HEALTH CARE AUTHORITY

[Filed June 30, 2023, 1:53 p.m., effective July 1, 2023]

Effective Date of Rule: July 1, 2023.

Purpose: The agency is amending rules to increase the income and resource limits for the tailored supports for older adults (TSOA) program eligibility and revise the application process.

Citation of Rules Affected by this Order: Amending WAC 182-513-1625, 182-513-1635, and 182-513-1640.

Statutory Authority for Adoption: RCW 41.05.021, 41.05.160; section 1115 of the Social Security Act.

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: The agency received approval from the Centers for Medicare and Medicaid Services (CMS) on June 30, 2023, of the medicaid transformation demonstration waiver which increases the income and resource limits for TSOA allowing more people to participate in the TSOA program. This emergency filing is necessary to ensure people who are at risk of needing long-term services and supports in the future and who don't currently meet medicaid financial eligibility criteria are able to participate effective July 1, 2023, while the agency is pursuing the permanent rule-making process filed under WSR 23-13-157.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 3, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

Date Adopted: June 30, 2023.

AMENDATORY SECTION(Amending WSR 17-12-019, filed 5/30/17, effective 7/1/17)

WAC 182-513-1625Tailored supports for older adults (TSOA)—Applications.

(1) Applications for tailored supports for older adults (TSOA) are submitted:

(a) Online at Washington Connection at www.washingtonconnection.org;

(b) By sending a completed HCA ((18-008))18-005 application for TSOA form to P.O. Box 45826, Olympia, WA 98605;

(d) By contacting the local area agency on aging (AAA) office at 1-855-567-0252; or

(e) By contacting the local home and community services (HCS) office. To find the local HCS office, see ((www.altsa.dshs.wa.gov/Resources/clickmap.htm))https://www.dshs.wa.gov/ALTSA/resources.

(2) Help filing an application:

(a) The medicaid agency or the agency's designee provides help with the application or renewal process in a manner that is accessible to people with disabilities, limitations, or other impairments as described in WAC 182-503-0120 and to those who are limited-English proficient as described in WAC 182-503-0110;

(b) For help filing an application, a person may:

(i) Contact a local AAA office;

(ii) Contact a local HCS office; or

(iii) Have an authorized representative apply on the person's behalf.

(3) The following people can apply for the TSOA program:

(a) The applicant (the person receiving care);

(b) The applicant's spouse;

(d) A legal guardian; or

(e) An authorized representative, as defined in WAC 182-500-0010.

(4) A phone interview is required to establish TSOA financial eligibility, but may be waived if the applicant is unable to comply:

(a) Due to the applicant's medical condition; and

(b) Because the applicant does not have another person that is able to conduct the interview on the applicant's behalf.

(5) The agency or the agency's designee processes TSOA applications using the same timelines under WAC 182-503-0060.

(6) TSOA begins on the date the person is determined presumptively eligible for TSOA under WAC 182-513-1620, or on the date all eligibility requirements are established if the person is not found presumptively eligible.

(7) When the person withdraws an application for TSOA, or is determined ineligible for TSOA services, the agency or the agency's designee denies the application under WAC 182-503-0080.

AMENDATORY SECTION(Amending WSR 17-12-019, filed 5/30/17, effective 7/1/17)

WAC 182-513-1635Tailored supports for older adults (TSOA)—Income eligibility.

(1) To determine income eligibility for the tailored supports for older adults (TSOA) program, the medicaid agency or the agency's designee uses the following rules depending on whether the person is single or married.

(2) If the TSOA applicant is single, the agency or the agency's designee:

(a) Determines available income under WAC 182-513-1325;

(b) Excludes income under WAC 182-513-1340; and

(c) Compares remaining gross nonexcluded income to ((the special income level (SIL)))400 percent of the federal benefit rate (FBR). To be eligible, a person's gross income must be equal to or less than ((the SIL (three hundred percent))400 percent of the ((federal benefit rate (FBR))))FBR.

(3) If the TSOA applicant is married, the agency or the agency's designee:

(a) Determines available income under WAC 182-513-1330 with the exception of subsections (5) and (6) of that section;

(b) Excludes income under WAC 182-513-1340; and

(c) Compares the applicant's remaining gross nonexcluded income to ((the SIL))400 percent of the FBR. To be eligible, a person's gross income must be equal to or less than ((the SIL (three hundred percent of the FBR)))400 percent of the FBR.

(4) The FBR changes annually on January 1st.

(5) The current TSOA income standard is found on the Washington apple health income and resource standards chart, institutional standards section; see www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

AMENDATORY SECTION(Amending WSR 17-12-019, filed 5/30/17, effective 7/1/17)

WAC 182-513-1640Tailored supports for older adults (TSOA)—Resource eligibility.

(1) The resource standard for a single applicant for tailored supports for older adults (TSOA) is (($53,100))six times the average monthly private nursing facility rate, as determined by the department of social and health services under chapter 74.46 RCW.

(2) The resource standard for a married couple is (($53,100))six times the average monthly private nursing facility rate, as determined by the department of social and health services under chapter 74.46 RCW, for the TSOA applicant plus the state spousal resource standard for the spousal impoverishment protections community (SIPC) spouse. The state spousal resource standard may change annually on July 1st. ((The resource standards are found at www.hca.wa.gov/free-or-low-cost-health-care/program-administration/program-standard-income-and-resources.))

(3) The medicaid agency or the agency's designee uses rules in WAC 182-513-1350 (1), (3) and (4) to determine general eligibility relating to resources, availability of resources, and which resources count.

(4) The TSOA recipient has one year from the date of initial eligibility of TSOA to transfer resources in excess of the TSOA standard to the SIPC spouse.

(5) The resource standard for TSOA changes annually on January 1st based on the current average private nursing facility rate, as determined by the department of social and health services under chapter 74.46 RCW.

(6) The current TSOA standards and the current average private nursing facility rate are found on the Washington apple health income and resource standards chart, institutional standards section; see www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.