HEALTH CARE AUTHORITY
[Filed December 2, 2019, 12:28 p.m.]
Preproposal statement of inquiry was filed as WSR 19-20-080.
Title of Rule and Other Identifying Information: WAC 182-513-1205 Determining eligibility for noninstitutional coverage in an alternate living facility (ALF).
Hearing Location(s): On January 7, 2020, at 10:00 a.m., at the Health Care Authority (HCA), Cherry Street Plaza, 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/Driving-parking-checkin-instructions.pdf or directions can be obtained by calling 360-725-1000.
Date of Intended Adoption: Not sooner than January 8, 2020.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email firstname.lastname@example.org, fax 360-586-9727, by January 7, 2020.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication relay services 711, email email@example.com, by December 20, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is amending WAC 182-513-1205 to change "department-contracted" to "medicaid-contracted" when referring to alternative living facilities.
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: Jason Crabbe, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-9563; Implementation and Enforcement: Steve Kozak, P.O. Box 45534, Olympia, WA 98504-5534, 360-725-1343.
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 changes to the proposed rules apply to clients, so they do not impose any costs on businesses.
December 2, 2019
AMENDATORY SECTION(Amending WSR 17-23-039, filed 11/8/17, effective 1/1/18)
WAC 182-513-1205Determining eligibility for noninstitutional coverage in an alternate living facility (ALF).
(1) This section describes the eligibility determination for noninstitutional coverage for a client who lives in ((a department-contracted))an agency-contracted alternate living facility (ALF) defined under WAC 182-513-1100.
(2) The eligibility criteria for noninstitutional Washington apple health (medicaid) coverage in an ALF follows SSI-related rules under WAC 182-512-0050 through 182-512-0960, with the exception of the higher income standard under subsection (3) of this section.
(3) A client is eligible for noninstitutional coverage under the categorically needy (CN) program if the client's monthly income after allowable exclusions under chapter 182-512 WAC:
(a) Does not exceed the special income level (SIL) defined under WAC 182-513-1100; and
(b) Is less than or equal to the client's assessed state rate at ((a department-contracted))an agency-contracted facility. To determine the CN standard: ((y × 31) + $38.84), where "y" is the state daily rate. $38.84 is based on the cash payment standard for a client living in an ALF setting under WAC 388-478-0006.
(4) A client is eligible for noninstitutional coverage under the medically needy (MN) program if the client's monthly income after allowable exclusions under chapter 182-512 WAC is less than or equal to the client's private rate at ((a department-contracted))an agency-contracted facility. To determine the MN standard: ((z × 31) + $38.84), where "z" is the facility's private daily rate. To determine MN spenddown liability, see chapter 182-519 WAC.
(5) For both CN and MN coverage, a client's countable resources cannot exceed the standard under WAC 182-512-0010.
(6) The agency or the agency's designee approves CN noninstitutional coverage for twelve months.
(7) The agency or the agency's designee approves MN noninstitutional coverage for a period of months described in WAC 182-504-0020 for an SSI-related client, provided the client satisfies any spenddown liability under chapter 182-519 WAC.
(8) Clients who receive medicaid personal care (MPC) or community first choice (CFC) pay all of their income to the ALF except a personal needs allowance under WAC 182-513-1105.
(9) A client may have to pay third-party resources as defined under WAC 182-513-1100 in addition to the payment under this subsection.