WSR 20-13-027
PERMANENT RULES
DEPARTMENT OF
SOCIAL AND HEALTH SERVICES
(Aging and Long-Term Support Administration)
[Filed June 9, 2020, 10:48 a.m., effective July 10, 2020]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The department is amending WAC 388-106-0715 to provide PACE clients, PACE organizations, and other stakeholders information about how clients can end their enrollment in the PACE program. This rule making will give guidance [on] how to disenroll and the specific timelines. The amendment updates the WAC language to align with recent Centers for Medicare and Medicaid [Services] (CMS) changes to C.F.R. 460.162 and 460.164.
The department filed a CR-102 Proposed rule making as WSR 20-08-042 on March 25, 2020, and a Continuance CR-102 Proposed rule making as WSR 20-09-075 on April 14, 2020.
Citation of Rules Affected by this Order: Amending WAC 388-106-0715.
Adopted under notice filed as WSR 20-09-075 on April 14, 2020.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 1, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 1, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
Date Adopted: June 9, 2020.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION(Amending WSR 06-05-022, filed 2/6/06, effective 3/9/06)
WAC 388-106-0715How do I end my enrollment in the PACE program?
(1) You may choose to voluntarily end your enrollment in the PACE program without cause at any time. To do so, you must give the PACE provider written notice. ((If you give notice:
(a) Before the fifteenth of the month, the department will end your enrollment effective at the end of the month; or
(b) After the fifteenth, the department will end your enrollment effective until the end of the following month))A PACE participant's voluntary disenrollment is effective on the first day of the month following the date the PACE organization receives the participant's notice of voluntary disenrollment.
(2) Your enrollment may also end involuntarily if you:
(a) Move out of the designated service area or are out of the service area for more than thirty consecutive days, unless the PACE provider agrees to a longer absence due to extenuating circumstances;
(b) Engage in disruptive or threatening behavior such that the behavior jeopardizes your health or safety, or the safety of others;
(c) Fail to comply with your plan of care or the terms of the PACE enrollment agreement;
(d) Fail to pay or make arrangements to pay your part of the costs after the thirty-day grace period;
(e) Become financially ineligible for medicaid services, unless you choose to pay privately;
(f) Are enrolled with a provider that loses its license ((and/or))or contract, or both; or
(g) No longer meet the nursing facility level of care requirement as defined in WAC 388-106-0205.
(3) For any of the above reasons, the PACE provider must give you written notice, including your appeal rights, explaining that they are terminating benefits. ((If the provider gives you notice:
(a) Before the fifteenth of the month, then the department will end your enrollment at the end of the month; or
(b) After the fifteenth, then the department will end your enrollment at the end of the following month))A PACE participant's involuntary disenrollment is effective on the first day of the next month that begins thirty days after the day the PACE organization sends notice of the disenrollment to the participant.
(4) Before the PACE provider can involuntarily end your enrollment in the PACE program, the department must review and approve it.