SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
Preproposal statement of inquiry was filed as WSR 00-07-100.
Title of Rule: WAC 388-71-0445 Under home and community programs, am I eligible for Chore-funded services?, 388-71-0470 Who pays for HCP services?, and 388-71-0480 If I am employed, can I still receive HCP services?
Purpose: Amending these rules for home and community programs is necessary to correct wording and to clarify the intent.
Statutory Authority for Adoption: RCW 74.09.520, 74.09.530, 74.39A.110, [74.39A.]120, and [74.39A.]130, and sections 205 (1)(c) and 206(3), chapter 346, Laws of 1998, and RCW 74.39A.030.
Statute Being Implemented: RCW 74.09.520, 74.09.530, 74.39A.110, [74.39A.]120, and [74.39A.]130, and sections 205 (1)(c) and 206(3), chapter 346, Laws of 1998, and RCW 74.39A.030.
Summary: The rules describe eligibility and participation requirements for Home and community programs -- Medicaid personal care, COPES and Chore.
Reasons Supporting Proposal: Amending the rules is necessary to correct wording and to clarify the intent.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Lois Wusterbarth, Program Manager, Aging and Adult Services Administration, 600 Woodland Square Loop, Lacey, WA, (360) 493-2538.
Name of Proponent: Department of Social and Health Services, Aging and Adult Services Administration, governmental.
Rule is not necessitated by federal law, federal or state court decision.
Explanation of Rule, its Purpose, and Anticipated Effects: This rule corrects the wording and clarifies the intent of existing rules regarding Chore eligibility, and client participation rules for COPES, Medicaid personal care and Chore.
Proposal Changes the Following Existing Rules: Amends existing rules in order to correct and clarify the intent and reorganize the contents for additional clarity.
No small business economic impact statement has been prepared under chapter 19.85 RCW. This rule clarifies and corrects the language and intent of previous rule. The changes affect only the clients DSHS serves. No business impact is effected due to these rule changes.
RCW 34.05.328 applies to this rule adoption. These rules meet the definition of a significant legislative rule but DSHS is exempt from preparing a cost benefit analysis per RCW. RCW 34.05.328 (5)(b)(vii) exempts DSHS rules that apply to client medical or financial eligibility.
Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on July 11, 2000, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Fred Swenson by June 30, 2000, phone (360) 664-6097, TTY (360) 664-6178, firstname.lastname@example.org.
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) 902-8292, by July 11, 2000.
Date of Intended Adoption: August 12, 2000.
May 25, 2000
Marie Myerchin-Redifer, Manager
Rules and Policies Assistance Unit2722.2
To be eligible for Chore-funded services, you must:
(1) Be eighteen years of age or older;
(2) Require assistance with at least one of the direct personal care tasks listed in WAC 388-15-202(17);
(3) Not be eligible for MPC or COPES, Medicare home health or other programs if these programs can meet your needs;
(4) Have net household income (as described in WAC 388-450-0005, 388-450-0015, and 388-450-0210) not exceeding:
(a) The sum of the cost of your chore services, and
(b) One-hundred percent of the FPL adjusted for family size.
(5) Have resources, as described in chapter 388-470 WAC, which does not exceed ten thousand dollars for a one-person family or fifteen thousand dollars for a two-person family. (Note: One thousand dollars for each additional family member may be added to these limits.)
(6) Not transfer assets on or ((
before)) after November 1,
1995 for less than fair market value as described in WAC 388-513-1365.
[Statutory Authority: RCW 74.39A.110, 74.39A.150. 00-04-056, § 388-71-0445, filed 1/28/00, effective 2/28/00.]
Depending on your income and resources, you may be required to pay participation toward the cost of your care. The department determines exactly what amount, if any, you pay. If you are receiving:
(1) COPES in-home ((
services)) or residential,
(a) You participate income ((
above the Medically needy
income level (MNIL) or Federal Poverty Level (FPL) directly to
the service provider.)) per rules in WAC 388-515-1505;
You pay the person providing the highest level of care
or multiple providers, so long as the amount authorized for
services is greater than the participation amount.
