WSR 06-19-017

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed September 8, 2006, 4:30 p.m. , effective October 9, 2006 ]


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

Purpose: The department has updated 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, 2006; and amended the bed hold section to clarify the requirements for third-party payment and clarify that an absence of less than twenty-four hours is not subject to a bed hold payment.

Citation of Existing Rules Affected by this Order: Amending WAC 388-105-0005, 388-105-0035, and 388-105-0045.

Statutory Authority for Adoption: Chapter 74.39A RCW.

Other Authority: RCW 18.20.290; chapters 372, 260, and 64, Laws of 2006.

Adopted under notice filed as WSR 06-16-076 on July 28, 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Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 3, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

Date Adopted: September 6, 2006.

Andy Fernando, Manager

Rules and Policies Assistance Unit

3669.6
AMENDATORY SECTION(Amending WSR 06-07-013, filed 3/3/06, effective 4/3/06)

WAC 388-105-0005   The daily Medicaid payment rates for 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:


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))

65.30

$((69.03))

70.41

$((45.27))

46.18

$((45.27))

46.18

$((45.90))

46.82

A Med (2) $((69.32))

70.71

$((74.33))

75.82

$((51.37))

52.40

$((51.37))

52.40

$((52.09))

53.13

A High (3) $((77.78))

79.34

$((82.78))

84.45

$((65.61))

66.92

$((65.61))

66.92

$((58.28))

59.45

B Low (4) $((64.02))

65.30

$((69.03))

70.41

$((45.27))

46.18

$((45.27))

46.18

$((45.90))

46.82

B Med (5) $((71.44))

72.87

$((76.45))

77.98

$((57.47))

58.62

$((57.47))

58.62

$((58.28))

59.45

B High (6) $((85.18))

86.88

$((90.19))

91.99

$((73.75))

75.23

$((73.75))

75.23

$((66.52))

67.85

C Low (7) $((69.32))

70.71

$((74.33))

75.82

$((51.37))

52.40

$((51.37))

52.40

$((52.09))

53.13

C Med (8) $((77.78))

79.34

$((82.78))

84.45

$((65.61))

66.92

$((65.61))

66.92

$((66.52))

67.85

C High (9) $((96.83))

98.77

$((101.84))

103.88

$((85.96))

87.68

$((85.96))

87.68

$((87.15))

88.89

D Low (10) $((71.44))

72.87

$((76.45))

77.98

$((57.47))

58.62

$((57.47))

58.62

$((66.52))

67.85

D Med (11) $((77.78))

79.34

$((82.78))

84.45

$((65.61))

66.92

$((65.61))

66.92

$((74.78))

76.28

D High (12) $((96.83))

98.77

$((101.84))

103.88

$((85.96))

87.68

$((85.96))

87.68

$((87.15))

88.89


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))

59.90

$((63.28))

64.54

$((45.27))

46.18

$((45.27))

46.18

$((45.90))

46.82

A Med (2) $((61.91))

63.15

$((66.45))

67.79

$((49.33))

50.32

$((49.33))

50.32

$((50.03))

51.03

A High (3) $((75.67))

77.18

$((80.22))

81.82

$((62.56))

63.81

$((62.56))

63.81

$((55.18))

56.28

B Low (4) $((58.73))

59.90

$((63.28))

64.54

$((45.27))

46.18

$((45.27))

46.18

$((45.90))

46.82

B Med (5) $((67.20))

68.54

$((71.75))

73.18

$((54.42))

55.51

$((54.42))

55.51

$((55.18))

56.28

B High (6) $((83.07))

84.73

$((87.62))

89.37

$((69.69))

71.08

$((69.69))

71.08

$((63.43))

64.70

C Low (7) $((61.91))

63.15

$((66.45))

67.79

$((49.33))

50.32

$((49.33))

50.32

$((50.03))

51.03

C Med (8) $((75.67))

77.18

$((80.22))

81.82

$((62.56))

63.81

$((62.56))

63.81

$((63.43))

