WSR 20-03-040
PERMANENT RULES
HEALTH CARE AUTHORITY
[Filed January 8, 2020, 1:08 p.m., effective February 8, 2020]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The agency is amending WAC 182-513-1205 to change "department-contracted" to "medicaid-contracted" when referring to alternate living facilities.
Citation of Rules Affected by this Order: Amending WAC 182-513-1205.
Other Authority: Not applicable.
Adopted under notice filed as WSR 19-24-075 on December 2, 2019.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 1, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: January 8, 2020.
Wendy Barcus
Rules Coordinator
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.