Purpose: These rules implement provisions in the Balanced Budget Act, which expand the coverage groups for Medicare cost-sharing programs. These rules have also been rewritten to meet the intent of the Governor's Executive Order 97-02. Implements new section WAC 388-517-1770.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-517-1720, 388-517-1740, and 388-517-1760; and amending WAC 388-517-1710, 388-517-1715, 388-517-1730, 388-517-1750, and 388-521-2160.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530.

Other Authority: H.R. 2015, Sec. 4732, The Balanced Budget Act of 1997.

Adopted under notice filed as WSR 98-08-083 on April 1, 1998.

Number of Sections Adopted in Order to Comply with Federal Statute: New 1, amended 5, repealed 0; Federal Rules or Standards: New 0, amended 0, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, amended 0, repealed 3.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, amended 5, repealed 3.

Number of Sections Adopted Using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 1, amended 5, repealed 3.

Effective Date of Rule: Thirty-one days after filing.

May 18, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending WSR 95-14-046, filed 6/28/95, effective 7/29/95)

WAC 388-517-1710  Medicare (("buy-in")) cost-sharing programs. (1) ((The department shall pay Medicare "buy-in" for)) This section describes the benefits and eligibility criteria common to the following Medicare cost-sharing programs:

(a) The qualified Medicare beneficiary (QMB) program;

(b) The special low-income Medicare beneficiary (SLMB) program;

(c) The qualified disabled working individual (QDWI) program:

(d) The qualified individual (QI) program; and

(e) The buy-in program.

(2) A person must be entitled to Medicare Part A and ((who receives:

(a) AFDC cash grant;

(b) SSI cash assistance;

(c) Categorically needy medical assistance; or

(d) Medically needy medical assistance.

(2) For a person eligible under subsection (1) of this section and subject to limitations under chapter 388-87 WAC, the department shall pay for:

(a) Supplementary medical insurance Part B premium, under Title XVIII of the Social Security Act;

(b) Coinsurance; and

(c) Deductibles.

(3) In addition to the benefits under subsection (2) (a), (b), and (c) of this section, the department shall pay Part A premiums, coinsurance, and deductibles, under Title XVIII of the Social Security Act, for a person eligible under WAC 388-517-1715 and 388-517-1720.

(4) The department shall only pay the Part B premium, under Title XVIII of the Social Security Act, for a person eligible under WAC 388-517-1730 and 388-517-1740.

(5) The department shall only pay Part A premium, under Title XVIII of the Social Security Act, for a person eligible under WAC 388-517-1750 and 388-517-1760)) have resources which do not exceed twice the standard described in WAC 388-511-1110 to receive Medicare cost-sharing benefits.

(3) A person determined eligible for the QMB program under WAC 388-517-1715 is eligible to receive Part A and Part B Medicare premiums, coinsurance, and deductibles.

(4) A person determined eligible for the SLMB program, levels one and two, under WAC 388-517-1730 is eligible to receive only the Part B Medicare premium.

(5) A person determined eligible for the QDWI program under WAC 388-516-1750 is eligible to receive only the Part A Medicare premium.

(6) A person determined eligible for the QI program under WAC 388-517-1770 is eligible to receive one dollar and seven cents per month reimbursement for Medicare premiums.

(7) A person determined ineligible for the QMB, SLMB (level one), or QDWI programs, is eligible for Part B Medicare premium, coinsurance and deductibles when the person is entitled to Medicare Part A and receives categorically needy or medically needy medical assistance.

[Statutory Authority: RCW 74.08.090. 95-14-046 (Order 3863), § 388-517-1710, filed 6/28/95, effective 7/29/95; 94-10-065 (Order 3732), § 388-517-1710, filed 5/3/94, effective 6/3/94. Formerly WAC 388-81-060.]

AMENDATORY SECTION (Amending WSR 95-14-046, filed 6/28/95, effective 7/29/95)

WAC 388-517-1715  Qualified Medicare beneficiary (QMB) ((eligible for Medicare cost sharing)) program. ((The department shall provide)) This section describes who is eligible for the QMB program.

(1) A person is eligible for Medicare cost sharing ((under)) described in WAC 388-517-1710(((3) for a person:

(1) Meeting the general nonfinancial requirements for an SSI-related person under chapter 388-511 WAC; and

(2) Entitled to Medicare hospital insurance benefits, Part A, under Title XVIII of the Social Security Act)) (2) when the person's income does not exceed one hundred percent of the federal poverty level (FPL). One hundred percent of the current FPL is:

(2) A QMB client's Social Security cost-of-living increase is not counted until April 1st of each year.

