WSR 02-18-099

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed September 3, 2002, 3:27 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 02-14-099.

Title of Rule: Medicaid rates for contracted home and community residential care services, WAC 388-105-0005, 388-105-0030, 388-105-0035, and 388-105-0040.

Purpose: To implement a $2.7 million reduction of funding for fiscal year 2003 for the assisted living facility (ALF) capital add-on rate. To increase the daily payment rates for boarding homes and adult family homes by the vendor rate increase of 1.5% and a bed hold amount.

Statutory Authority for Adoption: RCW 74.39A.030(3).

Statute Being Implemented: RCW 74.39A.030(3), chapter 371, Laws of 2002.

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Patricia Hague, Aging and Adult Services Administration, 640 Woodland Square Loop S.E., Lacey, WA 98503, (360) 725-2447.

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: To implement a $2.7 million reduction of funding for fiscal year 2003 for the assisted living facility (ALF) capital add-on rate. To increase the daily payment rates for boarding homes and adult family homes by the vendor rate increase of 1.5%.

Proposal Changes the Following Existing Rules: Updates rates for vendor increase and an amount for bed holds.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed new sections and amendments to chapter 388-105 WAC are exempt from a small business economic impact statement under RCW 19.85.025(3) and 34.05.310 (4)(f), "rules that set or adjust fees or rates pursuant to legislative standards."

RCW 34.05.328 does not apply to this rule adoption. Under RCW 34.05.328 (5)(b)(vi), rules that set or adjust fees or rates pursuant to legislative standards are exempt from RCW 34.05.328. The proposed new sections and amendments to chapter 388-105 WAC set medicaid payment rates for residential care facilities pursuant to chapter 74.39A RCW. RCW 74.39A.030(1) To the extent of available funding, the department shall expand cost-effective options for home and community services for consumers for whom the state participates in the cost of their care... and (3)(a) The department shall by rule establish payment rates for home and community services that support the provision of cost-effective care.

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on October 8, 2002, at 10 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by October 4, 2002, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., October 8, 2002.

Date of Intended Adoption: Not earlier than October 9, 2002.

August 29, 2002

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3136.4
Chapter 388-105 WAC

MEDICAID RATES FOR CONTRACTED HOME AND COMMUNITY RESIDENTIAL CARE ((SERVICE RATES)) SERVICES


AMENDATORY SECTION(Amending WSR 01-21-077, filed 10/18/01, effective 11/18/01)

WAC 388-105-0005   What are the daily Medicaid payment rates for contracted adult family home (AFH), adult residential care (ARC), and enhanced adult residential care (EARC) services?   For contracted AFH, ARC, and EARC services, the department pays the following daily rates for care of a Medicaid resident:


Four level payment system rates for AFHs, ARCs, & EARCs
Care Levels Non-

metropolitan

Metropolitan*

King Co.

Level 1 $((44.94)) 45.97 $((43.68)) 44.70 $((43.68)) 44.70
Level 2 $((47.84)) 49.19 $((50.05)) 51.43 $((55.42)) 56.88
Level 3 $((55.40)) 56.98 $((57.80)) 59.42 $((63.96)) 65.67
Level 4 $((66.66)) 68.06 $((70.52)) 71.98 $((76.67)) 78.22

*Benton, Clark, Franklin, Island, Kitsap, Pierce, Snohomish, Spokane, Thurston, Whatcom, and Yakima Counties.

[Statutory Authority: 2001 c 7 206. 01-21-077, 388-105-0005, filed 10/18/01, effective 11/18/01. Statutory Authority: Chapter 74.39A RCW. 01-14-056, 388-105-0005, filed 6/29/01, effective 7/30/01.]


NEW SECTION
WAC 388-105-0030   What are the daily Medicaid payment rates for contracted assisted living facilities (ALF) not receiving a capital rate add-on?   For contracted ALF services for care of a Medicaid resident, the department pays the following daily rates:


COPES ALF Daily Payment Rates w/o

Capital Add-on Rate

Care Levels Non-

metropolitan

Metropolitan*

King Co.

Level 1 $ 54.75 $ 56.26 $ 60.94
Level 2 $ 61.05 $ 62.83 $ 68.43
Level 3 $ 67.45 $ 69.81 $ 76.37

*Benton, Clark, Franklin, Island, Kitsap, Pierce, Snohomish, Spokane, Thurston, Whatcom, and Yakima Counties.

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NEW SECTION
WAC 388-105-0035   What are the requirements for a capital add-on rate for assisted living facilities (ALF)?   (1) Effective July 1, 2002, the department will grant a capital add-on rate to an ALF that:

(a) Meets the construction requirements of WAC 388-110-140; and

(b) Has a Medicaid occupancy percentage that equals or exceeds the applicable bi-yearly Medicaid minimum occupancy percentage set in accordance with subsection (3) of this section.

(2) The department will determine an ALF's Medicaid occupancy percentage by dividing its Medicaid resident days by the product of all its licensed boarding home beds irrespective of use times calendar days for the six-month period beginning one year prior to the percentage effective date.

(3)(a) To set the bi-yearly Medicaid minimum occupancy percentage, the department will:

(i) Determine the estimated total budgeted funds for capital add-on rates for the six-month period;

(ii) Rank from highest to lowest the individual ALF occupancy percentages determined in accordance with subsection (2) of this section;

(iii) Assign, beginning with the highest ALF Medicaid occupancy percentage, the estimated expenditure needed to pay the capital add-on rate to each facility for the six-month period;

(iv) Identify the ALF Medicaid occupancy percentage at which the estimated total budgeted funds determined under subsection (3)(a)(i) of this section would be expended; and

(v) Set that Medicaid occupancy percentage as the bi-yearly Medicaid minimum occupancy percentage.

(b) The bi-yearly Medicaid minimum occupancy percentage will be set every January 1 and July 1.

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NEW SECTION
WAC 388-105-0040   What are the daily capital add-on rates for assisted living facilities (ALF) and the ALF daily payment rates with a capital add-on rate?    For an ALF that qualifies for a capital add-on rate, the department will add the following amount to the per resident day payment rates in WAC 388-105-0030:


COPES ALF Add-on Rate July 1, 2002
Non-

metropolitan

Metropolitan*

King Co.

$ 4.68 $ 4.39 $ 4.84


COPES ALF Daily Payment Rates with a

Capital Add-on Rate

Care Levels Non-

metropolitan

Metropolitan*

King Co.

Level 1 $ 59.43 $ 60.65 $ 65.78
Level 2 $ 65.73 $ 67.22 $ 73.27
Level 3 $ 72.13 $ 74.20 $ 81.21

*Benton, Clark, Franklin, Island, Kitsap, Pierce, Snohomish, Spokane, Thurston, Whatcom, and Yakima Counties.

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Washington State Code Reviser's Office