WSR 18-10-024 PERMANENT RULES HEALTH CARE AUTHORITY [Filed April 24, 2018, 9:52 a.m., effective June 1, 2018]
Effective Date of Rule: June 1, 2018.
Purpose: The agency is amending and repealing WAC to create a process that allows a medicaid client to keep more of their income that would have otherwise been paid towards the client's cost care, in order to compensate and reimburse their guardian. The purpose of new WAC 182-513-1530 is to combine the former WAC sections and modify the existing process into one WAC section.
Citation of Rules Affected by this Order: New WAC 182-513-1530; repealing WAC 182-513-1505, 182-513-1510 and 182-513-1520; and amending WAC 182-513-1515 and 182-513-1525.
Adopted under notice filed as WSR 18-04-056 on February 1, 2018.
Changes Other than Editing from Proposed to Adopted Version:
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 2, Repealed 3.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 2, Repealed 3.
Date Adopted: April 24, 2018.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION (Amending WSR 16-15-042, filed 7/14/16, effective 7/14/16)
WAC 182-513-1515 Maximum guardianship fees and related costs before June 1, 2018.
((The superior court may allow guardianship fees and administrative costs in an amount set out in an order.)) (1) This section sets the maximum guardianship fees and related costs when:
(a) The court order was entered before June 1, 2018; and
(b) The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
(2) For court orders entered ((after June 15, 1998)) before June 1, 2018, where the order establishes or continues a legal guardianship for a ((department client, and requires a future review or accounting; then unless otherwise modified by the process described in WAC 388-79-040:
(1) The amount of)) client:
(a) Guardianship fees ((shall)) must not exceed ((one hundred seventy-five dollars)) $175 per month;
(((2) The amount of administrative)) (b) Costs directly related to establishing a guardianship for a ((department)) client ((shall)) must not exceed ((seven hundred dollars)) $700; and
(((3) The amount of administrative costs shall)) (c) Costs to maintain the guardianship must not exceed ((a total of six hundred dollars)) $600 during any three-year period.
AMENDATORY SECTION (Amending WSR 16-15-042, filed 7/14/16, effective 7/14/16)
WAC 182-513-1525 Procedure for allowing guardianship fees and related costs from client participation ((after September 1, 2003)) before June 1, 2018.
(1) ((After September 1, 2003, where a client is subject to a guardianship the department shall be entitled to notice of proceedings as described in RCW 11.92.150.
(2) The notice must be served to the department's regional administrator of the program that is providing services to the client. A list of the regional administrators will be furnished upon request.
(3) If the fees and costs requested and established by the order are equal to or less than the maximum amounts allowed under WAC 388-79-030, then the department will)) This section describes the procedure for allowing guardianship fees and related costs from client participation when:
(a) A court order was entered before June 1, 2018; and
(b) The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
(2) The medicaid agency or the agency's designee, after receiving the court order, adjusts the client's current participation to reflect the amounts, as allowed ((upon receipt by the department of the court order setting the monthly amounts.
(4) Should fees and costs in excess of the amounts allowed in WAC 388-79-030 be requested:
(a) At least ten days before filing the request with the court, the guardian must present the request in writing to the appropriate regional administrator to allow the department an opportunity to consider whether the request should be granted on an exceptional basis.
(b) In considering a request for extraordinary fees or costs, the department must consider the following factors:
(i) The department's obligation under federal and state law to ensure that federal medicaid funding is not jeopardized by noncompliance with federal regulations limiting deductions from the client's participation amount;
(ii) The usual and customary guardianship services for which the maximum fees and costs under WAC 388-79-030 must be deemed adequate for a medicaid client, including but not limited to:
(A) Acting as a representative payee;
(B) Managing the client's financial affairs;
(C) Preserving and/or disposing of property;
(D) Making health care decisions;
(E) Visiting and/or maintaining contact with the client;
(F) Accessing public assistance programs on behalf of the client;
(G) Communicating with the client's service providers; and
(H) Preparing any reports or accountings required by the court.
(iii) Extraordinary services provided by the guardian, such as:
(A) Unusually complicated property transactions;
(B) Substantial interactions with adult protective services or criminal justice agencies;
(C) Extensive medical services setup needs and/or emergency hospitalizations; and
(D) Litigation other than litigating an award of guardianship fees or costs.
