WSR 04-09-092

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed April 20, 2004, 4:18 p.m. ]

Date of Adoption: April 15, 2004.

Purpose: To implement SSB 5579 (chapter 231, Laws of 2003). SSB 5579 requires the department to change its current bed hold process to the process described in the bill.

Subsection (4) of new section WAC 388-105-0045 has been deleted because it conflicts with section 13, chapter 142, Laws of 2004.

Citation of Existing Rules Affected by this Order: Amending WAC 388-105-0005, 388-105-0030, and 388-105-0040.

Statutory Authority for Adoption: RCW 74.39A.030; chapter 231, Laws of 2003.

Adopted under notice filed as WSR 04-06-075 on March 3, 2004.

Changes Other than Editing from Proposed to Adopted Version: Subsection (4) in the proposed new WAC 388-105-0045 has been deleted from the rule as adopted. See Purpose above.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 3, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 3, Repealed 0.
Effective Date of Rule: Thirty-one days after filing.

April 15, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3263.7
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)) AL 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) 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.

(5) 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.

(6) 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.

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