WSR 03-15-011

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed July 3, 2003, 3:05 p.m. ]

Date of Adoption: July 3, 2003.

Purpose: Adopting amended WAC 388-105-0005, 388-105-0030, and 388-105-0040 and new WAC 388-105-0045, 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.

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

Statutory Authority for Adoption: Chapter 231, Laws of 2003.

Other Authority: Chapter 18.20 RCW.

Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; and that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

Reasons for this Finding: Section 11 of SSB 5579 requires the department to adopt rules concerning the bed-hold process and applicable rates. And the legislature made the finding in section 12 of SSB 5579 that "this act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately."

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 1, Amended 3, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 3, Repealed 0.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: Immediately.

July 3, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3263.3
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) not receiving a capital rate add-on?   For contracted ALF services for care of a Medicaid resident, the department pays the following daily rates:


COPES ALF 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) and the ALF daily payment rates with a capital add-on rate?   For an ALF 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 Add-on Rate July 1, 2002
Non-

metropolitan

Metropolitan*

King Co.

$ 4.68 $ 4.39 $ 4.84

COPES ALF 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   When a Medicaid resident is discharged from a facility for a hospital or nursing home stay, must the Adult Family Home (AFH) or a boarding home that contracts with the department to provide adult residential care services (ARC), enhanced adult residential care services (EARC), or assisted living services (AL) under chapter 74.39A RCW hold the bed or unit for the residents return?   (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) The AFH, ARC, EARC, and AL provider may seek third-party payment to hold a bed or unit for twenty-one days or longer. The provider may only collect from the third-party a payment not exceeding eighty-five percent of the average daily rate paid to the facility.

(5) 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.

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