SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Effective Date of Rule: July 1, 2007.
Purpose: Amending WAC 388-515-1510 Division of developmental disabilities (DDD) waivers and outward bound residential alternatives (OBRA):
|•||Increasing the personal needs allowance (PNA) 3.3% for clients residing in alternate living facilities (ALF).|
|•||Changing the personal needs allowance allowed in an alternate living facility from $38.84 to $40.12.|
|•||Clarifying the change in the room and board amount which is based on the federal benefit rate (FBR) minus $60.78 effective July 1, 2007.|
Citation of Existing Rules Affected by this Order: Amending WAC 388-515-1510.
Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, and 74.09.530.
Other Authority: Washington state 2007-09 operating budget (SHB 1128).
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: The Washington state 2007-09 operating budget (SHB 1128) increases the personal needs allowance (PNA) 3.3% effective July 1, 2007. A CR-101 has been filed as WSR 07-12-065, and an emergency rule is necessary while the department completes adoption of permanent rules.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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: June 13, 2007.
Stephanie E. Schiller
(1) The four DDD waivers are:
(b) Basic Plus,
(c) Core, and
(d) Community protection.
(2) The requirements for services for DDD waivers are contained in chapter 388-845 WAC. The department establishes eligibility for DDD waivers and OBRA services for a client who:
(a) Is both Medicaid eligible under the categorically needy (CN) program and meets the requirements for services provided by the division of developmental disabilities (DDD);
(b) Has attained institutional status as described in WAC 388-513-1320;
(c) Has been assessed as requiring the level of care provided in an intermediate care facility for the mentally retarded (ICF/MR);
(d) Has a department-approved plan of care that includes support services to be provided in the community;
(e) Is able to reside in the community according to the plan of care and chooses to do so;
(f) Meets the income and resource requirements described in subsection (3); and
(g) For the OBRA program only, the client must be a medical facility resident at the time of application.
(3) The department allows a client to have nonexcluded resources in excess of the standard described in WAC 388-513-1350(1) during the month of either an application or eligibility review if, when excess resources are added to nonexcluded income, the combined total does not exceed the special income level (SIL). Refer to WAC 388-513-1315 for rules used to determine nonexcluded income and resources. During other months, financial requirements include the following:
(a) Nonexcluded income must be at or below the SIL; and
(b) Nonexcluded resources not allocated to participation in a prior month must be at or below the resource standard.
(4) A client who is eligible for supplemental security income (SSI) does not participate in the cost of care for DDD waivers or OBRA services.
(5) An SSI-related client retains a maintenance needs amount of up to the SIL, who is:
(a) Living at home; or
(b) Living in an alternate living facility described in WAC 388-513-1305(1).
(6) A client described in subsection (5)(b) retains the greater of:
(a) The SSI grant standard; or
(b) An amount equal to a total of the following:
(i) A personal needs allowance (PNA) of ((
forty dollars and (( eighty-four)) twelve cents; plus
(ii) The facility's monthly ((
rate for)) board and room
rate based on the FBR minus sixty dollars and seventy-eight
cents, which the client pays to the facility; plus
(iii) The first twenty dollars of monthly earned or unearned income; and
(iv) The first sixty-five dollars plus one-half of the remaining earned income not previously excluded.
(7) If a client has a spouse in the home who is not receiving DDD waivers or OBRA services, the department allocates the client's income in excess of the amounts described in subsections (5) and (6) as an additional maintenance needs amount in the following order:
(a) One for the spouse, as described in WAC 388-513-1380 (7)(b); and
(b) One for any other dependent family member in the home, as described in WAC 388-513-1380 (7)(c).
(8) A client's participation in the cost of care for DDD waivers or OBRA services is the client's income:
(a) That exceeds the amounts described in subsections (5), (6), and (7); and
(b) Remains after deductions for medical expenses not subject to third-party payment for which the client remains liable, included in the following:
(i) Medicare and other health insurance premiums, deductibles, or coinsurance charges; and
(ii) Necessary medical care recognized under state law but not covered by Medicaid.
[Statutory Authority: RCW 71A.12.030, 71A.10.020, chapters 71A.10 and 71A.12 RCW, 2004 c 276. 04-18-054, § 388-515-1510, filed 8/27/04, effective 9/27/04. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500. 01-02-052, § 388-515-1510, filed 12/28/00, effective 1/28/01. Statutory Authority: RCW 11.92.180, 43.20B.460, 48.85.020, 74.04.050, 74.04.057, 74.08.090, 74.09.500, 74.09.530, 74.[09.]575, 74.09.585; 20 C.F.R. 416.1110-1112, 1123 and 1160; 42 C.F.R. 435.403 (j)(2) and 1005; and Sections 17, 1915(c), and 1924 (42 U.S.C. 1396) of the Social Security Act. 00-01-051, § 388-515-1510, filed 12/8/99, effective 1/8/00. Statutory Authority: RCW 74.08.090 and 74.09.500. 99-06-045, § 388-515-1510, filed 2/26/99, effective 3/29/99. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), § 388-515-1510, filed 5/3/94, effective 6/3/94. Formerly WAC 388-83-210.]