WSR 13-02-055

PROPOSED RULES

HEALTH CARE AUTHORITY


(Medicaid Program)

[ Filed December 26, 2012, 3:18 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 12-22-058.

Title of Rule and Other Identifying Information: WAC 182-551-1200 Client eligibility for hospice care.

Hearing Location(s): Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504 (metered public parking is available street side around building. A map is available at http://maa.dshs.wa.gov/pdf/CherryStreetDirectionsNMap.pdf

or directions can be obtained by calling (360) 725-1000), on February 5, 2013, at 10:00 a.m.

Date of Intended Adoption: Not sooner than February 6, 2013.

Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, delivery 626 8th Avenue, Olympia, WA 98504, e-mail arc@hca.wa.gov, fax (360) 586-9727, by 5:00 p.m. on February 5, 2013.

Assistance for Persons with Disabilities: Contact Kelly Richters by January 28, 2013, TTY (800) 848-5429 or (360) 725-1307 or e-mail kelly.richters@hca.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: During the revision of the hospice rules under WSR 12-09-079, the agency incorrectly added "medical care services" as an eligible program under WAC 182-551-1200 [(1)](d). To comply with the agency's federal Transitional Bridge 1115 Waiver, the agency must remove medicare care services from the list of eligible programs for hospice services.

Reasons Supporting Proposal: See Purpose above.

Statutory Authority for Adoption: RCW 41.05.021.

Statute Being Implemented: RCW 41.05.021.

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

Name of Proponent: HCA, medicaid program, governmental.

Name of Agency Personnel Responsible for Drafting: Wendy L. Boedigheimer, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1306; Implementation and Enforcement: Ellen Silverman, P.O. Box 45506, Olympia, WA 98504-5506, (360) 725-1570.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The agency has analyzed the proposed rules and concludes that they do not impose more than minor costs for affected small businesses.

A cost-benefit analysis is not required under RCW 34.05.328. RCW 34.05.328 does not apply to health care authority rules unless requested by the joint administrative rules [review] committee or applied voluntarily.

December 26, 2012

Kevin M. Sullivan

Rules Coordinator

OTS-5138.2


AMENDATORY SECTION(Amending WSR 12-09-079, filed 4/17/12, effective 5/18/12)

WAC 182-551-1200   Client eligibility for hospice care.   (1) A client who elects to receive hospice care must be eligible for one of the following medical assistance programs, subject to the restrictions and limitations in this chapter and other WAC:

(a) Categorically needy (CN);

(b) Children's health care as described in WAC ((388-505-0210)) 182-505-0210;

(c) Medically needy (MN); or

(d) ((Medical care services as described in WAC 182-508-0005 (within Washington state or designated border cities); or

(e))) Alien emergency medical (AEM) as described in WAC ((388-438-0110)) 182-507-0110, when the medical services are necessary to treat a qualifying emergency medical condition.

(2) A hospice agency is responsible to verify a client's eligibility with the client or the client's department of social and health services (DSHS) home and community services (HCS) office or community services office (CSO).

(3) A client enrolled in one of the medicaid agency's managed care organizations (MCO) must receive all hospice services, including facility room and board, directly through that MCO. The MCO is responsible for arranging and providing all hospice services for an MCO client.

(4) A client who is also eligible for medicare hospice under part A is not eligible for hospice care through the medicaid agency's hospice program. The medicaid agency does pay hospice nursing facility room and board for these clients if the client is admitted to a nursing facility or hospice care center (HCC) and is not receiving general inpatient care or inpatient respite care. See also WAC 182-551-1530.

(5) A client who meets the requirements in this section is eligible to receive hospice care through the medicaid agency's hospice program when all of the following is met:

(a) The client's physician certifies the client has a life expectancy of six months or less.

(b) The client elects to receive hospice care and agrees to the conditions of the "election statement" as described in WAC 182-551-1310.

(c) The hospice agency serving the client:

(i) Notifies the medicaid agency's hospice program within five working days of the admission of all clients, including:

(A) Medicaid-only clients;

(B) Medicaid-medicare dual eligible clients;

(C) Medicaid clients with third party insurance; and

(D) Medicaid-medicare dual eligible clients with third party insurance.

(ii) Meets the hospice agency requirements in WAC 182-551-1300 and 182-551-1305.

(d) The hospice agency provides additional information for a diagnosis when the medicaid agency requests and determines, on a case-by-case basis, the information that is needed for further review.

[Statutory Authority: RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. 12-09-079, 182-551-1200, filed 4/17/12, effective 5/18/12. 11-14-075, recodified as 182-551-1200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520. 05-18-033, 388-551-1200, filed 8/30/05, effective 10/1/05. Statutory Authority: RCW 74.09.520, 74.08.090, 42 C.F.R. 418.22 and 418.24. 99-09-007, 388-551-1200, filed 4/9/99, effective 5/10/99.]