SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
Preproposal statement of inquiry was filed as WSR 00-11-105.
Title of Rule: WAC 388-71-0700 Am I eligible for nursing facility care? and 388-97-027 Nursing facility admission and payment requirements.
Purpose: 1. Establish one standard for nursing home and COPES eligibility, eliminating redundancy and inconsistency; and
2. Reflect changes to the nursing facility admissions procedures.
Statutory Authority for Adoption: RCW 74.39A.040, 74.42.056.
Statute Being Implemented: RCW 74.39A.040, 74.42.056.
Summary: Health Care Financing Administration (HCFA) requires that there be one standard for COPES waivered-services. This standard is defined by the state's definition of nursing facility level of care. This proposal eliminates WAC 388-97-022 and adopts a general reference to the nursing facility level of care in WAC 388-71-0700 Am I eligible for nursing facility care? The rules also update procedures for admissions into the nursing facility.
Reasons Supporting Proposal: To comply with federal regulations.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Brooke Buckingham, AASA, 640 Woodland Square Loop, Lacey, 98503, (360) 725-2530.
Name of Proponent: Department of Social and Health Services, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: This rule eliminates redundant standards for nursing facility level of care. It also clarifies the procedures under which a nursing facility can admit and be paid for Medicaid clients. The department does not anticipate that the change in rule will have an impact on caseload.
Proposal Changes the Following Existing Rules: The proposal establishes a new rule under chapter 388-71 WAC; repeals WAC 388-97-022 Medical eligibility for nursing facility care and amends WAC 388-97-027 Nursing facility admission and payment requirements.
No small business economic impact statement has been prepared under chapter 19.85 RCW. A small business economic impact statement is not required because the rule does not impact small businesses.
RCW 34.05.328 applies to this rule adoption. Rules do meet the definition of "significant legislative rule," but the department is exempt from preparing a cost benefit analysis under RCW 34.05.328 (5)(b)(vii).
Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on October 10, 2000, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Kelly Cooper by October 3, 2000, phone (360) 664-6094, TTY (360) 664-6178, e-mail CoopeKD@dshs.wa.gov.
Submit Written Comments to: Identify WAC Numbers, Kelly Cooper, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by October 10, 2000.
Date of Intended Adoption: Not sooner than October 11, 2000.
August 31, 2000
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit2793.2NURSING FACILITY CARE
You are eligible for nursing facility services if the department:
(1) Assesses you and determines that you meet the functional criteria for nursing facility level of care as defined in WAC 388-71-0435(4); and
(2) Determines that your income and resources are within limits set through WAC 388-513-1315.
(1) A nursing facility must not admit any individual unless:
(a) The physician, hospital, department, or department designee screens the individual for the presence of a serious mental illness or a developmental disability as required under WAC 388-97-247;
(b) The ((
department assesses any Medicaid applicant or
recipient and determines that the individual meets the medical
eligibility requirements described in WAC 388-97-022; and
(c) For an individual admitted on a weekend, holiday, or after business hours, the)) nursing facility or hospital requests an assessment from the department.
(2) The department authorizes payment for:
(a) Newly admitted Medicaid-eligible individuals, who are
assessed and determined to be in need of nursing facility care,
per WAC ((
388-97-022)) 388-71-0700, on the date:
(i) Of the request for a department assessment; or
(ii) Nursing facility care actually begins, whichever is later.
(b) Current residents, who are converting to Medicaid from another payment source and are determined financial eligible, on the date of:
(i) Request for assessment; or
(ii) Financial application, whichever is earlier.
(iii) Exception: Payment back to the request date is limited to the certification period prior to the date of the financial application, per WAC 388-416-0015.
(3) If nursing facilities admit a Medicaid-eligible individual without a request for an assessment, they will not:
(a) Be reimbursed by the department; or
(b) Allowed to collect payment, including a deposit or minimum stay fee, from the client or the client's family or representative for any care provided before the date of request for assessment.
[Statutory Authority: RCW 18.51.070 and 74.42.620. 00-06-028, § 388-97-027, filed 2/24/00, effective 3/26/00.]
The following section of the Washington Administrative Code is repealed:
|WAC 388-97-022||Medical eligibility for nursing facility care.|