SOCIAL AND HEALTH SERVICES
(Aging and Long-Term Support Administration)
[Filed March 25, 2020, 8:16 a.m.]
Preproposal statement of inquiry was filed as WSR 20-03-124.
Title of Rule and Other Identifying Information: The department is proposing to amend WAC 388-106-0715 How do I end my enrollment in the PACE program?
Hearing Location(s): On May 5, 2020, at 10:00 a.m., at Office Building 2, Department of Social and Health Services (DSHS) Headquarters, 1115 Washington [Street S.E.], Olympia, WA 98504. Public parking at 11th and Jefferson. A map is available at https://www.dshs.wa.gov/office-of-the-secretary/driving-directions-office-bldg-2.
Date of Intended Adoption: Not earlier than May 6, 2020.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, email DSHSRPAURulesCoordinator@dshs.wa.gov, fax 360-664-6185, by 5:00 p.m., May 5, 2020.
Assistance for Persons with Disabilities: Contact Jeff Kildahl, DSHS rules consultant, phone 360-664-6092, fax 360-664-6185, TTY 711 relay service, email Kildaja@dshs.wa.gov, by April 21, 2020.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The department is proposing to amend WAC 388-106-0715 to provide PACE clients, PACE organizations, and other stakeholders information about how clients can end their enrollment in the PACE program. This rule making will give guidance how to disenroll and the specific timelines. The amendment updates the WAC language to align with recent Centers for Medicare and Medicaid (CMS) changes to C.F.R. 460.162 and 460.164.
Reasons Supporting Proposal: See purpose statement above.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: DSHS, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Kathryn Pittelkau, P.O. Box 45600, Olympia, WA 98504-5600, 360-725-2366.
A school district fiscal impact statement is not required under RCW 28A.305.135
A cost-benefit analysis is not required under RCW 34.05.328
. This amendment is exempt as allowed under RCW 34.05.328
(5)(b)(vii) which states in part, "[t]his section does not apply to … rules of the department of social and health services relating only to client medical or financial eligibility and rules concerning liability for care of dependents."
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Explanation of exemptions: The proposed rule does not have an economic impact on small businesses. It only impacts DSHS clients.
March 19, 2020
Katherine I. Vasquez
AMENDATORY SECTION(Amending WSR 06-05-022, filed 2/6/06, effective 3/9/06)
WAC 388-106-0715How do I end my enrollment in the PACE program?
(1) You may choose to voluntarily end your enrollment in the PACE program without cause at any time. To do so, you must give the PACE provider written notice. ((If you give notice:
(a) Before the fifteenth of the month, the department will end your enrollment effective at the end of the month; or
(b) After the fifteenth, the department will end your enrollment effective until the end of the following month))A PACE participant's voluntary disenrollment is effective on the first day of the month following the date the PACE organization receives the participant's notice of voluntary disenrollment.
(2) Your enrollment may also end involuntarily if you:
(a) Move out of the designated service area or are out of the service area for more than thirty consecutive days, unless the PACE provider agrees to a longer absence due to extenuating circumstances;
(b) Engage in disruptive or threatening behavior such that the behavior jeopardizes your health or safety, or the safety of others;
(c) Fail to comply with your plan of care or the terms of the PACE enrollment agreement;
(d) Fail to pay or make arrangements to pay your part of the costs after the thirty-day grace period;
(e) Become financially ineligible for medicaid services, unless you choose to pay privately;
(f) Are enrolled with a provider that loses its license ((and/or))or contract, or both; or
(g) No longer meet the nursing facility level of care requirement as defined in WAC 388-106-0205.
(3) For any of the above reasons, the PACE provider must give you written notice, including your appeal rights, explaining that they are terminating benefits. ((If the provider gives you notice:
(a) Before the fifteenth of the month, then the department will end your enrollment at the end of the month; or
(b) After the fifteenth, then the department will end your enrollment at the end of the following month))A PACE participant's involuntary disenrollment is effective on the first day of the next month that begins thirty days after the day the PACE organization sends notice of the disenrollment to the participant.
(4) Before the PACE provider can involuntarily end your enrollment in the PACE program, the department must review and approve it.