64.70

C High (9) $((93.65))

95.52

$((98.20))

100.16

$((79.85))

81.45

$((79.85))

81.45

$((80.97))

82.59

D Low (10) $((67.20))

68.54

$((71.75))

73.18

$((54.42))

55.51

$((54.42))

55.51

$((63.43))

64.70

D Med (11) $((75.67))

77.18

$((80.22))

81.82

$((62.56))

63.81

$((62.56))

63.81

$((70.65))

72.06

D High (12) $((93.65))

95.52

$((98.20))

100.16

$((79.85))

81.45

$((79.85))

81.45

$((80.97))

82.59

*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))

58.83

$((62.52))

63.77

$((45.27))

46.18

$((45.27))

46.18

$((45.90))

46.82

A Med (2) $((61.91))

63.15

$((66.75))

68.09

$((48.32))

49.29

$((48.32))

49.29

$((49.00))

49.98

A High (3) $((75.67))

77.18

$((80.51))

82.12

$((61.55))

62.78

$((61.55))

62.78

$((54.15))

55.24

B Low (4) $((57.68))

58.83

$((62.52))

63.77

$((45.27))

46.18

$((45.27))

46.18

$((45.90))

46.82

B Med (5) $((67.20))

68.54

$((72.04))

73.48

$((53.41))

54.48

$((53.41))

54.48

$((54.16))

55.24

B High (6) $((83.07))

84.73

$((87.91))

89.67

$((67.65))

69.00

$((67.65))

69.00

$((62.41))

63.66

C Low (7) $((61.91))

63.15

$((66.75))

68.09

$((48.32))

49.29

$((48.32))

49.29

$((49.00))

49.98

C Med (8) $((75.67))

77.18

$((80.51))

82.12

$((61.55))

62.78

$((61.55))

62.78

$((62.41))

63.66

C High (9) $((93.65))

95.52

$((98.49))

100.46

$((76.80))

78.34

$((76.80))

78.34

$((77.88))

79.44

D Low (10) $((67.20))

68.54

$((72.04))

73.48

$((53.41))

54.48

$((53.41))

54.48

$((62.41))

63.66

D Med (11) $((75.67))

77.18

$((80.51))

82.12

$((61.55))

62.78

$((61.55))

62.78

$((68.59))

69.96

D High (12) $((93.65))

95.52

$((98.49))

100.46

$((76.80))

78.34

$((76.80))

78.34

$((77.88))

79.44


** 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: Chapter 74.39A RCW. 06-07-013, 388-105-0005, filed 3/3/06, effective 4/3/06. 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.]


AMENDATORY SECTION(Amending WSR 06-07-012, filed 3/3/06, effective 4/3/06)

WAC 388-105-0035   Requirements for a capital add-on rate for licensed boarding homes contracted to provide assisted living (AL) services.   (1)(((a))) To the extent ((of available funding)) funds are appropriated to pay a capital add-on rate to AL contractors, beginning July 1, 2006 and every July 1 thereafter, the department will ((grant)) pay a capital add-on rate to AL contractors that have a Medicaid occupancy percentage that equals or exceeds ((the applicable biyearly Medicaid minimum occupancy percentage set)) sixty percent as determined in accordance with subsection (2) and (3) of this section ((and meet the construction requirements in subsection (4) of this section)). The department will pay the capital add-on rate to those AL contractors meeting the sixty percent Medicaid occupancy percentage for a full fiscal year i.e., July 1 through June 30.

(2) The department will determine an AL contractor's Medicaid occupancy percentage by dividing its Medicaid resident days from the last six months of the calendar year preceding the applicable July 1 rate effective date by the product of the weighted average for all its licensed boarding home beds irrespective of use times the calendar days (one hundred eighty-four) for the same six-month period ((beginning one year prior to the percentage effective date)).

