ((60.74)) 60.38 $ ((65.87)) 65.51
Level 2 $ ((65.82)) 65.19 $ ((67.31)) 66.68 $ ((73.36)) 72.73
Level 3 $ ((72.22)) 71.47 $ ((74.29)) 73.54 $ ((81.30)) 80.55

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

[Statutory Authority: 2002 c 371. 02-22-058, 388-105-0040, filed 10/31/02, effective 12/1/02.]


NEW SECTION
WAC 388-105-0045   Bed or unit hold Medicaid resident discharged for a hospital or nursing home stay from an adult family home (AFH) or a boarding home with an adult residential care services (ARC), enhanced adult residential care services (EARC), or assisted living services (AL) contract.   (1) When an AFH, ARC, EARC, or AL contracts to provide services under chapter 74.39A RCW, the AFH, ARC, EARC, and AL provider must hold a Medicaid eligible resident's bed or unit when:

(a) Short-term care is needed in a nursing home or hospital;

(b) The resident is likely to return to the AFH, ARC, EARC, or AL; and

(c) Payment is made under subsection (3) of this section.

(2) When the department pays the provider to hold the Medicaid resident's bed or unit during the resident's short-term nursing home or hospital stay, the provider must hold the unit or bed for up to twenty days.

(3) The department will compensate the provider for holding the bed or unit for the:

(a) First through seventh day at seventy percent of the daily rate paid for care of the resident before the hospital or nursing home stay; and

(b) Eighth through the twentieth day, at ten dollars and forty-three cents a day.

(4) The AFH, ARC, EARC, and AL provider may seek third-party payment to hold a bed or unit for twenty-one days or longer. The provider may only collect from the third-party a payment not exceeding eighty-five percent of the average Medicaid daily rate paid to the facility. To compute the average Medicaid daily rate, the provider will add the highest Medicaid daily rate for each Medicaid resident residing in the facility for any part of the month in which the unit or bed hold began and divide the total by the number of Medicaid residents residing in the facility in the month in which the bed hold began.

(5) If third-party payment is not available and the returning Medicaid resident continues to meet the admission criteria under chapter 388-71-WAC, the Medicaid resident may return to the first available and appropriate bed or unit.

(6) The department's social worker or case manager determines whether the:

(a) Care given in a nursing home or hospital will be short-term; and

(b) Resident is likely to return to the AFH, ARC, EARC, or AL facility.

(7) When the department's social worker or case manager determines that the Medicaid resident's stay in the nursing home or hospital is not short-term and the resident is unlikely to return to the AFH, ARC, EARC, or AL facility, then this section does not apply to any private contractual arrangements that the provider may make with a third party in regard to the discharged resident's unit or bed.

[]

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.

Legislature Code Reviser 

Register

Washington State Code Reviser's Office