WSR 98-08-077

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Medical Assistance Administration)

[Filed March 31, 1998, 3:52 p.m., effective April 1, 1998]



Date of Adoption: March 31, 1998

Purpose: This rule was proposed with chapter 388-79 WAC, and is being adopted separately because the federal standards for the community spouse needs allowance and shelter allocation must be in place by April 1, 1998. This rule sets fees allowable for a guardianship to charge a department client, and adopts the federal standards for community spouse needs allowance and for shelter allocation

Citation of Existing Rules Affected by this Order: Amending WAC 388-513-1380

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500

Other Authority: RCW 43.20B.460, 11.92.180, and Section 1924 (42 USC 396r-5)

Adopted under notice filed as WSR 98-03-085 on January 21, 1998 and WSR 98-05-053 on February 13, 1998

Changes Other than Editing from Proposed to Adopted Version: The new guardianship fee provisions (that will be adopted in chapter 388-79 WAC) will be implemented for MAA clients on June 15, 1998, rather than March 15, 1998.

A community spouse's needs allowance standard is raised from $1,327 to $1,358 to implement new federal standards.

The standard shelter allocation is raised from $399 to $408 to implement new federal standards.

The rule has been rewritten to improve understanding and readability

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 1, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, amended 0, repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 0, repealed 0.

Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: RCW 34.05.380 (3)(a) applies to this rule because federal law requires an April 1, 1998, implementation date

Effective Date of Rule: April 1, 1998

March 31, 1998

Edith M. Rice, Chief

Office of Legal Affairs

SHS-2305:11

AMENDATORY SECTION (Amending WSR 97-16-008, filed 7/24/97, effective 7/24/97)



WAC 388-513-1380  Institutional--Participation--Client share of monthly institutional payments. This section describes the allocations which can be deducted from the institutional client's income and excess resources in order to determine the amount available for the client's participation in the cost of care.

(1) ((In reducing payment to the institution, the department shall consider the institutionalized client's:

(a) Income under WAC 388-513-1330 (3)(a), (b), (c), and (d); and

(b) Resources under WAC 388-513-1350, 388-513-1360, and 388-513-1365.

(2) In reducing payment to the institution, the department shall consider the eligible institutionalized)) The client's excess resources are available to meet the cost of care after the following ((allocations)) deductions in this order:

(a) Health insurance and Medicare premiums, deductions, and co-insurance not paid by a third party; and

(b) Noncovered medical bills which are the liability of the client and not paid by a third party.

(((3))) (2) The ((department shall not use)) allocations used to reduce excess resources under subsection (((2))) (1) of this section cannot be used to reduce income under subsection (((4))) (3) of this section.

(((4) The department shall deduct the following amounts, in the following order, from the institutionalized client's total income, including amounts disregarded in determining eligibility))

(3) The client's nonexempt income is available to meet the cost of care after the following deductions in this order:

(a) ((Specified)) Deductions described in subsection (3)(a) may not total more than the one-person medically needy income level (MNIL):

(i) A personal needs allowance (PNA) as follows:

(((i))) (A) One hundred sixty dollars for a veteran living in a Medicaid-certified state veteran's home nursing facility;

(((ii))) (B) Ninety dollars for a single veteran, or widow or widower of a veteran receiving an improved veteran's pension; or

(((iii))) (C) Forty-one dollars and sixty-two cents for all other clients in a medical ((institutions)) facility.

(((b))) (ii) Federal, state, or local income taxes:

(((i))) (A) Mandatorily withheld from earned or unearned income for income tax purposes before receipt by the client; or

(((ii))) (B) Not covered by withholding, but are owed or have been paid by the client((; and)).

(iii) ((Does not exceed the one-person medically needy income level less the client's personal needs allowance.

(c))) Wages ((not to exceed the one-person medically needy income level (MNIL) less the client's personal needs allowance)) for a client who:

(((i))) (A) Is SSI-related; and

(((ii))) (B) Receives the wages as part of a department-approved training or rehabilitative program designed to prepare the client for a less restrictive placement. When determining this deduction((, the department shall:

(A) Not allow a deduction for)) employment expenses((; and

(B) Apply the client's wages not deducted under this subsection to the client's cost of care.

(d) The total amounts deducted under subsection (4) (a), (b), and (c) of this section shall not exceed the one-person MNIL.

(e))) are not deducted.

(iv) Guardianship fees and administrative costs including any attorney fees paid by the guardian, after June 15, 1998, only as allowed by chapter 388-79 WAC.

