Original Notice.

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

     Title of Rule and Other Identifying Information: WAC 388-105-0035 What are the requirements for a capital add-on rate for assisted living facilities (ALF)?

     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 98504, 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 the amendment of existing WAC 388-105-0035 to limit eligibility for a capital add-on rate to assisted living (AL) facilities that meet the construction requirements specified in WAC 388-105-0035 or 388-110-140 (2)(a) and (3). This amendment adds the requirement that the AL contractor must attest in writing that its facility meets the specified construction requirements of WAC 388-105-0035. If there is no attestation, then the AL contractor must meet the construction requirements of WAC 388-110-140 (2)(a) and (3).

     Further, this amendment adds the requirement that the AL contractor must place Medicaid clients in units that meet the construction requirements of WAC 388-105-0035 or 388-110-140 (2)(a) or (3).

     Reasons Supporting Proposal: Unless the department adopts a change to WAC 388-105-0035, then AL facilities that are comparable to newly constructed AL facilities would be excluded from consideration for a capital add-on rate. This could result in limiting access of Medicaid clients to the better AL facilities. Limiting access would be contrary to the public interest in ensuring the health, safety and general welfare of the public that depends on Medicaid to pay for their care in AL facilities.    

     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, Aging and Disability Services Administration, 640 Woodland Square Loop S.E., Lacey, WA 98503, (360) 725-2447; Implementation and Enforcement: Dick Rosage, (360) 725-2442.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. Under RCW 19.85.025(3) and 34.05.310 (4)(f), the department is exempt from preparing a small business economic impact statement. These rules set or adjust fees or rates pursuant to legislative standards.

     A cost-benefit analysis is not required under RCW 34.05.328. Under RCW 34.05.328 (5)(b)(vi), the department is exempt from preparing a cost-benefit analysis. These rules set or adjust fees or rates pursuant to legislative standards.

January 11, 2006

Andy Fernando, Manager

Rules and Policies Assistance Unit

     (a) Meets)) have a Medicaid occupancy percentage that equals or exceeds the applicable biyearly Medicaid minimum occupancy percentage set in accordance with subsection (3) of this section and meet the construction requirements ((of WAC 388-110-140; and))

     (((b) Has a Medicaid occupancy percentage that equals or exceeds the applicable biyearly Medicaid minimum occupancy percentage set in accordance with subsection (3) of this section.)) in subsection (4) of this section.

     (2) The department will determine an ((ALF's)) AL contractor's Medicaid occupancy percentage by dividing its Medicaid resident days by the product of all its licensed boarding home beds irrespective of use times calendar days for the six-month period beginning one year prior to the percentage effective date.

     (3)(a) To set the biyearly Medicaid minimum occupancy percentage, the department will:

     (i) Determine the estimated total budgeted funds for capital add-on rates for the six-month period;

     (ii) Rank from highest to lowest the individual ((ALF)) AL contractor occupancy percentages determined in accordance with subsection (2) of this section;

     (iii) Assign, beginning with the highest ((ALF)) AL contractor's Medicaid occupancy percentage, the estimated expenditure needed to pay the capital add-on rate to each facility for the six-month period;

     (iv) Identify the ((ALF)) AL contractor's Medicaid occupancy percentage at which the estimated total budgeted funds determined under subsection (3)(a)(i) of this section would be expended; and

     (v) Set that Medicaid occupancy percentage as the biyearly Medicaid minimum occupancy percentage.

     (b) The biyearly Medicaid minimum occupancy percentage will be set every January 1 and July 1.

     (4) To receive a capital add-on rate, the AL contractor that meets the Medicaid minimum occupancy percentage established in accordance with subsection (2) and (3) of this section must:

     (a) Attest in writing that it has units that meet the following requirements and that it places Medicaid residents in such units, except the contractor need only place the Medicaid resident in a room with a roll-in shower when the resident's service plan and assessment details require the Medicaid resident to have a roll-in shower:

     (i) A private apartment-like unit of two hundred and twenty square feet that may include counters, closets and built-ins, but must exclude the bathroom;

     (ii) A separate private bathroom that includes a sink, toilet, and a shower or bathtub. The licensed boarding home must have a minimum of one wheelchair accessible bathroom with a roll-in shower of at least forty-eight inches by thirty inches for every two residents whose care is partially or fully funded by Medicaid;

     (iii) A lockable entry door;

     (iv) A kitchen area equipped with a refrigerator, microwave oven or stove top; a counter surface of a minimum of thirty inches wide by twenty-four inches in depth, a maximum height of thirty-four inches, and a knee space beneath at least twenty-seven inches in height; a storage space for utensils and supplies; and

     (v) A living area wired for telephone and television service when available in the geographic location; or

     (b) When the Al contractor does not have units that meet the requirements of subsection (4)(a) of this section, then the AL contractor may receive a capital add-on rate when its AL facility meets the definition of "new boarding home" in WAC 388-110-140 (2)(a) or its AL facility is "grandfathered" under WAC 388-110-140(3).

[Statutory Authority: 2002 c 371. 02-22-058, § 388-105-0035, filed 10/31/02, effective 12/1/02.]