WSR 06-07-013

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed March 3, 2006, 4:24 p.m. , effective April 3, 2006 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: These rules are being revised to update the home and community residential rates from the four level payment system to the comprehensive assessment reporting evaluation (CARE) payment levels and to reflect the vendor rate increases of July 1, 2005; and to amend the bed hold section to clarify the requirements for third-party payment and to clarify that an absence less than twenty-four hours is not subject to a bed hold payment.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-105-0010, 388-105-0015, 388-105-0020, 388-105-0025, 388-105-0030 and 388-105-0040; and amending WAC 388-105-0005 and 388-105-0045.

Statutory Authority for Adoption: Chapter 74.39A RCW.

Adopted under notice filed as WSR 06-03-119 on January 17, 2006.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 6.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 6.

Date Adopted: February 28, 2005 [2006].

Andy Fernando, Manager

Rules and Policies Assistance Unit

3543.7
AMENDATORY SECTION(Amending WSR 04-09-092, filed 4/20/04, effective 5/21/04)

WAC 388-105-0005   ((What are)) The daily Medicaid payment rates for ((contracted)) clients assessed using the comprehensive assessment reporting evaluation (CARE) tool and that reside in adult family homes (AFH)((,)) and boarding homes contracted to provide assisted living (AL), adult residential care (ARC), and enhanced adult residential care (EARC) services((?)).   For contracted AFH((,)) and boarding homes contracted to provide AL, 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 $ 45.70 $ 44.43 $ 44.43
Level 2 $ 48.65 $ 50.89 $ 56.34
Level 3 $ 56.32 $ 58.76 $ 65.01
Level 4 $ 67.75)) $ 71.67 $ 77.91))

COMMUNITY RESIDENTIAL DAILY RATES FOR CLIENTS ASSESSED USING CARE
KING COUNTY
ARC EARC AFH
CARE CLASSIFICATION AL

Without Capital Add-on

AL

With Capital Add-on

A Low (1) $64.02 $69.03 $45.27 $45.27 $45.90
A Med (2) $69.32 $74.33 $51.37 $51.37 $52.09
A High (3) $77.78 $82.78 $65.61 $65.61 $58.28
B Low (4) $64.02 $69.03 $45.27 $45.27 $45.90
B Med (5) $71.44 $76.45 $57.47 $57.47 $58.28
B High (6) $85.18 $90.19 $73.75 $73.75 $66.52
C Low (7) $69.32 $74.33 $51.37 $51.37 $52.09
C Med (8) $77.78 $82.78 $65.61 $65.61 $66.52
C High (9) $96.83 $101.84 $85.96 $85.96 $87.15
D Low (10) $71.44 $76.45 $57.47 $57.47 $66.52
D Med (11) $77.78 $82.78 $65.61 $65.61 $74.78
D High (12) $96.83 $101.84 $85.96 $85.96 $87.15


COMMUNITY RESIDENTIAL DAILY RATES FOR CLIENTS ASSESSED USING CARE
METROPOLITAN COUNTIES*
ARC EARC AFH
CARE CLASSIFICATION AL

Without Capital

Add-on

AL

With Capital Add-on

A Low (1) $58.73 $63.28 $45.27 $45.27 $45.90
A Med (2) $61.91 $66.45 $49.33 $49.33 $50.03
A High (3) $75.67 $80.22 $62.56 $62.56 $55.18
B Low (4) $58.73 $63.28 $45.27 $45.27 $45.90
B Med (5) $67.20 $71.75 $54.42 $54.42 $55.18
B High (6) $83.07 $87.62 $69.69 $69.69 $63.43
C Low (7) $61.91 $66.45 $49.33 $49.33 $50.03
C Med (8) $75.67 $80.22 $62.56 $62.56 $63.43
C High (9) $93.65 $98.20 $79.85 $79.85 $80.97
D Low (10) $67.20 $71.75 $54.42 $54.42 $63.43
D Med (11) $75.67 $80.22 $62.56 $62.56 $70.65
D High (12) $93.65 $98.20 $79.85 $79.85 $80.97

*Benton, Clark, Franklin, Island, Kitsap, Pierce, Snohomish, Spokane, Thurston, Whatcom, and Yakima counties.