(b) A monthly needs allowance for the community spouse not to exceed, effective January 1, ((1997, one thousand nine hundred seventy-six)) 1998, two thousand nineteen dollars, unless specified in subsection (((6))) (5) of this section. ((The department shall ensure)) The monthly needs allowance is:

(i) An amount added to the community spouse's gross income to provide a total ((community spouse's income)) of one thousand three hundred ((twenty-seven)) fifty-eight dollars;

(ii) Excess shelter expenses as specified under subsection (((5))) (4) of this section; and

(iii) Allowed only to the extent the client's income ((of the institutionalized spouse)) is made available to the community spouse.

(((f) An amount for the))

(c) A monthly maintenance needs ((of)) amount for each dependent ((family member)) or minor child, dependent parent or dependent sibling:

(i) Residing with the community spouse((:

(i))), equal to one-third of the amount that one thousand three hundred ((twenty-seven)) fifty-eight dollars exceeds the family member's income. Child support received from an absent parent is the child's income.

(ii) (("Family member" means a:

(A) Dependent or minor child;

(B) Dependent parent; or

(C) Dependent sibling of the institutionalized or community spouse.

(g) When an institutional client does not have a community spouse, an amount for the maintenance needs of family members residing in the client's home)) Not residing with the community spouse, equal to the ((medically needy income level)) MNIL for the number of ((legal dependents)) family members in the home less the income of the ((dependents)) family members.

(((h) Amounts for)) (d) Incurred medical expenses, not subject to third-party payment, which are the current liability of the client including((, but not limited to)):

(i) Health insurance premiums, deductions, and coinsurance((, or deductible charges)) amounts; and

(ii) Necessary medical care recognized under state law, but not covered under Medicaid.

(((i))) (e) Maintenance of the home of a single person or institutionalized couple:

(i) Up to one hundred percent of the one-person federal poverty level per month;

(ii) Limited to a six-month period; ((and))

(iii) When a physician has certified that the client is likely to return to the home within the six-month period; and

(iv) When social service staff documents initial need for the income exemption and reviews the person's circumstances after ninety days.

(((5))) (4) For the purposes of this section, ((the department shall)) "excess shelter expenses" equal the actual expenses under subsection (4)(a) of this section less the standard shelter allocation under subsection (4)(b) of this section:

(a) ((Determine)) Shelter expenses ((to be)) are the actual required maintenance expenses for the community spouse's principal residence for:

(i) Rent;

(ii) Mortgage;

(iii) Taxes and insurance;

(iv) Any maintenance care for a condominium or cooperative; and

(v) The food stamp standard utility allowance ((for utilities)), provided the utilities are not included in the maintenance charges for a condominium or cooperative.

(b) ((Consider)) The standard shelter allocation ((to be three)) is four hundred ((ninety-nine)) eight dollars, effective April 1, 1997.

(((c) Consider as "excess shelter expenses" an amount equal to the actual expenses under subsection (5)(a) of this section less the standard shelter allocation under subsection (5)(b) of this section.

(6))) (5) The ((department shall determine the)) amount the institutional spouse may allocate((s)) to the community spouse may ((only)) be greater than the amount in subsection (((4)(e)(i)))(3)(b) of this section only when:

(a) A court enters an order against the institutionalized client for the ((community spouse)) support of the community spouse; or

(b) A hearings officer determines a greater amount is needed because of exceptional circumstances resulting in extreme financial duress.

(((7) The client shall use the income remaining after allocations specified in subsection (4) of this section toward payment of the client's cost of care at the department rate.

(8) SSI-related clients.

(a))) (6) SSI((-related)) clients shall continue to receive total payment under 1611 (b)(1) of the Social Security Act for the first three full calendar months of institutionalization in a public or Medicaid-approved medical institution or facility when the:

(((i))) (a) Stay in the institution or facility is not expected to exceed three months; and

(((ii) SSI-related)) (b) The client((s)) plans to return to former living arrangements.

(((b) The department shall not consider the SSI payment

when computing the client's participation amount.

(9) The department shall not consider income from reparation payments made by the Federal Republic of Germany when computing the client's participation amount.))



[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530 and Social Security Act, Federal Register, March 10, 1997, pgs. 10856 - 10859, 42 U.S.C. 1396 (a)(l)(m). 97-16-008, 388-513-1380, filed 7/24/97, effective 7/24/97. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 95-44. 96-09-033 (Order 3963), 388-513-1380, filed 4/10/96, effective 5/11/96. Statutory Authority: RCW 74.08.090. 95-11-045 (Order 3848), 388-513-1380, filed 5/10/95, effective 6/10/95. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 94-49, notice of increase in SSI level. 95-05-022 (Order 3832), 388-513-1380, filed 2/8/95, effective 3/11/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-513-1380, filed 5/3/94, effective 6/3/94. Formerly WAC 388-95-360.]

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