(3)(((a) To set the biyearly Medicaid minimum occupancy percentage, the department will:

(i) Determine the estimated total budgeted funds for capital add-on rates for the six-month period;

(ii) Rank from highest to lowest the individual AL contractor occupancy percentages determined in accordance with subsection (2) of this section;

(iii) Assign, beginning with the highest AL contractor's Medicaid occupancy percentage, the estimated expenditure needed to pay the capital add-on rate to each facility for the six-month period;

(iv) Identify the AL contractor's Medicaid occupancy percentage at which the estimated total budgeted funds determined under subsection (3)(a)(i) of this section would be expended; and

(v) Set that Medicaid occupancy percentage as the biyearly Medicaid minimum occupancy percentage.

(b) The biyearly Medicaid minimum occupancy percentage will be set every January 1 and July 1.

(4) To receive a capital add-on rate, the AL contractor that meets the Medicaid minimum occupancy percentage established in accordance with subsection (2) and (3) of this section must:

(a) Attest in writing that it has units that meet the following requirements and that it places Medicaid residents in such units, except the contractor need only place the Medicaid resident in a room with a roll-in shower when the resident's service plan and assessment details require the Medicaid resident to have a roll-in shower:

(i) A private apartment-like unit of two hundred and twenty square feet that may include counters, closets and built-ins, but must exclude the bathroom;

(ii) A separate private bathroom that includes a sink, toilet, and a shower or bathtub. The licensed boarding home must have a minimum of one wheelchair accessible bathroom with a roll-in shower of at least forty-eight inches by thirty inches for every two residents whose care is partially or fully funded by Medicaid;

(iii) A lockable entry door;

(iv) A kitchen area equipped with a refrigerator, microwave oven or stove top; a counter surface of a minimum of thirty inches wide by twenty-four inches in depth, a maximum height of thirty-four inches, and a knee space beneath at least twenty-seven inches in height; a storage space for utensils and supplies; and

(v) A living area wired for telephone and television service when available in the geographic location; or

(b) When the Al contractor does not have units that meet the requirements of subsection (4)(a) of this section, then the AL contractor may receive a capital add-on rate when its AL facility meets the definition of "new boarding home" in WAC 388-110-140 (2)(a) or its AL facility is "grandfathered" under WAC 388-110-140(3))) For the purposes of this section, Medicaid resident days include those clients enrolled in medicaid managed long-term care programs, including but not limited to the program for all inclusive care (PACE) and medicaid/medicare integration project (MMIP).

[Statutory Authority: Chapter 74.39A RCW. 06-07-012, 388-105-0035, filed 3/3/06, effective 4/3/06. Statutory Authority: 2002 c 371. 02-22-058, 388-105-0035, filed 10/31/02, effective 12/1/02.]


AMENDATORY SECTION(Amending WSR 06-07-013, filed 3/3/06, effective 4/3/06)

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)) contracted to provide 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 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)(a) When the department pays the contractor to hold the Medicaid resident's bed or unit during the resident's short-term nursing home or hospital stay, the contractor must hold the ((unit or)) bed or unit for up to twenty days. If during the twenty day bed hold period, a department case manager determines that the Medicaid resident's hospital or nursing home stay is not short term and the Medicaid resident is unlikely to return to the AFH, ARC, EARC or AL facility, the department will cease paying for the bed hold the day the case manager notifies the contractor of his/her decision.

(b) 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 contractor for holding the bed or unit for the:

(a) First through seventh day at seventy percent of the medicaid daily rate paid for care of the resident before the hospital or nursing home stay; and

(b) Eighth through the twentieth day, at ((ten)) eleven dollars ((and 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 388-106 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) 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 only subsection (4) of this section applies to any private contractual arrangements that the contractor may make with a third party in regard to the discharged resident's unit or bed.

[Statutory Authority: Chapter 74.39A RCW. 06-07-013, 388-105-0045, filed 3/3/06, effective 4/3/06. Statutory Authority: RCW 74.39A.030, 2003 c 231. 04-09-092, 388-105-0045, filed 4/20/04, effective 5/21/04.]

Washington State Code Reviser's Office