WSR 13-04-094

PERMANENT RULES

HEALTH CARE AUTHORITY


(Medicaid Program)

[ Filed February 6, 2013, 10:06 a.m. , effective March 9, 2013 ]


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

Purpose: To comply with the agency's federal Transitional Bridge 1115 Waiver, the agency is removing medical care services from the list of eligible programs for hospice services. 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).

Citation of Existing Rules Affected by this Order: Amending WAC 182-551-1200.

Statutory Authority for Adoption: RCW 41.05.021.

Adopted under notice filed as WSR 13-02-055 on December 26, 2012.

Changes Other than Editing from Proposed to Adopted Version: No change to the text. The purpose statement in the agency's CR-102 did have a typo. The word "medicare" was used when referencing medical care services. The actual text reflected the proper language which was being struck (Medical care services).

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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: February 6, 2013.

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.]