Original Notice.

Preproposal statement of inquiry was filed as WSR 00-05-038.

Title of Rule: New WAC 388-539-0200 AIDS -- Health insurance premium payment program and repealing WAC 388-539-001, 388-539-050, 388-539-100, and 388-539-150.

Purpose: The department is replacing several sections of rule with a single section, written to comply with the Governor's Executive Order 97-02 on regulatory reform. The new consolidated rule reflects long-standing program policy, adopts a new upper income limit, is more readable, and has been reviewed in consultation with the regulated community.

Statutory Authority for Adoption: RCW 74.08.090.

Statute Being Implemented: RCW 74.09.757.

Summary: The department is replacing several sections of rule with a single consolidated section. The proposed rule adopts a new upper income limit and reflects long-standing program policy.

Reasons Supporting Proposal: To ensure that department rules reflect current and accurate department policy, to eliminate confusion by consolidating related rules and to comply with the Governor's Executive Order 97-02 on regulatory reform.

Name of Agency Personnel Responsible for Drafting: L. Mike Freeman, MAA/RIP, P.O. Box 45533, Olympia, WA 98504-5533, (360) 725-1350; Implementation and Enforcement: Sharon Black, MAA/COB, 817 S.E. 8th Avenue, Olympia, WA 98501, (360) 725-1210.

Name of Proponent: Department of Social and Health Services, Medical Assistance Administration, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The rule continues the implementation of a program authorized by the Washington state legislature. The program allows the Medical Assistance Administration to assist persons who are seriously ill with AIDS by paying their health insurance premiums. The purpose of the program is to preserve those persons' assets and so forestall Medicaid eligibility.

Proposal Changes the Following Existing Rules: The rule proposed clarifies the previous rules and program operational policy, providing greater detail about long-standing policy. The proposed rule places one additional restriction on the regulated community in regard to an upper income limit. This limit is consistent with the limit the Department of Health places on its program for persons living with HIV. Otherwise, the proposed rule does not impose additional restrictions on the regulated community or increase the costs to clients, contractors or the department.

No small business economic impact statement has been prepared under chapter 19.85 RCW. MAA reviewed the proposed rule and concluded that the rule will not place "a more than minor impact on businesses."

RCW 34.05.328 applies to this rule adoption. MAA reviewed the proposed rule and determined that it meets the definitions of "a significant legislative rule." Therefore, MAA has analyzed the probable costs and the probable benefits of the proposed rule, taking into account both the qualitative and quantitative benefits and costs. MAA's analysis revealed that no new costs will be imposed, existing costs will not be increased, and benefits to businesses will not be decreased. A statement of probable costs and probable benefits may be obtained from the person listed above.

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on June 27, 2000, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Fred Swenson by June 16, 2000, phone (360) 664-6097, TTY (360) 664-6178, e-mail swensfh@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, by June 27, 2000.

Date of Intended Adoption: Not sooner than June 30, 2000.

May 11, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

(1) The purpose of the AIDS health insurance premium payment program is to help individuals who are not eligible for MAA's medical programs and who are diagnosed with AIDS, pay their health insurance premiums.

(2) To be eligible for the AIDS health insurance premium payment program, individuals must:

(a) Be diagnosed with AIDS as defined in WAC 246-100-011;

(b) Be a resident of the state of Washington;

(c) Be responsible for all, or part of, the health insurance premium payment (without MAA's help);

(d) Not be eligible for one of MAA's other medical programs;

(e) Not have personal income that exceeds three hundred seventy percent of the federal poverty level; and

(f) Not have personal assets, after exemptions, exceeding fifteen thousand dollars. The following personal assets are exempt from the personal assets calculation:

(i) A home used as the person's primary residence; and

(ii) A vehicle used as personal transportation.

(3) MAA may contract with a not-for-profit community agency to administer the Aids health insurance premium payment program. MAA or its contractor determines an individual's initial eligibility and redetermines eligibility on a periodic basis. To be eligible, individuals must:

(a) Cooperate with MAA's contractor;

(b) Cooperate with eligibility determination and redetermination process; and

(c) Initially meet and continue to meet the eligibility criteria in subsection (2) of this section.

(4) Individuals, diagnosed with AIDS, who are eligible for one of MAA's medical programs may ask MAA to pay their health insurance premiums under a separate process. The client's community services office (CSO) is able to assist the client with this process.

(5) Once an individual is eligible to participate in the AIDS health insurance premium payment program, eligibility would cease only when one of the following occurs. The individual:

(a) Is deceased;

(b) Voluntarily quits the program;

(c) No longer meets the requirements of subsection (2) of this section; or

(d) Has benefits terminated due to the legislature's termination of the funding for this program.

(6) MAA sets a reasonable payment limit for health insurance premiums. MAA sets its limit by tracking the charges billed to MAA for MAA clients who have AIDS. MAA does not pay health insurance premiums that exceed fifty percent of the average of charges billed to MAA for its clients with AIDS.

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     The following sections of the Washington Administrative Code are repealed:

WAC 388-539-001	Purpose.
WAC 388-539-050	Definitions.
WAC 388-539-100	Eligibility.
WAC 388-539-150	Premium payment.

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