WSR 14-01-112 PERMANENT RULES DEPARTMENT OF SOCIAL AND HEALTH SERVICES (Aging and Long-Term Support Administration) [Filed December 18, 2013, 10:58 a.m., effective January 18, 2014] Effective Date of Rule: Thirty-one days after filing.
Purpose: The department is amending chapter 388-106 WAC due to changes the Centers for Medicare and Medicaid Services (CMS) made to eligibility rules for the federal money follows the person (MFP) grant. As part of the Patient Affordable Care Act (PACA), MFP eligibility was reduced from a six-month institutional stay to ninety qualified days and medicaid eligibility changed from thirty days to one day immediately prior to discharge. Current WAC does not reflect these changes. PACA also extended the grant from an expiration of 2013 to 2020. Due to this extension, it was also decided that additional rule needed to be add to roads to community living WAC for use in planned action notices and exception to rule requests.
Citation of Existing Rules Affected by this Order: Amending WAC 388-106-0250, 388-106-0255, 388-106-0260, and 388-106-0265.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.
Other Authority: Affordable Care Act (ACA).
Adopted under notice filed as WSR 13-21-125 on October 22, 2013.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 4, Amended 4, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 4, Amended 4, Repealed 0.
Date Adopted: December 11, 2013.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION (Amending WSR 08-18-046, filed 8/29/08, effective 9/29/08)
WAC 388-106-0250 What is the roads to community living (RCL) demonstration project and who is eligible?
(1) Roads to community living (RCL) is a demonstration project, funded by a ((five-year)) "money follows the person" grant originally authorized under section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171) and extended through the Patient Affordable Care Act (P.L. 111-148). It is designed to test services and supports which help customers move from institutional settings into the community if they wish to. (2) To be eligible, the department must assess your needs in CARE per chapter 388-106 or 388-845 WAC and you must: (a) Have a continuous ((six months or longer)) stay of at least 90 days in a qualified institutional setting (hospital, nursing home, residential habilitation center); (i) Any days you were solely receiving medicare-paid, short term rehabilitation services are excluded from the 90 days. (ii) If you are discharging from a state psychiatric hospital and meet the length of stay criteria, you must be under age 22, or age 65 and older. (b) ((Be medicaid eligible for at least thirty days)) Have received at least one day of medicaid-paid inpatient services immediately prior to discharge from the institutional setting; (c) Intend to move to a qualified community setting (home, apartment, licensed residential setting with four or less unrelated individuals); and (d) ((Not be able to move into a qualified community setting using available long-term care resources)) On the day of discharge, you must be functionally and financially eligible for, but are not required to receive, medicaid waiver or state plan services. (((3) When you are discharged to a qualified community setting, you are eligible for continuous medicaid coverage until your RCL services end.))
AMENDATORY SECTION (Amending WSR 08-18-046, filed 8/29/08, effective 9/29/08)
WAC 388-106-0255 ((How long are RCL services available to me)) What services may I receive under RCL?
((Roads to community living (RCL) can be authorized for no longer than three hundred sixty-five days in a qualified community setting. Day one of the demonstration year is the day you move from the institutional setting into the qualified community setting. Day three hundred sixty-five is the last day you can receive demonstration services.)) Following eligibility and case management criteria outlined in chapters 388-106 or 388-845 WAC: (1) The state plan or medicaid waiver services for which you would otherwise be eligible; (2) You may receive additional RCL demonstration services; and (3) When you are discharged to a qualified community setting, you are eligible for continuous medicaid coverage until your RCL services end.
NEW SECTION
WAC 388-106-0256 When do RCL services start?
(1) RCL services to prepare for your discharge may begin while you are in the institution. (2) After discharge, roads to community living (RCL) can be authorized for no longer than three hundred sixty-five days in a qualified community setting. Day one of the demonstration year is the day you move from the institutional setting into the qualified community setting. Day three hundred sixty-five is the last day you can receive demonstration services.
NEW SECTION
WAC 388-106-0257 How do I remain eligible for RCL?
You remain eligible for RCL until any of the following occur: (1) Reach the end of your demonstration year; (2) Return to an institution for longer than 30 days (you can re-enroll later); (3) Move out of state; or (4) No longer want the service.
AMENDATORY SECTION (Amending WSR 08-18-046, filed 8/29/08, effective 9/29/08)
WAC 388-106-0260 How do I pay for RCL services?
Depending on your income and resources, you may be required to ((pay participation)) participate toward the cost of ((your)) the services you receive under RCL, including personal care and demonstration services, as outlined in chapters 388-515 or 388-106 WAC.
NEW SECTION
WAC 388-106-0261 How does the department determine the number of hours or the payment rate for my personal care in RCL?
(1) The number of personal care hours you receive is determined by the CARE assessment as outlined in chapter 388-106 WAC. (2) The payment rate structure for residential personal care received in a residential facility is outlined in chapter 388-106 WAC.
NEW SECTION
WAC 388-106-0262 What may change the number of hours or payment rate for my personal care in RCL?
The maximum number of in-home personal care hours or payment rate you can receive may change: (1) When you have a change in any of the criteria listed in WAC 388-106-0125, 388-106-0115, 388-106-0120 and/or 388-106-0130; or (2) Because you meet the criteria in WAC 388-440-0001, an exception to rule is approved by the department.
AMENDATORY SECTION (Amending WSR 08-18-046, filed 8/29/08, effective 9/29/08)
WAC 388-106-0265 Do I have the right to ((a fair)) an administrative hearing while receiving RCL services?
Yes, you may request ((a fair)) an administrative hearing based on the rules outlined in WAC 388-106-1305 to contest eligibility decisions made by the department. Once your three hundred sixty-five days of roads to community living (RCL) eligibility end, per WAC ((388-106-0255)) 388-106-0256, you may not request ((a fair)) an administrative hearing to contest the conclusion of RCL services or to request an extension.
|