PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
Date of Adoption: October 20, 2000.
Purpose: The purpose of these rules is to (1) establish one standard for nursing home and COPES eligibility, eliminating redundancy and inconsistency; and (2) reflect changes to the nursing facility admissions procedures.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-97-022; and amending WAC 388-97-027.
Statutory Authority for Adoption: RCW 74.39A.040, 74.42.056.
Adopted under notice filed as WSR 00-18-098 on September 5, 2000.
Changes Other than Editing from Proposed to Adopted Version: WAC 388-97-027, language from this section has been removed and put into chapter 388-71 WAC, Social services for adults. This is necessary to clarify requirements for recipients of nursing facility care. There will be reference to WAC 388-71-0700 for easy access.
WAC 388-71-0700, the heading of this section has been changed to broaden the intent of the rule. It now is "What are the requirements for nursing facility eligibility, assessment, and payment?" This rule adds language (removed from WAC 388-97-027) regarding assessment and payment requirements. It clarifies that Medicaid clients and private-pay individuals cannot be admitted without being screened for a mental illness or developmental disability.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 1, Repealed 1.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 1, Repealed 1.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 1, Repealed 1.
Other Findings Required by Other Provisions of Law as Precondition to Adoption or Effectiveness of Rule: An immediate effective date is required to comply with federal laws regarding nursing facility level of care.Effective Date of Rule: October 31, 2000.
October 20, 2000
Edith M. Rice, Chief
Office of Legal Affairs
2823.3
(((1) A nursing facility must not admit any
individual unless:
(a) The physician, hospital, department, or department designee screens the individual for the presence of a serious mental illness or a developmental disability as required under WAC 388-97-247;
(b) The department assesses any Medicaid applicant or recipient and determines that the individual meets the medical eligibility requirements described in WAC 388-97-022; and
(c) For an individual admitted on a weekend, holiday, or after business hours, the nursing facility or hospital requests an assessment from the department.
(2) The department authorizes payment for:
(a) Newly admitted Medicaid-eligible individuals, who are assessed and determined to be in need of nursing facility care, per WAC 388-97-022, on the date:
(i) Of the request for a department assessment; or
(ii) Nursing facility care actually begins, whichever is later.
(b) Current residents, who are converting to Medicaid from another payment source and are determined financial eligible, on the date of:
(i) Request for assessment; or
(ii) Financial application, whichever is earlier.
(iii) Exception: Payment back to the request date is limited to the certification period prior to the date of the financial application, per WAC 388-416-0015.
(3) If nursing facilities admit a Medicaid-eligible individual without a request for an assessment, they will not:
(a) Be reimbursed by the department; or
(b) Allowed to collect payment, including a deposit or minimum stay fee, from the client or the client's family or representative for any care provided before the date of request for assessment)) Refer to WAC 388-71-0700 (3) through (5).
[Statutory Authority: RCW 18.51.070 and 74.42.620. 00-06-028, § 388-97-027, filed 2/24/00, effective 3/26/00.]
The following section of the Washington Administrative Code is repealed:
| WAC 388-97-022 | Medical eligibility for nursing facility care. |
(1) If you are a Medicaid client or paying privately, the nursing facility cannot admit you unless the physician, hospital, department, or department designee screens you for the presence of a serious mental illness or a developmental disability as required under WAC 388-97-247.
(2) You are eligible for nursing facility care if the department:
(a) Assesses you and determines that you meet the functional criteria for nursing facility level of care as defined in WAC 388-71-0435(4); and
(b) Determines that you meet the eligibility requirements set through WAC 388-513-1315.
(3) If you are Medicaid eligible and the nursing facility admits you without a request for assessment from the department, the nursing facility will not:
(a) Be reimbursed by the department; or
(b) Allowed to collect payment, including a deposit or minimum stay fee, from you or your family/representative for any care provided before the date of request for assessment.
(4) If you are eligible for Medicaid-funding nursing facility care, the department pays for your services beginning on the date:
(a) Of the request for a department assessment; or
(b) Nursing facility care actually begins, whichever is later.
(5) If you become financially eligible for Medicaid after you have been admitted, the department pays for your nursing facility care beginning on the date of:
(a) Request for assessment or financial application, whichever is earlier; or
(b) Nursing facility placement; or
(c) When you are determined financially eligible, whichever is later.
(d) Exception: Payment back to the request date is limited to three months prior to the month that the financial application is received.
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