WSR 21-13-171
EXPEDITED RULES
HEALTH CARE AUTHORITY
[Filed June 23, 2021, 11:41 a.m.]
Title of Rule and Other Identifying Information: WAC 182-513-1230 Program of all-inclusive care for the elderly (PACE).
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The health care authority (HCA) is amending this section to replace "chemical dependency" with "substance use disorder (SUD)."
Reasons Supporting Proposal: HCA is amending this section as part of a larger effort to fix outdated behavioral health references and terminology, to update references to correct state agencies, and to make other minor housekeeping changes related to behavioral health integration.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Micheal Williams, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1346; Implementation and Enforcement: Mark Westenhaver, P.O. Box 45534, Olympia, WA 98504-5534, 360-725-1324.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Not applicable.
This notice meets the following criteria to use the expedited adoption process for these rules:
Corrects typographical errors, make address or name changes, or clarify language of a rule without changing its effect.
Explanation of the Reason the Agency Believes the Expedited Rule-Making Process is Appropriate: Corrects terminology.
NOTICE
THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO HCA Rule Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, phone 360-725-1306, fax 360-586-9272, email arc@hca.wa.gov, AND RECEIVED BY August 24, 2021.
June 23, 2021
Wendy Barcus
Rules Coordinator
OTS-3170.1
AMENDATORY SECTION(Amending WSR 17-03-116, filed 1/17/17, effective 2/17/17)
WAC 182-513-1230Program of all-inclusive care for the elderly (PACE).
(1) The program of all-inclusive care for the elderly (PACE) provides long-term services and supports (LTSS), medical, mental health, and ((chemical dependency))substance use disorder (SUD) treatment through a department-contracted managed care plan using a personalized plan of care for each enrollee.
(2) Program rules governing functional eligibility for PACE are listed under WAC 388-106-0700, 388-106-0705, 388-106-0710, and 388-106-0715.
(3) A person is financially eligible for PACE if the person:
(a) Is age:
(i) Fifty-five or older and disabled under WAC 182-512-0050; or
(ii) Sixty-five or older;
(b) Meets nursing facility level of care under WAC 388-106-0355;
(c) Lives in a designated PACE service area;
(d) Meets financial eligibility requirements under this section; and
(e) Agrees to receive services exclusively through the PACE provider and the PACE provider's network of contracted providers.
(4) Although PACE is not a home and community based (HCB) waiver program, financial eligibility is determined using the HCB waiver rules under WAC 182-515-1505 when a person is living at home or in an alternate living facility (ALF), with the following exceptions:
(a) PACE enrollees are not subject to the transfer of asset rules under WAC 182-513-1363; and
(b) PACE enrollees may reside in a medical institution thirty days or longer and still remain eligible for PACE services. The eligibility rules for institutional coverage are under WAC 182-513-1315 and 182-513-1380.
(5) A person may have to pay third-party resources as defined under WAC 182-513-1100 in addition to the room and board and participation.