Original Notice.

     Preproposal statement of inquiry was filed as WSR 05-13-127.

     Title of Rule and Other Identifying Information: Chapter 388-105 WAC, Medicaid rates for contracted home and community residential care services. Amending WAC 388-105-0005 What are the daily Medicaid payment rates for contracted adult family homes (AFH), adult residential care (ARC), and enhanced adult residential care (EARC) services?, 388-105-0045 Bed or unit hold Medicaid resident discharged for a hospital or nursing home stay from an adult family home (AFH) or a boarding home with an adult residential care services (ARC), enhanced adult residential care services (EARC), or assisted living services (AL) contract; and repealing WAC 388-105-0010, 388-105-0015, 388-105-0020, 388-105-0025, 388-105-0030, and 388-105-040.

     Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane, behind Goodyear Tire. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on February 21, 2006, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than February 22, 2006.

     Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98054, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., February 21, 2006.

     Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant by February 17, 2006, TTY (360) 664-6178 or (360) 664-6097 or by e-mail at schilse@dshs.wa.gov.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing amendments to chapter 388-105 WAC to:

•	Update the home and community residential rates from the four level payment system to the comprehensive assessment reporting evaluation (CARE) payment levels and to reflect the vendor rate increases of July 1, 2005; and
•	Amend the bed hold section to clarify the requirements for third-party payment and no payment for an absence less than twenty-four hours.

     Reasons Supporting Proposal: To codify increases in rates; limitation on third-party payments for bed holds; and clarify when an absence makes a bed eligible for a bed hold payment. The subject matter in rules repealed in this proposal are not incorporated in chapter 388-106 WAC, or in the amended rules in this proposal, making the repealed sections obsolete.

     Statutory Authority for Adoption: Chapter 74.39A RCW.

     Statute Being Implemented: Chapter 74.39A RCW.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of social and health services, governmental.

     Name of Agency Personnel Responsible for Drafting: Patricia Hague, 640 Woodland Square Loop S.E., Lacey, WA 98503, (360) 725-2447; Implementation and Enforcement: Richard Rosage, 640 Woodland Square Loop S.E., Lacey, WA 98503, (360) 725-2442.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The 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)(e), rules the content of which is explicitly and specifically dictated by statute; and (f) rules that set or adjust fees or rates pursuant to legislative standards.

     The 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 subsection (3)(a) The department shall by rule establish payment rates for home and community services that support the provision of cost-effective care.

     WAC 388-105-0045 repeats the requirements of RCW 18.20.290 and exists solely to include adult family homes in the bed hold program.

     A cost-benefit analysis is not required under RCW 34.05.328. 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 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 subsection (3)(a) The department shall by rule establish payment rates for home and community services that support the provision of cost-effective care.

     Under RCW 34.05.328 (5)(b)(v) Rules the content of which is explicitly and specifically dictated by statute. WAC 388-105-0045 repeats the requirements of RCW 18.20.290 and exists solely to include adult family homes in the bed hold program.

     The repealed rules in this proposal are not considered significant legislative rules. The subject matter of the repealed sections are incorporated in chapter 388-106 WAC or in the amended sections in this proposal.

January 11, 2006

Andy Fernando, Manager

Rules and Policies Assistance Unit

((Four level payment system rates for AFHs, ARCs, & EARCs
Care Levels	Non- metropolitan		Metropolitan*		King Co.
Level 1	$ 45.70		$ 44.43		$ 44.43
Level 2	$ 48.65		$ 50.89		$ 56.34
Level 3	$ 56.32		$ 58.76		$ 65.01
Level 4	$ 67.75))		$ 71.67		$ 77.91))

COMMUNITY RESIDENTIAL DAILY RATES FOR CLIENTS ASSESSED USING CARE
		KING COUNTY
				ARC	EARC	AFH
CARE CLASSIFICATION		AL Without Capital Add-on	AL With Capital Add-on
A Low (1)		$64.02	$69.03	$45.27	$45.27	$45.90
A Med (2)		$69.32	$74.33	$51.37	$51.37	$52.09
A High (3)		$77.78	$82.78	$65.61	$65.61	$58.28
B Low (4)		$64.02	$69.03	$45.27	$45.27	$45.90
B Med (5)		$71.44	$76.45	$57.47	$57.47	$58.28
B High (6)		$85.18	$90.19	$73.75	$73.75	$66.52
C Low (7)		$69.32	$74.33	$51.37	$51.37	$52.09
C Med (8)		$77.78	$82.78	$65.61	$65.61	$66.52
C High (9)		$96.83	$101.84	$85.96	$85.96	$87.15
D Low (10)		$71.44	$76.45	$57.47	$57.47	$66.52
D Med (11)		$77.78	$82.78	$65.61	$65.61	$74.78
D High (12)		$96.83	$101.84	$85.96	$85.96	$87.15

