_______________________________________________
SUBSTITUTE
HOUSE BILL 1341
_______________________________________________
AS
AMENDED BY THE SENATE
Passed
Legislature - 2001 Regular Session
State
of Washington 57th Legislature 2001 Regular Session
By
Read
first time 03/08/2001. Referred to Committee on .
Developing a home and community-based waiver for persons
in community residential settings.
AN
ACT Relating to increasing community residential options for nursing facility
eligible clients; amending RCW 74.09.700; and adding a new section to chapter
74.39 RCW.
BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec.
1. RCW
74.09.700 and 1993 c 57 s 2 are each amended to read as follows:
(1)
To the extent of available funds and subject to any conditions placed on
appropriations made for this purpose, medical care may be provided under the
limited casualty program to persons not otherwise eligible for medical
assistance or medical care services who are medically needy as defined in the
social security Title XIX state plan and medical indigents in accordance with
eligibility requirements established by the department. The eligibility
requirements may include minimum levels of incurred medical expenses. This
includes residents of nursing facilities ((and)), residents of
intermediate care facilities for the mentally retarded, and individuals who
are otherwise eligible for section 1915(c) of the federal social security act
home and community-based waiver services, administered by the department of
social and health services aging and adult services administration, who are
aged, blind, or disabled as defined in Title XVI of the federal social security
act and whose income exceeds three hundred percent of the federal supplement
security income benefit level.
(2)
Determination of the amount, scope, and duration of medical coverage under the
limited casualty program shall be the responsibility of the department, subject
to the following:
(a)
Only the following services may be covered:
(i)
For persons who are medically needy as defined in the social security Title XIX
state plan: Inpatient and outpatient hospital services, and home and
community-based waiver services;
(ii)
For persons who are medically needy as defined in the social security Title XIX
state plan, and for persons who are medical indigents under the eligibility
requirements established by the department: Rural health clinic services;
physicians' and clinic services; prescribed drugs, dentures, prosthetic
devices, and eyeglasses; nursing facility services; and intermediate care
facility services for the mentally retarded; home health services; hospice services;
other laboratory and x-ray services; rehabilitative services, including
occupational therapy; medically necessary transportation; and other services
for which funds are specifically provided in the omnibus appropriations act;
(b)
Medical care services provided to the medically indigent and received no more
than seven days prior to the date of application shall be retroactively
certified and approved for payment on behalf of a person who was otherwise
eligible at the time the medical services were furnished: PROVIDED, That
eligible persons who fail to apply within the seven-day time period for medical
reasons or other good cause may be retroactively certified and approved for
payment.
(3)
The department shall establish standards of assistance and resource and income
exemptions. All nonexempt income and resources of limited casualty program
recipients shall be applied against the cost of their medical care services.
NEW
SECTION. Sec. 2. A
new section is added to chapter 74.39 RCW to read as follows:
(1)
To the extent of available funds and subject to any conditions placed on
appropriations for this purpose, the department may provide one or more home
and community-based waiver programs in accordance with section 1915(c) of the
federal social security act for Washington residents who have a gross income in
excess of three hundred percent of the federal supplemental security income
benefit level. The waiver services provided in accordance with this section
may differ from, and shall operate with a separate limit or limits on total
enrollment than, those provided for persons who are categorically needy as
defined in Title XIX of the federal social security act. The department shall
adopt rules to establish eligibility criteria, applicable income standards, and
the specific waiver services to be provided. Total annual enrollment levels
and the services to be provided shall be as specified in the waiver agreement
or agreements with the federal government, subject to any conditions on
appropriations for this purpose.
(2)
If a nursing facility resident becomes eligible for home and community-based
waiver service alternatives to nursing facility care, but chooses to continue
to reside in a nursing facility, the department must allow that choice.
However, if the resident is a medicaid recipient, the resident must require a
nursing facility level of care.
(3)
If a recipient of home and community-based waiver services may continue to
receive home and community-based waiver services, despite an otherwise
disqualifying level of income, but chooses to seek admission to a nursing
facility, the department must allow that choice. However, if the resident is a
medicaid recipient, the resident must require a nursing facility level of care.
(4)
The department will fully disclose to all individuals eligible for waiver
services under this section the services available in different long-term care
settings.
