WSR 97-11-082

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Public Assistance)

[Filed May 21, 1997, 11:17 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 97-01-090.

Title of Rule: WAC 388-505-0510 Residence and 388-513-1320 Institutional--Status.

Purpose: Comply with federal requirements concerning residence status of an institutionalized person. Adds new cross-reference.

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

Statute Being Implemented: 42 CFR 435.403 (j)(2).

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Medical Assistance Administration, 617 8th S.E., Olympia, WA, (360) 753-7462.

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

Rule is necessary because of federal law, 42 CFR 435.403 (j)(2).

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule does not have an economic impact on small businesses. It concerns eligibility policy and affects only clients and staff.

Section 201, chapter 403, Laws of 1995, does not apply to this rule adoption. This section (RCW 34.05.328) does not pertain to the Department of Social and Health Services rules.

Hearing Location: Lacey Government Center, 1009 College Street S.E., Room 104-1, Lacey, WA 98503, on June 24, 1997, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Leslie Baldwin by June 13, 1997, TTY (360) 902-8324, voice (360) 902-7540, e-mail lbaldwin@dshs.wa.gov.

Submit Written Comments to: Leslie Baldwin, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, by June 24, 1997.

Date of Intended Adoption: No sooner than June 25, 1997.

May 21, 1997

Merry A. Kogut, Manager

Rules and Policies Assistance Unit

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

WAC 388-505-0510 Residence. (1) A client receiving medical care program benefits other than medically indigent shall be a resident of the state of Washington. A client need not be a resident of the county in which medical care is obtained.

(2) The department shall consider a client a resident if the client:

(a) Intends to remain permanently or for an indefinite period in the state; or

(b) Enters the state with a job commitment or seeks employment, whether the client is or is not currently employed.

(3) The department shall not consider a person temporarily entering the state, for the sole purpose of obtaining medical care, as a resident. For an institutionalized person, refer to WAC 388-513-1320(4).

(4) The department shall consider a client's residence the state:

(a) Making a state supplemental security income (SSI) supplementary payment; or

(b) Making federal payments for foster or adoption assistance under Title IV-E of the Social Security Act; or

(c) Of residence of the parent or legal guardian, if one has been appointed, for an institutionalized minor child; or

(d) Of residence of the parent or legal guardian, if one has been appointed, for an institutionalized client twenty-one years of age or older who became incapable of determining residential intent before twenty-one years of age; or

(e) Where a client is residing if the person becomes incapable before twenty-one years of age; or

(f) Making a placement in an out-of-state institution.

(5) The department shall determine the state of residence of a noninstitutionalized child, unless married or emancipated, following the rules under chapter 388-215 WAC.

(6) The department shall ensure married or emancipated minor children follow the rules of subsections (1), (2), (3) and (4) of this section.

(7) When two or more states cannot agree which state is the client's state of residence, the department shall require the state in which the client is physically located to be the state of residence.

[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-505-0510, filed 5/3/94, effective 6/3/94. Formerly WAC 388-83-025.]

AMENDATORY SECTION (Amending Order 3980, filed 5/10/96, effective 6/10/96 WAC 388-513-1320 Institutional status. (1) The department shall find that a person has achieved institutional status when the person is residing or expected to reside in a Medicaid-certified medical facility for a period of at least:

(a) Ninety consecutive days for an AFDC-related child seventeen years of age or younger in residential mental health or chemical dependency/substance abuse treatment; or

(b) Thirty consecutive days for an SSI-related person and AFDC-related persons other than as described under subsection (1)(a) of this section.

(2) The department shall consider a person receiving waivered program services or hospice services to have achieved institutional status.

(3) The department shall make medical assistance available to an otherwise eligible person who has achieved institutional status as described under subsection (1) or (2) of this section.

(4) The department shall not deny Medicaid eligibility to a person in a nursing facility:

(a) On the grounds that the person did not establish residence in this state before entering the nursing facility; and

(b) When the person meets residency requirements described under chapter 388-505 WAC at the time the person applies for medical assistance.

[Statutory Authority: RCW 74.08.090. 96-11-072 (Order 3980), 388-513-1320, filed 5/10/96, effective 6/10/96; 94-10-065 (Order 3732), 388-513-1320, filed 5/3/94, effective 6/3/94.]

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