WSR 97-12-081

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Medical Assistance Administration)

(Public Assistance)

[Filed June 4, 1997, 10:31 a.m.]

Original Notice.

Exempt from preproposal statement of inquiry under RCW 34.05.310(4).

Title of Rule: WAC 388-522-2205 and 388-524-2405.

Purpose: Implement federal requirements for longer time frames for Medicaid to continue upon termination of SSI.

Statutory Authority for Adoption: RCW 74.08.090 and 74.09.530.

Statute Being Implemented: 42 CFR 435 and 42 U.S.C. 1302.

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, Medical Assistance Administration, 617 8th S.E., Olympia, WA 98504, (360) 753-7462.

Name of Proponent: Department of Social and Health Services, governmental.

Rule is necessary because of federal law, 42 CFR Part 435.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule has no impact on small business as it just affects the benefit amount for SSI recipients.

Section 201, chapter 403, Laws of 1995, does not apply to this rule adoption. This section (RCW 34.05.328) does not apply to the Department of Social and Health Services.

Hearing Location: Lacey Government Center (behind Tokyo Bento restaurant), 1009 College Street S.E., Room 104-A, Lacey, WA 98503, on July 8, 1997, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Leslie Baldwin, Rules Coordinator, by June 27, 1997, TTY (360) 902-8324, phone (360) 902-7540, e-mail lbaldwin@dshs.wa.gov.

Submit Written Comments to and Identify WAC Numbers: Leslie Baldwin, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, FAX (360) 902-8292, by July 8, 1997.

Date of Intended Adoption: No sooner than July 9, 1997.

June 3, 1997

Merry A. Kogut, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending Order 3732, filed 5/3/94, effective 6/3/94)

WAC 388-522-2205 Redetermination of medical assistance. (1) Before termination of a client's medical assistance, the department shall redetermine the client's eligibility for other medical assistance programs or the medically indigent program.

(a) When additional information is necessary to redetermine eligibility, the department shall give the client ten days notice and an opportunity to provide such information.

(b) The department shall give the client advance and adequate notice of the redetermination decision before termination of medical assistance as described under WAC 388-245-1700.

(c) ((Until the department redetermines a client's eligibility in conformity with the requirements of this section,)) The client shall remain eligible for categorically needy medical benefits until the department redetermines a client's eligibility according to the requirements of this section.

(2) ((The department shall redetermine the client's eligibility for other financial and medical programs within thirty calendar days)) When SSA terminates the client's SSI/SSP financial benefits, refer to WAC 388-524-2405.

[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-522-2205, filed 5/3/94, effective 6/3/94. Formerly parts of WAC 388-85-105 and 388-85-110.]

AMENDATORY SECTION (Amending Order 3732, filed 5/3/94, effective 6/3/94)

WAC 388-524-2405 SSI/state supplement termination. ((When SSA terminates an SSI/state supplemental client because of failure to meet blindness and disability criteria under Title XVI,)) (1) The department shall ((terminate)) provide uninterrupted medical assistance ((at the end of the second month following the month in which eligibility based on disability or blindness criteria ceases)) for a period of up to one hundred twenty days:

(a) For a person whose SSI/state supplemental is terminated; and

(b) While the department redetermines the person's eligibility for other financial or medical programs.

(((1) If the client has)) (2) The department shall continue medical assistance for a person:

(a) Who has filed a timely request for a hearing under SSA jurisdiction; and ((SSA continues benefits, the department shall continue medical assistance concurrently))

(b) Until SSA makes a final decision on the hearing request and any subsequent timely appeals.

(((2))) (3) The department shall not ((authorize the CSO to re))submit a request for a redetermination of blindness or disability ((for consideration of the categorically needy or medically needy program.

(3) If the client)) unless:

(a) The person presents new medical evidence ((to the CSO or the client's));

(b) The person's medical condition ((worsens, the department shall require a referral to SSA))changes significantly; or

(c) The termination of SSI/state supplement or Social Security Disability Insurance was not based on a review of current medical evidence.