SOCIAL AND HEALTH SERVICES
(Medical Assistance Administration)
Date of Adoption: July 5, 2000.
Purpose: The department has replaced several sections of rule with a single section, written to comply with the Governor's Executive Order 97-02 on regulatory reform. The new consolidated rule reflects long-standing program policy, adopts a new upper income limit, is more readable, and has been reviewed in consultation with the regulated community. New WAC 388-539-0200 AIDS health insurance premium payment program.
Citation of Existing Rules Affected by this Order: Repealing WAC 388-539-001, 388-539-050, 388-539-100, and 388-539-150.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.757.
Adopted under notice filed as WSR 00-11-062 on May 15, 2000.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 4.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 1, Amended 0, Repealed 4.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 1, Amended 0, Repealed 4. Effective Date of Rule: Thirty-one days after filing.
July 5, 2000
Edith M. Rice, Chief
Office of Legal Affairs2671.7
ACQUIRED HUMAN IMMUNODEFICIENCY SYNDROME INSURANCE PROGRAM))
HIV/AIDS RELATED SERVICES
(1) The purpose of the AIDS health insurance premium payment program is to help individuals who are not eligible for MAA's medical programs and who are diagnosed with AIDS, pay their health insurance premiums.
(2) To be eligible for the AIDS health insurance premium payment program, individuals must:
(a) Be diagnosed with AIDS as defined in WAC 246-100-011;
(b) Be a resident of the state of Washington;
(c) Be responsible for all, or part of, the health insurance premium payment (without MAA's help);
(d) Not be eligible for one of MAA's other medical programs;
(e) Not have personal income that exceeds three hundred seventy percent of the federal poverty level; and
(f) Not have personal assets, after exemptions, exceeding fifteen thousand dollars. The following personal assets are exempt from the personal assets calculation:
(i) A home used as the person's primary residence; and
(ii) A vehicle used as personal transportation.
(3) MAA may contract with a not-for-profit community agency to administer the Aids health insurance premium payment program. MAA or its contractor determines an individual's initial eligibility and redetermines eligibility on a periodic basis. To be eligible, individuals must:
(a) Cooperate with MAA's contractor;
(b) Cooperate with eligibility determination and redetermination process; and
(c) Initially meet and continue to meet the eligibility criteria in subsection (2) of this section.
(4) Individuals, diagnosed with AIDS, who are eligible for one of MAA's medical programs may ask MAA to pay their health insurance premiums under a separate process. The client's community services office (CSO) is able to assist the client with this process.
(5) Once an individual is eligible to participate in the AIDS health insurance premium payment program, eligibility would cease only when one of the following occurs. The individual:
(a) Is deceased;
(b) Voluntarily quits the program;
(c) No longer meets the requirements of subsection (2) of this section; or
(d) Has benefits terminated due to the legislature's termination of the funding for this program.
(6) MAA sets a reasonable payment limit for health insurance premiums. MAA sets its limit by tracking the charges billed to MAA for MAA clients who have AIDS. MAA does not pay health insurance premiums that exceed fifty percent of the average of charges billed to MAA for its clients with AIDS.
The following sections of the Washington Administrative Code are repealed:
|WAC 388-539-150||Premium payment.|