(c) Should the court determine after consideration of the facts and law that fees and costs in excess of the amounts allowed in WAC 388-79-030 are just and reasonable and should be allowed, then the department will adjust the client's current participation to reflect the amounts allowed upon receipt by the department of the court order setting the monthly amounts.
(5) In no event may a client's)) under WAC 182-513-1380, 183-515-1509, or 183-515-1514.
(3) A client's participation cannot be prospectively or retrospectively reduced to pay guardianship fees and related costs incurred:
(a) Before ((the effective date of)) the client's long-term care medicaid eligibility effective date; ((or))
(b) During any ((subsequent)) time ((period)) when the client was not eligible for((,)) or did not receive long-term care services; or
(c) After the client has died. ((There is no client participation towards DDD certified and contracted supported living services under chapter 388-820 WAC, so the department has no responsibility to reimburse the client for guardianship fees when those fees result in the client having insufficient income to pay their living expenses.
(6) If))
(4) The fees and costs allowed by the court at the final accounting must not exceed the amounts advanced and paid to the guardian from the client's participation if:
(a) The court, at a prior accounting, ((has)) allowed the guardian to receive guardianship fees and related costs from the client's ((monthly income)) participation in advance of services rendered by the guardian((,)); and
(b) The client dies before the next accounting((, the fees and costs allowed by the court at the final accounting may be less than, but may not exceed, the amounts advanced and paid to the guardian from the client's income.
(7) Guardians must furnish the regional administrator with complete packets to include all documents filed with the court and with formal notice clearly identifying the amount requested)).
NEW SECTION
WAC 182-513-1530 Maximum guardianship fee and related cost deductions allowed from a client's participation or room and board on or after June 1, 2018.
(1) General information.
(a) This section sets the maximum guardianship fee and related cost deductions when:
(i) A court order was entered on or after June 1, 2018; or
(ii) The client under guardianship began receiving medicaid-funded long-term services and supports on or after June 1, 2018.
(b) This section only applies to a client who is:
(i) Eligible for and receives institutional services under chapter 182-513 WAC or home and community-based waiver services under chapter 182-515 WAC, and who is required to pay participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
(ii) Eligible for long-term services and supports under chapter 182-513 or 182-515 WAC, and who is required to pay only room and board.
(c) All requirements of this section remain in full force whether or not the agency appears at a guardianship proceeding.
(d) In this section, the agency does not delegate any authority in determining eligibility or post-eligibility for medicaid clients.
(i) Under the authority granted by RCW 11.92.180, the agency does not deduct more than the amounts allowed by this section from participation or room and board.
(ii) The eligibility rules under Title 182 WAC remain in full force and effect.
(e) The agency does not reduce a client's participation or room and board under this section for guardianship fees or related costs accumulated during any month that a client was not required to pay:
(i) Participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
(ii) Room and board under chapter 182-513 or 182-515 WAC.
(f) If the client has another fiduciary, payee, or other principal-agency relationship and the agent is allowed compensation, any monthly guardianship fee approved under this section is reduced by the agent's compensation.
(2) Maximum guardianship fee and related cost deductions.
(a) The maximum guardianship fee and related cost deductions under this section include all guardianship services provided to the client, regardless of the number of guardians appointed to a client during a period of time, or whether the client has multiple guardians appointed at the same time.
(b) Maximum guardianship fees and related cost deductions are as follows:
(i) The total deduction for costs directly related to establishing a guardianship for a client cannot exceed $1,850;
(ii) The total deduction for guardianship-related costs cannot exceed $1,200 during any three-year period; and
(iii) The amount of the monthly deduction for guardianship fees cannot exceed $235 per month.
(3) For people under subsection (1)(b)(i) of this section – Participation deductions.
(a) After receiving the court order, the agency or its designee adjusts the client's current participation to reflect the deductions under WAC 182-513-1380, 182-515-1509, or 182-515-1514.
(b) The amounts of the participation deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.
(c) For clients who pay room and board in addition to participation, if the client's amount of participation is insufficient to allow for the amounts under subsection (2) of this section, then, regardless of any provision of chapter 182-513 or 182-515 WAC, the client's room and board will be adjusted to allow the amounts under subsection (2) of this section.
(4) For people under subsection (1)(b)(ii) of this section - Room and board deductions.
(a) The agency adjusts the client's room and board after receiving the court order, regardless of any provision of chapter 182-513 or 182-515 WAC.
(b) The amounts of the room and board deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.
REPEALER
The following sections of the Washington Administrative Code are repealed:
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