WSR 04-21-059

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)

[ Filed October 18, 2004, 3:35 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-12-098.

Title of Rule and Other Identifying Information: WAC 388-416-0035 Medicare savings program certification periods.

Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on November 23, 2004, at 10:00 a.m.

Date of Intended Adoption: Not sooner than November 24, 2004.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., November 23, 2004.

Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by November 19, 2004, TTY (360) 660-6178 or (360) 664-6097.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The amended rule is to reflect a name change for one of the Medicare savings program (MSP) eligibility categories and to meet the department's clear and concise rule-writing requirement.

Reasons Supporting Proposal: See above.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530.

Statute Being Implemented: RCW 74.04.050, 74.04.057, 74.08.090, and 74.090.530 [74.09.530]; 42 U.S.C. 1396a (a) (Section 1902 (n)(2) of the Social Security Act of 1924).

Rule is not necessitated by federal law, federal or state court decision.

Name of Proponent: Department of Social and Health Services, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Carole McCrae, P.O. Box 45534, Olympia, WA 98504-5534, (360) 725-1250.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule change does not affect small businesses.

A cost-benefit analysis is not required under RCW 34.05.328. This is a client medical eligibility rule which is exempt under the provisions of RCW 34.05.328 (5)(b)(vii).

October 15, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3462.1
AMENDATORY SECTION(Amending WSR 98-16-044, filed 7/31/98, effective 9/1/98)

WAC 388-416-0035   Medicare savings program certification periods ((for Medicare cost sharing programs)).   (((1) The certification period for the qualified Medicare beneficiary (QMB) program:

(a) Is for twelve months; and

(b) Begins the first day of the month following the month of QMB eligibility determination; and

(2) The certification period for the qualified disabled working individual (QDWI) program:

(a) Is twelve months; and

(b) May begin up to three months prior to the month of application if on the first day of the first month of the certification period the person:

(i) Is or had been enrolled in Medicare Part A; and

(ii) Meets or has met the department's eligibility requirements for QDWI.

(3) The certification period for the:

(a) Special low income medicare beneficiary (SLMB) program is twelve months in duration;

(b) Expanded special low income medicare beneficiary (ESLMB) program extends to the end of the calendar year.

(4) The certification periods for SLMB and ESLMB may begin up to three months prior to the month of application if on the first day of the first month of the certification period the person:

(a) Is or has been enrolled in Medicare Part B; and

(b) Meets or has met the department's eligibility requirements for SLMB or ESLMB.

(5) The certification period for SLMB coverage is twelve months in duration.)) Certification periods for the different kinds of Medicare savings programs are not all the same. The chart below explains the differences.


Medicare Savings Program Certification Period Start Date
QMB (qualified Medicare beneficiary)

S03

12 months On the first day of the month following QMB eligibility determination
SLMB (Special low income Medicare beneficiary)

S05

12 months Up to three months prior to the certification period if on the first day of the first month of certification, the person:

Is or has been enrolled in Medicare Part B; and

Meets SLMB eligibility requirements.

QDWI (Qualified disabled working individual)

S04

12 months Up to three months prior to the certification period if on the first day of the first month of certification, the person:

Is or has been enrolled in Medicare Part A; and

Meets QDWI eligibility requirements.

QI-1 (Qualified individual)

S06

Thru the end of the calendar year following QI-1 eligibility determination Up to three months prior to the certification period if on the first day of the first month of certification, the person:

Is or has been enrolled in Medicare Part B; and

Meets QI-1 eligibility requirements.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-416-0035, filed 7/31/98, effective 9/1/98. Formerly WAC 388-521-2150, 388-521-2155 and 388-521-2160.]

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