WSR 18-22-032
PROPOSED RULES
HEALTH CARE AUTHORITY
(Employees and Retirees Benefits Division)
[Admin #2018-02—Filed October 29, 2018, 1:44 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 18-17-034.
Title of Rule and Other Identifying Information: WAC 182-13-010 Purpose, 182-13-020 Definitions, 182-13-030 Eligibility, and 182-13-040 Application for medicare supplemental coverage.
Hearing Location(s): On December 11, 2018, at 10:00 a.m., at the 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 https://www.hca.wa.gov/assets/program/Drivingparking-checkin-instructions.pdf or directions can be obtained by calling 360-725-1000.
Date of Intended Adoption: No sooner than December 12, 2018.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, email arc@hca.wa.gov, fax 360-586-9727, by December 11, 2018.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-725-9727, telecommunication relay services 711, email amber.lougheed@hca.wa.gov, by December 7, 2018.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Making technical amendments to:
| |
| • | Change references from medicare supplement coverage to medicare supplemental coverage. |
| • | Revise several definitions in WAC 182-13-020. |
| • | Align eligibility in WAC 182-13-030 with RCW 41.05.197. |
| • | Clarify state residents can apply for medicare supplemental coverage thirty days before they are enrolled in Parts A and B of medicare. |
| • | Allow residents to apply within sixty-three days instead of sixty days for coverage after becoming a new resident. |
| • | Include guaranteed issue periods by cross-referencing RCW 48.66.045 and 48.66.055. |
Reasons Supporting Proposal: See purpose.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Stella Ng, 626 8th Avenue S.E., Olympia, WA, 360-725-0852; Implementation: Barbara Scott, 626 8th Avenue S.E., Olympia, WA, 360-725-0830, and Enforcement: Scott Palafox, 626 8th Avenue S.E., Olympia, WA, 360-725-1858.
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. RCW
34.05.328 does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rules do not impose any cost on small businesses.
October 29, 2018
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-010Purpose.
The purpose of this chapter is to establish criteria for state residents for participation in medicare ((supplement))supplemental coverage available through the HCA.
AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-020Definitions.
Unless otherwise specifically provided, the definitions contained in this section apply throughout this chapter.
(1) "HCA" means the Washington state health care authority.
(2) "Health plan," or "plan" means any individual or group: Policy, agreement, or other contract providing coverage for medical, surgical, hospital, or emergency care services, whether issued, or issued for delivery, in Washington or any other state. "Health Plan" or "plan" also includes
any group health plan that is maintained by any state and governed by the Public Health Services Act in 42 U.S.C. Chapter 6A, self-insured coverage governed by the federal Employee Retirement Income Security Act
of 1974, coverage through the
Washington state health
insurance ((
Access Act))
pool as described in chapter
48.41 RCW, ((
coverage through the Basic Health Plan as described in chapter 70.47 RCW, and)) coverage through the medicaid program as described in Title
74 RCW
, and coverage through the Washington state health benefit exchange as described in chapter 43.71 RCW. "Health plan" or "plan" does not mean or include: Hospital confinement indemnity coverage as described in WAC 284-50-345; disability income protection coverage as described in WAC 284-50-355; accident only coverage as described in WAC 284-50-360; specified disease and specified accident coverage as described in WAC 284-50-365; limited benefit health insurance coverage as described in WAC 284-50-370; long-term care benefits as described in chapter
48.84 RCW; or limited health care coverage ((
such as dental only, vision only, or chiropractic only))
(e.g., dental only).
(3) "Lapse in coverage" means a period of time greater than ((ninety))sixty-three continuous days without coverage by a health plan.
(4) "Resident" means a person who demonstrates that ((he/she lives))they live in the state of Washington ((at the time of application for, and issuance of coverage))by providing evidence of residency.
AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-030Eligibility.
((Residents are))A resident is eligible to apply for medicare ((supplement))supplemental coverage ((arranged by))available through the HCA ((when they are))provided the resident is:
(1) ((Eligible for))Enrolled in Parts A and B of medicare((,)); and
(2) ((
Actually enrolled in both Parts A and B of medicare not later than the effective date of medicare supplement coverage.))
Not eligible to purchase coverage as a retired or disabled employee under RCW 41.05.195.AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-040Application for medicare ((supplement))supplemental coverage.
Residents meeting eligibility requirements may apply for medicare ((supplement))supplemental coverage ((arranged by))available through the HCA:
(1) ((During the initial open enrollment period of January 1 through June 30, 1995, or))No earlier than thirty days before they are enrolled in both Parts A and B of medicare;
(2) Within ((sixty))sixty-three days after becoming a resident((, or
(3) In the thirty day period before the resident becomes eligible for medicare, or
(4) Within sixty days of retirement, or
(5)))of Washington state;
(3) During any open enrollment period established by federal or state law((, or
(6)));
(4) During any open enrollment period established by the HCA subsequent to the initial open enrollment period provided that the applicant is replacing a health plan with no lapse in coverage; or
(5) When replacing coverage as described in RCW 48.66.045 or when enrolling during a guaranteed issue period as described in RCW 48.66.055.