WSR 05-14-074

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed June 30, 2005, 1:53 p.m. , effective June 30, 2005 ]


Purpose: Adopting new rules to implement the Medicare-Medicaid integration program (MMIP), a new and innovative managed care program in the state of Washington that will combine long-term care and medical services under one coordinated service delivery model and capitated payment structure, thereby improving client health outcomes through increased coordination, while better managing Medicaid expenditures.

Statutory Authority for Adoption: RCW 74.08.090.

Other Authority: 42 C.F.R. 441.302(a), Social Security Act, Section 1915(c) waiver rules, 42 C.F.R. 438.

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.

Reasons for this Finding: These new rules will allow the department to immediately implement coordinated medical and long-term care services under MMIP to improve client outcomes and preserve the health of eligible frail seniors and persons with disabilities. The new rules will offer clients additional choice in their long-term care options, will result in more efficient care and enhanced service delivery, and will help the department better manage Medicaid resources.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 5, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 5, Amended 0, Repealed 0.

Date Adopted: June 24, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

3570.1MEDICARE/MEDICAID INTEGRATION PROGRAM (MMIP) SERVICES
NEW SECTION
WAC 388-106-0720   What services may I receive under MMIP?   (1) Once you are determined eligible, your care plan could include, but is not limited to, any of the following long-term care services:

(a) Care coordination;

(b) Personal care services in your own home or in a residential facility;

(c) Home Health Aide;

(d) Adult Day Services;

(e) Environmental Modifications;

(f) Personal Emergency Response System (PERS);

(g) Skilled Nursing;

(h) Specialized Medical Equipment and Supplies;

(i) Home Delivered Meals;

(j) Residential care;

(k) Nursing facility care.

(2) The care plan may also include, but is not limited to, the following medical services:

(a) Primary medical care;

(b) Restorative therapies, including speech, occupational, and physical therapy;

(c) Nursing Services;

(d) Durable medical equipment (e.g., wheelchair);

(e) Pharmaceutical products;

(f) Immunizations and vaccinations;

(g) Vision Care;

(h) Emergency room visits and inpatient hospital stays. The care plan may also include other services determined necessary by the interdisciplinary team to improve and maintain your overall health status.

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NEW SECTION
WAC 388-106-0725   Am I eligible for MMIP services?   To qualify for Medicaid-funded MMIP services, you must:

(1) Be age sixty-five or older;

(2) Live within the designated MMIP service area;

(3) Be eligible for Medicare (Parts A and B);

(4) Be eligible for Medicaid-funded medical and/or long-term care services.

(a) To be eligible to receive long-term care services under this program, you must be assessed by the department (per WAC 388-106-0020) and meet either MPC (per WAC 388-500-0005) or COPES/Nursing Facility Level of Care eligibility (per WAC 388-515-1505).

(b) Ongoing functional and financial eligibility for long-term care services will be determined on at least an annual basis by the state.

(c) If you are determined not eligible for long-term care services, you may be eligible to receive medical services under MMIP; and

(5) Not be enrolled in any other medical coverage plan that purchases services on a prepaid basis (e.g., prepaid health plan).

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NEW SECTION
WAC 388-106-0730   How do I pay for MMIP services?   Depending on your income and resources, you may be required to pay for part of your MMIP services. The department's financial worker will determine what amount, if any, you must contribute toward the cost of your care.

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NEW SECTION
WAC 388-106-0735   How do I disenroll from MMIP?   You may choose to disenroll from MMIP for any reason at any time. See WAC 388-538-061 for additional information on ending enrollment in MMIP.

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NEW SECTION
WAC 388-106-0740   What is the fair hearing process for enrollee appeals of managed care organization actions?   See WAC 388-538-112 for additional information about the fair hearing process.

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Washington State Code Reviser's Office