Purpose: To comply with federal regulations as clarified by the federal Centers for Medicare and Medicaid (CMS), the department is amending the eligibility criteria for the alien emergency medical (AEM) program. Clients who meet COPES/nursing facility level of care will no longer automatically qualify for the AEM program; and personal care services, waiver services, and nursing facility services will no longer be covered under AEM.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-438-0110.

     Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 74.09.530.

     Under RCW 34.05.350 the agency for good cause finds 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: Being out of compliance with federal regulation (42 C.F.R. § 440.255) could jeopardize the state's federal funding for the AEM program.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 1, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: October 19, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

     (2) Except for the social security number, citizenship, or alien status requirements, an alien must meet categorical Medicaid eligibility requirements as described in:

     (a) WAC 388-505-0110, for an SSI-related person;

     (b) WAC 388-505-0220, for family medical programs;

     (c) WAC 388-505-0210, for a child under the age of nineteen; or

     (d) WAC 388-523-0100, for medical extensions.

     (3) When an alien has monthly income that exceeds the CN medical standards, the department will consider AEM medically needy coverage for children or for adults who are age sixty-five or over or who meet SSI disability criteria. See WAC 388-519-0100.

     (4) To qualify for the AEM program, the alien must meet one of the criteria described in subsection (2) of this section and have((:

     (a) A)) a qualifying emergency medical condition as described in WAC 388-500-0005((; or

     (b) Been approved by the department for, and receiving, nursing facility or COPES level of care)).

     (5) The alien's date of arrival in the United States is not used when determining eligibility for the AEM program.

     (6) The department does not deem a sponsor's income and resources as available to the client when determining eligibility for the AEM program. The department counts only the income and resources a sponsor makes available to the client.

     (7) Under the AEM program, a person receives CN scope of care, as described in WAC 388-529-0100. Covered services are limited to those medical services necessary for treatment of the person's emergency medical condition. The following services are not covered:

     (a) Organ transplants and related services;

     (b) Prenatal care, except labor and delivery; ((and))

     (c) School-based services;

     (d) Personal care services;

     (e) Waiver services; and

     (f) Nursing facility services, unless they are approved by the department's medical consultant.

     (8) When a person's income exceeds the CN income standard as described in subsection (3) of this section, the person has spend down liability and MN scope of care. MN scope of care is described in WAC 388-529-0100. The medical service limitations and exclusions described in subsection (7) are also excluded under the MN program.

     (9) A person determined eligible for the AEM program is certified for three months. The number of three-month certification periods is not limited, but, the person must continue to meet eligibility criteria in subsection (2) and (4) of this section.

     (10) A person is not eligible for the AEM program if they entered the state specifically to obtain medical care.

[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.08.090. 04-15-057, § 388-438-0110, filed 7/13/04, effective 8/13/04. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, and Section 1903 (v)(2)(c) of the Social Security Act. 03-24-058, § 388-438-0110, filed 12/1/03, effective 1/1/04. Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, § 388-438-0110, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.08.090 and C.F.R. 436.128, 436.406(c) and 440.255. 01-05-041, § 388-438-0110, filed 2/14/01, effective 3/17/01. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, 42 C.F.R. 435.139 and 42 C.F.R. 440.255. 99-23-082, § 388-438-0110, filed 11/16/99, effective 12/17/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, § 388-438-0110, filed 7/31/98, effective 9/1/98.]