WSR 09-04-065

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed February 2, 2009, 4:30 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 08-12-070.

     Title of Rule and Other Identifying Information: The department is amending 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 and 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 contracted to provide adult residential care (ARC), enhanced adult residential care (EARC), or assisted living services (AL).

     Hearing Location(s): Office Building 2, Auditorium, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html or by calling (360) 664-6094), on March 10, 2009, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than March 11, 2009.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on March 10, 2009.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by February 24, 2009, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose of this rule making is to:

• Implement phase one of full implementation of a seventeen CARE level payment system for community residential providers effective July 1, 2008. The effect is to increase adult family home rates; and
• Clarify when a client currently receiving bed hold assistance returns to the facility, the client must be in residence for twenty-four hours before a departure will result in a new bed hold sequence. If the client leaves before the expiration of twenty-four hours, then the bed hold sequence on which the client's bed was held when the client returned will continue.

     Reasons Supporting Proposal: Under chapter 329, Laws of 2008, the legislature required the implementation of the seventeen level payment system. The amendment to WAC 388-105-0045 prevents over expending bed hold funds by defining when a client has returned to a facility.

     Statutory Authority for Adoption: RCW 74.39A.030, 18.20.290, and chapter 329, Laws of 2008.

     Statute Being Implemented: RCW 74.39A.030 and 18.20.290.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting: Patricia Hague, Mailstop 45600, Olympia, Washington 98504, (360) 725-2447; Implementation and Enforcement: Ken Callaghan, Mailstop 45600, Olympia, Washington 98504, (360) 725-2499.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. Under RCW 19.85.025(3), 19.85.030 (1)(a) and 34.05.310 (4)(f), the department is exempt from preparing a small business economic impact statement (SBEIS).

     RCW 19.85.025(3), this chapter does not apply to the adoption of a rule described in RCW 34.05.310(4).

     RCW 34.05.310(4), this section does not apply to: Subsection (f) Rules that set or adjust fees or rates pursuant to legislative standards; the adoption of rules to set or adjust fees is cost neutral.

     RCW 19.85.030 (1)(a) In the adoption of a rule under chapter 34.05 RCW, an agency shall prepare an SBEIS: (a) If the proposed rule will impose more than minor costs on businesses in an industry.

     A cost-benefit analysis is not required under RCW 34.05.328. Under RCW 34.05.328 (5)(b)(vi), the department is exempt from preparing a cost-benefit analysis for these rules. The rules set or adjust fees or rates pursuant to legislative standards.

     RCW 34.05.328 (5)(b), this section does not apply to: Subsection (vi) Rules that set or adjust fees or rates pursuant to legislative standards.

January 27, 2009

Stephanie E. Schiller

Rules Coordinator

3990.6
AMENDATORY SECTION(Amending WSR 06-19-017, filed 9/8/06, effective 10/9/06)

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))) $((65.30))

69.22

 $((70.41))

74.64

 $((46.18))

48.95

 $((46.18))

48.95

 $((46.82))

48.32
A Med (((2))) $((70.71))

74.95

 $((75.82))

80.37

 $((52.40))

55.54

 $((52.40))

55.54

 $((53.13))

54.83
A High (((3))) $((79.34))

84.10

 $((84.45))

89.52

 $((66.92))

61.00

 $((66.92))

61.00

 $((59.45))

61.35
B Low (((4))) $((65.30))

69.22

 $((70.41))

74.64

 $((46.18))

48.95

 $((46.18))

48.95

 $((46.82))

48.56
B Med (((5))) $((72.87))

77.24

 $((77.98))

82.66

 $((58.62))

62.14

 $((58.62))

62.14

 $((59.45))

61.66
B Med-High $87.48 $92.90 $66.07 $66.07 $66.06
B High (((6))) $((86.88))

92.09

 $((91.99))

97.51

 $((75.23))

75.53

 $((75.23))

75.53

 $((67.85))

75.53
C Low (((7))) $((70.71))

74.95

 $((75.82))

80.37

 $((52.40))

55.54

 $((52.40))

55.54

 $((53.13))

54.83
C Med (((8))) $((79.34))

84.10

 $((84.45))

89.52

 $((66.92))

69.72

 $((66.92))

69.72

 $((67.85))

70.02
C ((High (9))) Med-High $((98.77))

104.70

 $((103.88))

110.12

 $((87.68))

92.94

 $((87.68))

92.94

 $((88.89))

91.73
C High $105.74 $111.16 $93.82 $93.82 $93.01
D Low (((10))) $((72.87))

77.24

 $((77.98))

82.66

 $((58.62))

75.07

 $((58.62))

75.07

 $((67.85))

71.38
D Med (((11))) $((79.34))

85.82

 $((84.45))

91.24

 $((66.92))

86.98

 $((66.92))

86.98

 $((76.28))

87.36
D Med-High $110.98 $116.40 $110.61 $110.61 $105.12
D High (((12))) $((98.77))

119.59

 $((103.88))

125.01

 $((87.68))

119.59

 $((87.68))

119.59

 $((88.89))

119.69
E Med $144.53 $149.95 $144.53 $144.53 $144.63
E High $169.47 $174.89 $169.47 $169.47 $169.57


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))) $((59.90))

63.49

 $((64.54))

68.41

 $((46.18))

48.95

 $((46.18))

48.95

 $((46.82))

48.32
A Med (((2))) $((63.15))

66.94

 $((67.79))

71.86

 $((50.32))

53.34

 $((50.32))

53.34

 $((51.03))

52.66
A High (((3))) $((77.18))

81.81

 $((81.82))

