WSR 21-18-045
PERMANENT RULES
HEALTH CARE AUTHORITY
[Filed August 25, 2021, 9:40 a.m., effective September 25, 2021]
Effective Date of Rule: Thirty-one days after filing.
Purpose: The health care authority is amending WAC 182-513-1230 to replace "chemical dependency" with "substance use disorder (SUD)."
Citation of Rules Affected by this Order: Amending WAC 182-513-1230.
Adopted under notice filed as WSR 21-13-171 on June 23, 2021.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.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: August 25, 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.