WSR 20-13-063
PROPOSED RULES
HEALTH CARE AUTHORITY
[Filed June 15, 2020, 4:18 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 20-06-042.
Title of Rule and Other Identifying Information: WAC 182-524-0100 General, 182-524-0200 Definitions, and 182-524-0275 Eligibility—COFA Islander dental care coverage (new).
Hearing Location(s): On July 21, 2020, at 10:00 a.m.
As more counties move into Phase 2 of the Governor's Safe Start plan, it is yet unknown whether by the date of this public hearing restrictions of meeting in public places will be eased. Therefore, this hearing is being held virtually only. This will not be an in-person hearing and there is not a physical location available.
You must register for this public hearing on July 21, 2020, 10:00 a.m. PDT at https://attendee.gotowebinar.com/register/6074456904428252685.
After registering, you will receive a confirmation email containing information about joining the webinar.
Date of Intended Adoption: Not sooner than July 22, 2020.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email arc@hca.wa.gov, fax 360-586-9727, by July 21, 2020.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunications relay services 711, email amber.lougheed@hca.wa.gov, by July 10, 2020.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is creating a new section within chapter 182-524 WAC to implement RCW 74.09.719, which provides dental services for compact of free association (COFA) Islanders and revising other sections as necessary.
Reasons Supporting Proposal: See purpose.
Statutory Authority for Adoption: RCW 41.05.021, 41.05.160.
Statute Being Implemented: RCW 74.09.719.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Health care authority (HCA), governmental.
Name of Agency Personnel Responsible for Drafting: Michael Williams, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1346; Implementation and Enforcement: Ariel Pyrtek, P.O. Box 45505, Olympia, WA 98504-2716, 360-725-1919.
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 are regarding eligibility and do not impose any costs on businesses.
June 15, 2020
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 19-11-082, filed 5/17/19, effective 6/17/19)
WAC 182-524-0100General.
(1) Compact of Free Association (COFA) islander health care ((is a))and COFA islander dental care are state-funded programs administered by the health care authority (the agency) to pay the monthly premiums and out-of-pocket expenses for silver level qualified health plans or qualified dental plans for eligible COFA islanders.
(2) For the purpose of this chapter, "our," "us," and "we" refer to the agency or the agency's designee and "you" refers to the applicant for, or recipient of, COFA islander health care.
(3) You have the right to appeal any adverse agency action regarding COFA islander health care or COFA islander dental care as described in chapter 182-526 WAC. For coordinated appeals with the Washington health benefit exchange, as described under WAC 182-526-0102, we treat appeals made to either the Washington health benefit exchange or us as filed on the same day. You will not have to submit any information that you have previously submitted to either the Washington health benefit exchange or us.
AMENDATORY SECTION(Amending WSR 19-11-082, filed 5/17/19, effective 6/17/19)
WAC 182-524-0200Definitions.
This section defines terms used in this chapter. See chapter 182-500 WAC for additional definitions.
"Advance premium tax credit (APTC)" - A tax credit taken in advance to lower a monthly health insurance payment (or premium).
"COFA islander" – A person who is a citizen of the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau.
"COFA islander dental care" - An agency-administered program that pays the premium and out-of-pocket costs for a stand-alone dental plan for eligible COFA islanders.
"COFA islander health care" - An agency-administered program that pays the premium and out-of-pocket costs for a silver level qualified health plan for eligible COFA islanders.
"Compact of Free Association (COFA)" - A legal agreement between the government of the United States and the governments of the Federated States of Micronesia (U.S. Pub. L. 108-188); the Republic of the Marshall Islands (U.S. Pub. L. 108-188); and the Republic of Palau (U.S. Pub. L. 99-658).
"Cost-sharing funds" - Agency-provided funds for out-of-pocket costs.
"Out-of-pocket costs" - Copayments, coinsurance, deductibles, and other cost-sharing requirements imposed under a qualified health plan for services, pharmaceuticals, devices, and other health benefits covered by the plan and rendered as in-network. Excludes premiums, balance billing amounts for out-of-network providers, and spending for noncovered services.
"Premium cost" – A person's premium for a qualified health plan, minus the amount of the person's advanced premium tax credit.
"Qualified dental plan (QDP)" – A stand-alone dental plan offered by the Washington health benefit exchange (HBE). For a definition of stand-alone dental plan, see WAC 284-43-6020.
"Qualified dental plan - Noncovered services" - In-network services that are not covered by the QDP, and are consistent with but do not exceed benefits covered under the agency's adult dental program described in chapter 182-535 WAC.
"Silver level qualified health plan (QHP)" - Silver level indicates the category of a qualified health plan (QHP) offered by the Washington health benefit exchange (HBE). For a definition of QHP, see WAC 182-500-0090.
NEW SECTION
WAC 182-524-0275Eligibility—COFA islander dental care coverage.
You apply for COFA islander dental care the same way you would apply for COFA islander health care as described in WAC 182-524-0250.
(1) To be eligible for state-funded COFA islander dental care, you must enroll in a qualified dental plan (QDP) through the Washington health benefit exchange (HBE) during open enrollment or when you qualify for a special enrollment period as described in 45 C.F.R. 155.410 and 45 C.F.R. 420.
(2) You are eligible for COFA islander dental care administered by us no earlier than January 1, 2021, if you enroll in a QDP and:
(a) Meet the requirements of COFA islander health care as described in WAC 182-524-0300 (1)(a) through (f); or
(b) Are enrolled in medicare, meet the requirements as described in WAC 182-524-0300 (1)(a) and (c) and:
(i) Are a resident as described in WAC 182-524-0400 (1) through (3).
(ii) You can be temporarily out-of-state and remain on COFA islander dental care if you:
(A) Intend to return once the purpose of your absence concludes; and
(B) Meet the eligibility requirements described in this section.
(3) Eligibility for COFA islander dental care under subsection (2) of this section is subject to the availability of amounts appropriated for the program as described in WAC 182-524-0300(2).
(4) Your COFA islander dental care begins the first day of the month your QDP coverage begins and you meet the other eligibility requirements described in subsection (2) of this section.
(5) We will pay for your premiums, QDP out-of-pocket costs and QDP-noncovered services the same way we pay your premiums and out-of-pocket costs for COFA islander health care as described in WAC 182-524-0600. We may require authorization for payment for QDP-noncovered services.
(6) We will not pay for expenses incurred by people not covered under COFA islander dental care or services excluded under the medicaid dental program as described in WAC 182-535-1100.
(7) We will send you notices and letters according to the same provisions and requirements as the letters we send regarding COFA islander health care as described in WAC 182-524-0500.
(8) We will terminate your COFA islander dental care if you:
(a) No longer meet the eligibility criteria described in subsection (2) of this section;
(b) Request termination;
(c) Perform an act, practice, or omission that constitutes fraud and your insurer rescinds your policy;
(d) Use your COFA islander dental care cost-sharing funds to pay for anything other than:
(i) Out-of-pocket costs for dental coverage under your QDP; or
(ii) Authorized QDP-noncovered services.
(9) We will reinstate your COFA islander dental care if you are:
(a) Terminated in error; or
(b) Successful in your appeal of a termination.
(10) If you report a change that makes you eligible for COFA islander dental care, your sponsorship begins either:
(a) The first day of the following month, if the change was reported on or before the fifteenth of the month; or
(b) The first day of the month after the following month, if the change was reported after the fifteenth of the month.
(11) Your COFA islander dental care ends the day your enrollment in a silver level QHP ends or the last day of the month your COFA islander dental care eligibility ends, whichever is earlier.