SOCIAL AND HEALTH SERVICES
(Medicaid Purchasing Administration)
Effective Date of Rule: Immediately.
Purpose: The legislature passed ESHB 1086, which authorized the department of social and health services to place long-term care clients residing in nursing homes and paid for with state-only funds into less restrictive community care settings while continuing to meet the client's care needs.
Citation of Existing Rules Affected by this Order: Amending WAC 388-438-0125.
Statutory Authority for Adoption: Chapter 5, Laws of 2011, ESHB 1086.
Other Authority: RCW 74.08.090.
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; and that in order to implement the requirements or reductions in appropriations enacted in any budget for fiscal years 2009, 2010, or 2011, which necessitates the need for the immediate adoption, amendment, or repeal of a rule, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the fiscal needs or requirements of the agency.
Reasons for this Finding: See Purpose statement above.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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: April 13, 2011.
Katherine I. Vasquez
(2) Long-term care services are defined in this section as services provided in one of the following facilities:
(a) Nursing facility, as defined in WAC 388-97-0001;
(b) Adult family home, as defined in RCW 70.128.010;
(c) Assisted living facility, as described in WAC 388-513-1301;
(d) Enhanced adult residential care facility, as described in WAC 388-513-1301;
(e) Adult residential care facility, as described in WAC 388-513-1301.
(3) Long-term care services will be provided in one of the facilities listed in subsection (2)(b) through (e) of this section unless nursing facility care is required to sustain life.
(4) To be eligible for the state-funded ((
facility)) long-term care services program described in this
section, an adult nineteen years of age or older must meet all
of the following conditions:
(a) Meet the general eligibility requirements for medical programs described in WAC 388-503-0505 (2) and (3)(a), (b), (e), and (f);
(b) Reside in ((
a nursing facility as defined in WAC 388-97-0001)) one of the settings described in subsection (2)
of this section;
(c) Attain institutional status as described in WAC 388-513-1320;
(d) Meet the functional eligibility described in WAC 388-106-0355 for nursing facility level of care;
(e) Not have a penalty period due to a transfer of assets as described in WAC 388-513-1363, 388-513-1364, 388-513-1365, and 388-513-1366;
(f) Not have equity interest in a primary residence of more than five hundred thousand dollars as described in WAC 388-513-1350; and
(g) Any annuities owned by the adult or spouse must meet the requirements described in chapter 388-561 WAC.
(3))) (5) An adult who is related to the supplemental
security income (SSI) program as described in WAC 388-475-0050
(1), (2), and (3) must meet the financial requirements
described in WAC 388-513-1325, 388-513-1330, and 388-513-1350.
(4))) (6) An adult who does not meet the SSI-related
criteria in subsection (2) of this section may be eligible
under the family institutional medical program rules described
in WAC 388-505-0250 or 388-505-0255.
(5))) (7) An adult who is not eligible for the
state-funded (( alien nursing facility)) long-term care
services program under categorically needy (CN) rules may
qualify under medically needy (MN) rules described in:
(a) WAC 388-513-1395 for adults related to SSI; or
(b) WAC 388-505-0255 for adults related to family institutional medical.
(6))) (8) All adults qualifying for the state-funded
(( alien nursing facility)) long-term care program will receive
CN scope of medical coverage described in WAC 388-501-0060.
(7))) (9) The department determines how much an
individual is required to pay toward the cost of care using
the following rules:
(a) For an SSI-related individual residing in a nursing home, see rules described in WAC 388-513-1380.
(b) For an SSI-related individual residing in one of the other settings described in subsection (2) of this section, see rules described in WAC 388-515-1509.
(c) For an individual eligible under the family institutional program, see WAC 388-505-0265.
(8))) (10) A person is not eligible for state-funded
nursing facility care if that person entered the state
specifically to obtain medical care.
(9))) (11) A person eligible for the state-funded
(( alien nursing facility)) long-term care program is certified
for a twelve month period.
[Statutory Authority: RCW 74.04.050, 74.08.090, and 2009 c 564 §§ 1109, 201, 209. 10-19-085, § 388-438-0125, filed 9/17/10, effective 10/18/10.]