WSR 98-01-191

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

(Medical Assistance Administration)

[Filed December 23, 1997, 4:03 p.m., effective January 1, 1998]

Date of Adoption: December 23, 1997.

Purpose: To adopt new community spouse monthly needs allowance standard effective January 1, 1998.

Citation of Existing Rules Affected by this Order: Amending WAC 388-513-1380.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.500.

Other Authority: Section 1924 (42 U.S.C. 1396r-5).

Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

Reasons for this Finding: Implementation of federal increase in standards required to be effective January 1, 1998, in order to continue receiving federal funds.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, amended 0, repealed 0; Federal Rules or Standards: New 0, amended 1, repealed 0; or Recently Enacted State Statutes: New 0, amended 0, repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, amended 0, repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, amended 0, repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, amended 0, repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, amended 0, repealed 0; Pilot Rule Making: New 0, amended 0, repealed 0; or Other Alternative Rule Making: New 0, amended 0, repealed 0.

Effective Date of Rule: January 1, 1998.

December 23, 1997

Edith M. Rice, Chief

for Merry Kogut, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending WSR 97-16-008, filed 7/24/97, effective 7/24/97)

WAC 388-513-1380 Institutional--Participation--Client share of monthly institutional payments. A client's monthly income and resources which exceed the department's standards will be used to determine a client's share of monthly institutional cost of care as described under this section.

(1) ((In reducing payment to the institution, the department shall consider the institutionalized client's:

(a) Income under WAC 388-513-1330 (3)(a), (b), (c), and (d); and

(b) Resources under WAC 388-513-1350, 388-513-1360, and 388-513-1365.

(2) In)) When reducing payment to the institution, the ((department shall consider the eligible institutionalized)) client's excess resources are available to meet the cost of care after the following allocations in the following order:

(a) Health insurance and Medicare premiums, deductions, and co-insurance not paid by a third party; and

(b) Noncovered medical bills which are the liability of the client and not paid by a third party.

(((3))) (2) The ((department shall not use)) allocations used to reduce excess resources under subsection (((2))) (1) of this section cannot be used to reduce income under subsection (((4))) (3) of this section.

(((4) The department shall deduct the following amounts, in the following order,))

(3) From the ((institutionalized)) client's total income((, including)) which includes the income amounts disregarded in determining eligibility, deduct the following amounts, in the following order:

(a) Specified personal needs allowance (PNA) as follows:

(i) One hundred sixty dollars for a veteran living in a Medicaid-certified state veteran's home nursing facility;

(ii) Ninety dollars for a single veteran, or widow or widower of a veteran receiving an improved veteran's pension; or

(iii) Forty-one dollars and sixty-two cents for all other clients in a medical ((institutions)) facility.

(b) Federal, state, or local income taxes:

(i) Mandatorily withheld from earned or unearned income for income tax purposes before receipt by the client; or

(ii) Not covered by withholding, but are owed or have been paid by the client; and

(iii) ((Does)) Which do not exceed the one-person medically needy income level (MNIL) less the client's ((personal needs allowance)) PNA.

(c) Wages not to exceed the one-person ((medically needy income level ())MNIL(())) less the client's ((personal needs allowance)) PNA for a client who:

(i) Is SSI-related; and

(ii) Receives the wages as part of a department-approved training or rehabilitative program designed to prepare the client for a less restrictive placement. When determining this deduction((, the department shall)):

(A) ((Not allow a deduction for)) Employment expenses are not deducted; and

(B) ((Apply)) The client's wages not deducted under this subsection are applied to the client's cost of care.

(d) The total amounts deducted under subsection (((4))) (3)(a), (b), and (c) of this section shall not exceed the one-person MNIL.

(e) A monthly needs allowance for the community spouse not to exceed, effective January 1, ((1997, one thousand nine hundred seventy-six)) 1998, two thousand nineteen dollars, unless specified in subsection (((6))) (5) of this section. ((The department shall ensure)) The monthly needs allowance is:

(i) An amount added to the community spouse's gross income to provide a total community spouse's income of one thousand three hundred twenty-seven dollars;

(ii) Excess shelter expenses as specified under subsection (((5))) (4) of this section; and

(iii) Allowed only to the extent income of the institutionalized spouse is made available to the community spouse.