COMMUNITY RESIDENTIAL DAILY RATES FOR CLIENTS ASSESSED USING CARE
NON-METROPOLITAN COUNTIES**
ARC EARC AFH
CARE CLASSIFICATION AL

Without Capital

Add-on

AL

With Capital Add-on

A Low (1) $57.68 $62.52 $45.27 $45.27 $45.90
A Med (2) $61.91 $66.75 $48.32 $48.32 $49.00
A High (3) $75.67 $80.51 $61.55 $61.55 $54.15
B Low (4) $57.68 $62.52 $45.27 $45.27 $45.90
B Med (5) $67.20 $72.04 $53.41 $53.41 $54.16
B High (6) $83.07 $87.91 $67.65 $67.65 $62.41
C Low (7) $61.91 $66.75 $48.32 $48.32 $49.00
C Med (8) $75.67 $80.51 $61.55 $61.55 $62.41
C High (9) $93.65 $98.49 $76.80 $76.80 $77.88
D Low (10) $67.20 $72.04 $53.41 $53.41 $62.41
D Med (11) $75.67 $80.51 $61.55 $61.55 $68.59
D High (12) $93.65 $98.49 $76.80 $76.80 $77.88

** Non-Metropolitan Counties: Adams, Asotin, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Garfield, Grant, Grays Harbor, Jefferson, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Orielle, San Juan, Skagit, Skamania, Stevens, Wahkiakum, Walla Walla and Whitman.

[Statutory Authority: RCW 74.39A.030, 2003 c 231. 04-09-092, 388-105-0005, filed 4/20/04, effective 5/21/04. 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.]

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
AMENDATORY SECTION(Amending WSR 04-09-092, filed 4/20/04, effective 5/21/04)

WAC 388-105-0045   Bed or unit hold Medicaid resident discharged for a hospital or nursing home stay from an adult family home (AFH) or a boarding home with an adult residential care services (ARC), enhanced adult residential care services (EARC), or assisted living services (AL) contract.   (1) When an AFH, ARC, EARC, or AL contracts to provide services under chapter 74.39A RCW, the AFH, ARC, EARC, and AL ((provider)) contractor 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)) contractor to hold the Medicaid resident's bed or unit during the resident's short-term nursing home or hospital stay, the ((provider)) contractor must hold the unit or bed for up to twenty days. A Medicaid resident's discharge from an AFH, ARC, EARC, or an AL facility for a short term stay in a nursing home or hospital must be longer than twenty-four hours before subsection (3) of WAC 388-105-0045 applies.

(3) The department will compensate the ((provider)) contractor 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)) seventy-eight cents a day.

(4) The AFH, ARC, EARC, or AL facility may seek third-party payment to hold a bed or unit for twenty-one days or longer. The third-party payment shall not exceed the Medicaid daily rate paid to the facility for the resident. If third-party payment is not available and the returning Medicaid resident continues to meet the admission criteria under chapter 388-71 and/or 106 WAC, then the Medicaid resident may return to the first available and appropriate bed or unit.

(5) The department's social worker or case manager determines whether the:

(a) ((Care given)) Stay in a nursing home or hospital will be short-term; and

(b) Resident is likely to return to the AFH, ARC, EARC, or AL facility.

(6) When the resident's stay in the hospital or nursing home exceeds twenty days or the department's social worker or case manager determines that the Medicaid resident's stay in the nursing home or hospital is not short-term and the resident is unlikely to return to the AFH, ARC, EARC, or AL facility, then ((this)) only subsection (4) of this section ((does not apply)) applies to any private contractual arrangements that the ((provider)) contractor may make with a third party in regard to the discharged resident's unit or bed.

[Statutory Authority: RCW 74.39A.030, 2003 c 231. 04-09-092, 388-105-0045, filed 4/20/04, effective 5/21/04.]


REPEALER

     The following sections of the Washington Administrative Code are repealed:
WAC 388-105-0010 What are care levels?
WAC 388-105-0015 How does the department determine whether the Medicaid resident needs assistance in completing ADLs and/or has unmet care needs?
WAC 388-105-0020 How does the department determine at which care level the Medicaid resident will be placed?
WAC 388-105-0025 How many ADL values and unmet care need points correspond to the four care levels?
WAC 388-105-0030 What are the daily Medicaid payment rates for contracted assisted living facilities (AL) not receiving a capital rate add-on?
WAC 388-105-0040 What are the daily capital add-on rates for assisted living facilities (AL) and the AL daily payment rates with a capital add-on rate?

Washington State Code Reviser's Office