SOCIAL AND HEALTH SERVICES
(Aging and Long-Term Support Administration)
[Filed October 19, 2018, 3:25 p.m.]
Continuance of WSR 18-08-072.
Preproposal statement of inquiry was filed as WSR 17-17-074.
Title of Rule and Other Identifying Information: The department is proposing to create WAC 388-71-0548 When is an individual provider subject to an overpayment?
Hearing Location(s): On November 27, 2018, at 10:00 a.m., at Office Building 2, Department of Social and Health Services (DSHS) Headquarters, 1115 Washington, Olympia, WA 98504. Public parking at 11th and Jefferson. A map is available at https://www.dshs.wa.gov/sesa/rules-and-policies-assistance-unit/driving-directions-office-bldg-2.
Date of Intended Adoption: Not earlier than November 28, 2018.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, email DSHSRPAURulesCoordinator@dshs.wa.gov, fax 360-664-6185, by 5:00 p.m., November 27, 2018.
Assistance for Persons with Disabilities: Contact Jeff Kildahl, DSHS rules consultant, phone 360-664-6092, fax 360-664-6185, TTY 711 relay service, email Kildaja@dshs.wa.gov, by November 13, 2018.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The purpose for adding this new overpayment section for individual providers to chapter 388-71 WAC is to define the circumstances in which an individual provider is subject to an overpayment, clarify the department's authority to collect an overpayment, clarify an individual provider's right to an administrative hearing when they receive an overpayment notice, and provide information about how an individual provider requests an administrative hearing related to an overpayment.
This CR-102 is being filed as a continuance to the CR-102 filed as WSR 18-08-072 on April 3, 2018.
Reasons Supporting Proposal: See purpose statement above.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: DSHS, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Stacy Graff, P.O. Box 45600, Olympia, WA 98504-5600, 360-725-2533.
A school district fiscal impact statement is not required under RCW 28A.305.135
A cost-benefit analysis is not required under RCW 34.05.328
. Rules are exempt per RCW 34.05.328
(5)(b)(v), rules the content of which is explicitly and specifically dictated by statute.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW 19.85.025
(3) as the rule content is explicitly and specifically dictated by statute.
October 18, 2018
Katherine I. Vasquez
WAC 388-71-0548When is an individual provider subject to an overpayment?
(1) Unless payment is otherwise required by state or federal law, it is an overpayment as defined in RCW 43.20B.010
if an individual provider (IP) is paid by the department and:
(a) Did not actually perform the work;
(b) Payment is for dates of service after the death of the client;
(c) Payment is for services provided when the client was admitted to a hospital, nursing home, or other institutional setting;
(d) Payment is for dates of service when the client was outside of the United States;
(e) Did not have a valid IP services contract at the time the services were provided and had been notified by the department to stop the provision of services;
(f) Had not completed required training or obtained required certification at the time the services were provided and had been notified by the department to stop the provision of services;
(g) Had a disqualifying crime or negative action at the time the services were provided and had been notified by the department to stop the provision of services;
(h) Provided services after being notified by the department to stop the provision of services;
(i) Provided services that are not included in the client's plan of care;
(j) Provided services that exceeded the amount of the client's benefit in the client's plan of care where those services were not necessitated by an emergent and immediate need of the client and the IP is not a family member or household member of the client; or
(k) Received duplicate payment(s).
(2) If the department determines an IP was overpaid, even if it was due to department error, the department recovers any moneys that the IP received as a result of overpayments, as authorized under chapter 41.05A
RCW or 43.20B
(a) The department will send the IP notice of the overpayment.
(b) The IP has a right to request an administrative hearing when notice of an overpayment is received from the department.
(c) To request an administrative hearing, an IP must send a written request to the office of financial recovery within twenty-eight days of the IP's receipt of notice of the overpayment that:
(i) States the basis for contesting the overpayment notice;
(ii) Includes a copy of the department's notice with the request; and
(iii) Is sent by certified mail return receipt requested (CMRRR) or another trackable delivery service.
(d) The appeal process will be governed by the Administrative Procedure Act (chapter 34.05