86.73

 $((63.81))

58.17

 $((63.81))

58.17

 $((56.28))

58.08
B Low (((4))) $((59.90))

63.49

 $((64.54))

68.41

 $((46.18))

48.95

 $((46.18))

48.95

 $((46.82))

48.56
B Med (((5))) $((68.54))

72.65

 $((73.18))

77.57

 $((55.51))

58.84

 $((55.51))

58.84

 $((56.28))

58.37
B Med-High $82.29 $87.21 $62.57 $62.57 $62.60
B High (((6))) $((84.73))

89.81

 $((89.37))

94.73

 $((71.08))

73.40

 $((71.08))

73.40

 $((64.70))

73.40
C Low (((7))) $((63.15))

66.94

 $((67.79))

71.86

 $((50.32))

53.56

 $((50.32))

53.56

 $((51.03))

53.05
C Med (((8))) $((77.18))

81.81

 $((81.82))

86.73

 $((63.81))

68.82

 $((63.81))

68.82

 $((64.70))

68.31
C ((High (9))) Med-High $((95.52))

101.25

 $((100.16))

106.17

 $((81.45))

86.34

 $((81.45))

86.34

 $((82.59))

85.23
C High $102.26 $107.18 $91.84 $91.84 $90.43
D Low (((10))) $((68.54))

72.65

 $((73.18))

77.57

 $((55.51))

74.04

 $((55.51))

74.04

 $((64.70))

69.80
D Med (((11))) $((77.18))

83.48

 $((81.82))

88.40

 $((63.81))

85.24

 $((63.81))

85.24

 $((72.06))

85.01
D Med-High $107.33 $112.25 $107.87 $107.87 $101.92
D High (((12))) $((95.52))

116.30

 $((100.16))

121.22

 $((81.45))

116.30

 $((81.45))

116.30

 $((82.59))

115.79
E Med $140.04 $144.96 $140.04 $140.04 $139.53
E High $163.78 $168.70 $163.78 $163.78 $163.27

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


COMMUNITY RESIDENTIAL DAILY RATES FOR CLIENTS ASSESSED USING CARE
NONMETROPOLITAN COUNTIES**
ARC EARC AFH
CARE CLASSIFICATION AL Without Capital Add-on AL With Capital Add-on
A Low (((1))) $((58.83))

62.36

 $((63.77))

67.60

 $((46.18))

48.95

 $((46.18))

48.95

 $((46.82))

48.32
A Med (((2))) $((63.15))

66.94

 $((68.09))

72.18

 $((49.29))

52.25

 $((49.29))

52.25

 $((49.98))

51.58
A High (((3))) $((77.18))

81.81

 $((82.12))

87.05

 $((62.78))

57.23

 $((62.78))

57.23

 $((55.24))

57.01
B Low (((4))) $((58.83))

62.36

 $((63.77))

67.60

 $((46.18))

48.95

 $((46.18))

48.95

 $((46.82))

48.56
B Med (((5))) $((68.54))

72.65

 $((73.48))

77.89

 $((54.48))

57.75

 $((54.48))

57.75

 $((55.24))

57.29
B Med-High $82.29 $87.53 $61.40 $61.40 $61.38
B High (((6))) $((84.73))

89.81

 $((89.67))

95.05

 $((69.00))

69.42

 $((69.00))

69.42

 $((63.66))

69.42
C Low (((7))) $((63.15))

66.94

 $((68.09))

72.18

 $((49.29))

52.25

 $((49.29))

52.25

 $((49.98))

51.58
C Med (((8))) $((77.18))

81.81

 $((82.12))

87.05

 $((62.78))

65.05

 $((62.78))

65.05

 $((63.66))

65.70
C ((High (9))) Med-High $((95.52))

101.25

 $((100.46))

106.49

 $((78.34))

83.04

 $((78.34))

83.04

 $((79.44))

81.98
C High $102.26 $107.50 $86.81 $86.81 $85.52
D Low (((10))) $((68.54))

72.65

 $((73.48))

77.89

 $((54.48))

69.99

 $((54.48))

69.99

 $((63.66))

66.01
D Med (((11))) $((77.18))

83.48

 $((82.12))

88.72

 $((62.78))

80.57

 $((62.78))

80.57

 $((69.96))

80.39
D Med-High $107.33 $112.57 $101.96 $101.96 $96.37
D High (((12))) $((95.52))

109.93

 $((100.46))

115.17

 $((78.34))

109.93

 $((78.34))

109.93

 $((79.44))

109.48
E Med $132.36 $137.60 $132.36 $132.36 $131.92
E High $154.80 $160.04 $154.80 $154.80 $154.36

** Nonmetropolitan 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, RCW 18.20.290, 2006 c 372, 260, and 64. 06-19-017, § 388-105-0005, filed 9/8/06, effective 10/9/06. 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.]

4039.1
AMENDATORY SECTION(Amending WSR 06-19-017, filed 9/8/06, effective 10/9/06)

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 contracted to provide adult residential care (ARC), enhanced adult residential care (EARC), or assisted living services (AL).   (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 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.

     (c) When a Medicaid resident on bed hold leave returns to an AFH, ARC, EARC, or an AL facility but remains less than twenty-four hours, the bed hold leave on which the resident returned applies after the resident's discharge. A new bed hold leave will begin only when the returned resident has resided in the facility for more than twenty-four hours before the resident's next discharge.

     (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 eleven dollars 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, RCW 18.20.290, 2006 c 372, 260, and 64. 06-19-017, § 388-105-0045, filed 9/8/06, effective 10/9/06. 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