(f) An amount for the maintenance needs of each dependent family member residing with the community spouse:

(i) Equal to one-third of the amount one thousand three hundred twenty-seven dollars exceeds the family member's income. Child support received from an absent parent is the child's income.

(ii) "Family member" means a:

(A) Dependent or minor child;

(B) Dependent parent; or

(C) Dependent sibling of the institutionalized or community spouse.

(g) When an institutional client does not have a community spouse, an amount for the maintenance needs of family members residing in the client's home equal to the ((medically needy income level)) MNIL for the number of ((legal dependents)) family members in the home less the income of the ((dependents)) family members.

(h) Amounts for incurred medical expenses not subject to third-party payment which are the current liability of the client including((, but not limited to)):

(i) Health insurance premiums, coinsurance, or deductible charges; and

(ii) Necessary medical care recognized under state law, but not covered under Medicaid.

(i) Maintenance of the home of a single person or couple:

(i) Up to one hundred percent of the one-person federal poverty level per month;

(ii) Limited to a six-month period; ((and))

(iii) When a physician has certified that the client is likely to return to the home within the six-month period; and

(iv) When social service staff documents initial need for the income exemption and reviews the person's circumstances after ninety days.

(((5))) (4) For the purposes of this section, ((the department shall)):

(a) ((Determine)) Shelter expenses ((to be)) are the actual required maintenance expenses for the community spouse's principal residence for:

(i) Rent;

(ii) Mortgage;

(iii) Taxes and insurance;

(iv) Any maintenance care for a condominium or cooperative; and

(v) The food stamp standard utility allowance ((for utilities)), provided the utilities are not included in the maintenance charges for a condominium or cooperative.

(b) ((Consider)) The standard shelter allocation ((to be)) is three hundred ninety-nine dollars, effective April 1, 1997.

(c) ((Consider as)) "Excess shelter expenses" ((an amount)) equal ((to)) the actual expenses under subsection (((5))) (4)(a) of this section less the standard shelter allocation under subsection (((5))) (4)(b) of this section.

(((6))) (5) The ((department shall determine the)) amount the institutional spouse may allocate((s)) to the community spouse may ((only)) be greater than the amount in subsection (((4)(e)(i)))(3)(e) of this section only when:

(a) A court enters an order against the institutionalized client for the community spouse support; or

(b) A hearings officer determines a greater amount is needed because of exceptional circumstances resulting in extreme financial duress.

(((7) The client shall use)) (6) The income remaining after allocations specified in ((subsection (4))) subsections (3) and (5) of this section ((toward payment of)) is the client's participation in cost of care ((at the department rate)).

(8) SSI-related clients((.

(a) SSI-related clients)) shall continue to receive total payment under 1611 (b)(1) of the Social Security Act for the first three full calendar months of institutionalization in a public or Medicaid-approved medical institution or facility when the:

(((i))) (a) Stay in the institution or facility is not expected to exceed three months; and

(((ii) SSI-related)) (b) The client((s)) plans to return to former living arrangements.

(((b) The department shall not consider the SSI payment))

(9) When computing the client's participation amount((.

(9))), the ((department shall not consider)) following income is not counted:

(a) The SSI payment; or

(b) Income from reparation payments made by the Federal Republic of Germany ((when computing the client's participation amount)).

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530 and Social Security Act, Federal Register, March 10, 1997, pgs. 10856 - 10859, 42 U.S.C. 1396 (a)(l)(m). 97-16-008, 388-513-1380, filed 7/24/97, effective 7/24/97. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 95-44. 96-09-033 (Order 3963), 388-513-1380, filed 4/10/96, effective 5/11/96. Statutory Authority: RCW 74.08.090. 95-11-045 (Order 3848), 388-513-1380, filed 5/10/95, effective 6/10/95. Statutory Authority: RCW 74.08.090 and Title XIX State Agency Letter 94-49, notice of increase in SSI level. 95-05-022 (Order 3832), 388-513-1380, filed 2/8/95, effective 3/11/95. Statutory Authority: RCW 74.08.090. 94-10-065 (Order 3732), 388-513-1380, filed 5/3/94, effective 6/3/94. Formerly WAC 388-95-360.]