COMMUNITY RESIDENTIAL DAILY RATES FOR CLIENTS ASSESSED USING CARE
		METROPOLITAN COUNTIES*
				ARC	EARC	AFH
CARE CLASSIFICATION		AL Without Capital Add-on	AL With Capital Add-on
A Low (1)		$58.73	$63.28	$45.27	$45.27	$45.90
A Med (2)		$61.91	$66.45	$49.33	$49.33	$50.03
A High (3)		$75.67	$80.22	$62.56	$62.56	$55.18
B Low (4)		$58.73	$63.28	$45.27	$45.27	$45.90
B Med (5)		$67.20	$71.75	$54.42	$54.42	$55.18
B High (6)		$83.07	$87.62	$69.69	$69.69	$63.43
C Low (7)		$61.91	$66.45	$49.33	$49.33	$50.03
C Med (8)		$75.67	$80.22	$62.56	$62.56	$63.43
C High (9)		$93.65	$98.20	$79.85	$79.85	$80.97
D Low (10)		$67.20	$71.75	$54.42	$54.42	$63.43
D Med (11)		$75.67	$80.22	$62.56	$62.56	$70.65
D High (12)		$93.65	$98.20	$79.85	$79.85	$80.97

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

COMMUNITY RESIDENTIAL DAILY RATES FOR CLIENTS ASSESSED USING CARE
		NON-METROPOLITAN COUNTIES**
				ARC	EARC	AFH
CARE CLASSIFICATION		AL Without Capital Add-on	AL With Capital Add-on
A Low (1)		$57.68	$62.52	$45.27	$45.27	$45.90
A Med (2)		$61.91	$66.75	$48.32	$48.32	$49.00
A High (3)		$75.67	$80.51	$61.55	$61.55	$54.15
B Low (4)		$57.68	$62.52	$45.27	$45.27	$45.90
B Med (5)		$67.20	$72.04	$53.41	$53.41	$54.16
B High (6)		$83.07	$87.91	$67.65	$67.65	$62.41
C Low (7)		$61.91	$66.75	$48.32	$48.32	$49.00
C Med (8)		$75.67	$80.51	$61.55	$61.55	$62.41
C High (9)		$93.65	$98.49	$76.80	$76.80	$77.88
D Low (10)		$67.20	$72.04	$53.41	$53.41	$62.41
D Med (11)		$75.67	$80.51	$61.55	$61.55	$68.59
D High (12)		$93.65	$98.49	$76.80	$76.80	$77.88

** Non-Metropolitan Counties: Adams, Asotin, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Garfield, Grant, Grays Harbor, Jefferson, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Orielle, San Juan, Skagit, Skamania, Stevens, Wahkiakum, Walla Walla and Whitman.

[Statutory Authority: RCW 74.39A.030, 2003 c 231. 04-09-092, § 388-105-0005, filed 4/20/04, effective 5/21/04. Statutory Authority: 2002 c 371. 02-22-058, § 388-105-0005, filed 10/31/02, effective 12/1/02. 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.]

     (a) Short-term care is needed in a nursing home or hospital;

     (b) The resident is likely to return to the AFH, ARC, EARC, or AL; and

     (c) Payment is made under subsection (3) of this section.

     (2) When the department pays the ((provider)) contractor to hold the Medicaid resident's bed or unit during the resident's short-term nursing home or hospital stay, the ((provider)) contractor must hold the unit or bed for up to twenty days. A Medicaid resident's discharge from an AFH, ARC, EARC, or an AL facility for a short term stay in a nursing home or hospital must be longer than twenty-four hours before subsection (3) of WAC 388-105-0045 applies.

     (3) The department will compensate the ((provider)) contractor for holding the bed or unit for the:

     (a) First through seventh day at seventy percent of the daily rate paid for care of the resident before the hospital or nursing home stay; and

     (b) Eighth through the twentieth day, at ten dollars and ((forty-three)) seventy-eight cents a day.

     (4) The AFH, ARC, EARC, or AL facility may seek third-party payment to hold a bed or unit for twenty-one days or longer. The third-party payment shall not exceed the Medicaid daily rate paid to the facility for the resident. If third-party payment is not available and the returning Medicaid resident continues to meet the admission criteria under chapter 388-71 and/or 106 WAC, then the Medicaid resident may return to the first available and appropriate bed or unit.

     (5) The department's social worker or case manager determines whether the:

     (a) ((Care given)) Stay in a nursing home or hospital will be short-term; and

     (b) Resident is likely to return to the AFH, ARC, EARC, or AL facility.

     (6) When the resident's stay in the hospital or nursing home exceeds twenty days or the department's social worker or case manager determines that the Medicaid resident's stay in the nursing home or hospital is not short-term and the resident is unlikely to return to the AFH, ARC, EARC, or AL facility, then ((this)) only subsection (4) of this section ((does not apply)) applies to any private contractual arrangements that the ((provider)) contractor may make with a third party in regard to the discharged resident's unit or bed.

[Statutory Authority: RCW 74.39A.030, 2003 c 231. 04-09-092, § 388-105-0045, filed 4/20/04, effective 5/21/04.]

     The following sections of the Washington Administrative Code are repealed:

WAC 388-105-0010	What are care levels?
WAC 388-105-0015	How does the department determine whether the Medicaid resident needs assistance in completing ADLs and/or has unmet care needs?
WAC 388-105-0020	How does the department determine at which care level the Medicaid resident will be placed?
WAC 388-105-0025	How many ADL values and unmet care need points correspond to the four care levels?
WAC 388-105-0030	What are the daily Medicaid payment rates for contracted assisted living facilities (AL) not receiving a capital rate add-on?
WAC 388-105-0040	What are the daily capital add-on rates for assisted living facilities (AL) and the AL daily payment rates with a capital add-on rate?