PDFWAC 182-551-1530

Payment method for medicaid-medicare dual eligible clients.

(1) The medicaid agency will not pay the portion of hospice care for a client that is covered under medicare part A. Nursing home room and board charges described in WAC 182-551-1510 that are not covered under medicare part A may be covered by the medicaid agency.
(2) The medicaid agency may pay for hospice care provided to a client:
(a) Covered by medicaid part B (medical insurance); and
(b) Not covered by medicare part A.
(3) For hospice care provided to a medicaid-medicare dual eligible client, hospice agencies are responsible to bill:
(a) Medicare before billing the medicaid agency;
(b) The medicaid agency for hospice nursing facility room and board;
(c) The medicaid agency for hospice care center room and board; and
(d) Medicare for general inpatient care or inpatient respite care.
(4) All the limitations and requirements related to hospice care described in subchapter I apply to the payments described in this section.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 16-03-035, § 182-551-1530, filed 1/12/16, effective 2/12/16. Statutory Authority: RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. WSR 12-09-079, § 182-551-1530, filed 4/17/12, effective 5/18/12. WSR 11-14-075, recodified as § 182-551-1530, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-18-033, § 388-551-1530, filed 8/30/05, effective 10/1/05. Statutory Authority: RCW 74.09.520 and 74.08.090, 42 C.F.R. 418.22 and 418.24. WSR 99-09-007, § 388-551-1530, filed 4/9/99, effective 5/10/99.]