[Statutory Authority: RCW 74.08.090. 95-14-046 (Order 3863), § 388-517-1715, filed 6/28/95, effective 7/29/95; 94-10-065 (Order 3732), § 388-517-1715, filed 5/3/94, effective 6/3/94. Formerly WAC 388-82-140 (part).]

AMENDATORY SECTION (Amending WSR 95-14-046, filed 6/28/95, effective 7/29/95)

WAC 388-517-1730  Special low-income Medicare beneficiaries (SLMB) ((eligible for Medicare cost sharing)) program. ((The department shall provide)) This section describes who is eligible for the SLMB program.

(1) A person is eligible for Medicare cost sharing ((under)) described in WAC 388-517-1710(((4) for a person)) (3) when the person has countable income for:

(((1) Meeting the general nonfinancial requirements for an SSI-related person under chapter 388-511 WAC; and))

(a) Level one of SLMB countable income, which is over one hundred percent of the FPL, but does not exceed one hundred twenty percent of the FPL. One hundred twenty percent of the FPL is:

(b) Level two of SLMB countable income, which is over one hundred twenty percent of the FPL, but does not exceed one hundred thirty-five percent of the FPL. One hundred thirty-five percent of the FPL is:

(2) ((Entitled to Medicare hospital insurance benefits, Part A, under Title XVIII of the Social Security Act)) A person whose income is described in level two is eligible for the SLMB program only if the person is not eligible for another medical assistance program.

(3) An SLMB client's Social Security cost-of-living increase is not counted until April 1st of each year.

[Statutory Authority: RCW 74.08.090. 95-14-046 (Order 3863), § 388-517-1730, filed 6/28/95, effective 7/29/95; 94-10-065 (Order 3732), § 388-517-1730, filed 5/3/94, effective 6/3/94. Formerly WAC 388-82-150 (part).]

AMENDATORY SECTION (Amending WSR 95-14-046, filed 6/28/95, effective 7/29/95)

WAC 388-517-1750  ((Hospital premium insurance enrollment for the)) Qualified disabled working individuals (QDWI) program. ((The department shall pay premiums)) This section describes who is eligible for the QDWI program. A person is eligible for Medicare ((Part A under)) cost-sharing described in WAC 388-517-1710(((4) for an SSI-related)) (4) when the person:

(1) ((Who)) Is not otherwise entitled to medical assistance; and

(2) ((Entitled to enroll for Medicare hospital insurance benefits, Part A, under section 1818A of the Social Security Act.)) Has countable income which does not exceed two hundred percent of the FPL. Two hundred percent of current FPL is:

[Statutory Authority: RCW 74.08.090. 95-14-046 (Order 3863), § 388-517-1750, filed 6/28/95, effective 7/29/95; 94-10-065 (Order 3732), § 388-517-1750, filed 5/3/94, effective 6/3/94. Formerly WAC 388-82-160 (part).]

NEW SECTION

WAC 388-517-1770  Qualified individuals (QI) program. This section describes who is eligible for the QI program. A person is eligible for Medicare cost-sharing described in WAC 388-517-1710(5) when the person:

(1) Is not otherwise eligible for medical assistance; and

(2) Has countable income over one hundred thirty-five percent of the FPL, but does not exceed one hundred seventy-five percent of the FPL. One hundred seventy-five percent of the FPL is:

[]

REPEALER

The following sections of the Washington Administrative Code are repealed:

WAC 388-517-1720 Qualified Medicare beneficiaries--Income and resources.

WAC 388-517-1740 Special low-income Medicare beneficiaries (SLMB)--Income and resources.

WAC 388-517-1760 Qualified disabled working individuals (QDWI) income and resources.

AMENDATORY SECTION (Amending WSR 94-10-065, filed 5/3/94, effective 6/3/94)

WAC 388-521-2160  Effective date and certification period for the special low-income Medicare beneficiary (SLMB) program. ((The department shall ensure the effective date of eligibility for)) (1) A client is eligible for Medicare cost-sharing under the SLMB program ((shall be the later of the)) beginning:

(((1))) (a) The first day of the month ((in which)) the client ((is enrolled in Part B)) applies; or

(((2) Retroactive period described under))

(b) Retroactively according to WAC 388-521-2105(2).

(2) A client who is eligible for level one SLMB, according to WAC 388-517-1730 (1)(a), is certified for twelve months from the date of application.

(3) A client who qualifies for level two SLMB, according to WAC 388-517-1730 (1)(b) on or after January 1, 1998, is certified through the end of the calendar year in which the client applied while funds remain available.

(4) A client who qualifies for the qualified individual (QI) program, according to WAC 388-517-1770(2) on or after January 1, 1998, is certified through the end of the calendar year in which the client applied while funds remain available.

[Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), § 388-521-2160, filed 5/3/94, effective 6/3/94. Formerly WAC 388-84-115 (part).]