(c))) If you have nonexempt income that exceeds the cost of
COPES services, you may retain the difference((
(d) Rules regarding COPES in-home participation are found in WAC 388-515-1505)).
(2) MPC in-home services, you do not participate toward the cost of your personal care services.
(3) MPC services in a residential setting and you are:
(a) An SSI beneficiary who receives only SSI income, you only pay for board and room. You are allowed to keep a personal allowance of at least thirty-eight dollars and eighty-four cents.
(b) An SSI beneficiary who receives SSI and SSA benefits, you only pay for board and room. You are allowed to keep a personal allowance of at least fifty-eight dollars and eighty-four cents.
(c) An SSI-related person per WAC 388-511-1105, you may be required to participate towards the cost of your personal care services in addition to your board and room if your financially eligibility is based on the facility's state contracted rate plus add-on hours. You will receive a personal allowance of fifty-eight dollars and eighty-four cents.
(d) A GA-X client in an adult family home, you are allowed to keep a personal allowance of thirty-eight dollars and eighty-four cents only. The remainder of your grant must be paid to the facility.
(4) Chore services, you may retain an amount equal to one
hundred percent of the federal poverty level, adjusted for family
size, as the home maintenance allowance and pay the difference
between the FPL and your nonexempt income ((
(as defined in WAC 388-513-1340) to your provider.
(4) COPES residential services, you pay toward the cost of your room, board, personal care services, and health insurance premiums. You may retain a fifty-eight dollars and eighty-four cents clothing and personal incidental allowance (CPI) and pay any remaining MNIL income up to the residential facility rate for the cost of room and board. HCFA does not allow COPES clients the twenty dollar disregard. Rules regarding COPES residential participation are found in WAC 388-515-1505.
(5) MPC residential services, and you are:
(a) An SSI or SSI-related Medicaid recipient you participate income toward the room and board only. You are guaranteed a personal allowance of at least thirty-eight dollars and eighty-four cents a month; or
(b) A non-SSI client and become SSI or SSI-related because the cost of your care in the facility exceeds your income, you may be required to participate towards the cost of your room, board, personal care services, and health insurance premiums. You will receive a personal allowance of fifty-eight dollars and eighty-four cents a month)). Exempt income includes:
(a) Income listed in WAC 388-513-1340;
(b) Spousal income allocated and actually paid as participation in the cost of the spouse's community options program entry system (COPES) services;
(c) Amounts paid for medical expenses not subject to third party payment;
(d) Health insurance premiums, coinsurance or deductible charges; and
(e) If applicable, those work expense deductions listed as WAC 388-71-480(2).
[Statutory Authority: RCW 74.39A.120, 74.39.010, 74.39.020. 00-04-056, § 388-71-0470, filed 1/28/00, effective 2/28/00.]
If you are disabled, as determined under WAC 388-511-1105, you may be employed and still be eligible to receive HCP services.
(1) If you remain Medicaid eligible under the categorically needy program, you are financially eligible for MPC services.
(2) If you are not Medicaid eligible due to your earned income and resources, you may be eligible to receive chore personal care services.
(a) You may be required to pay participation per WAC 388-71-0465(3) for any earned income above one hundred percent of the federal poverty level.
(b) The department will exempt fifty percent of your earned income after work expense deductions. Work expense deductions are:
(i) Personal work expenses in the form of self-employment taxes (FICA); and income taxes when paid;
(ii) Payroll deductions required by law or as a condition of employment in the amounts actually withheld;
(iii) The necessary cost of transportation to and from the place of employment by the most economical means, except rental cars;
(iv) Expenses necessary for continued employment such as tools, materials, union dues, transportation to service customers is not furnished by the employer; and
(v) Uniforms needed on the job and not suitable for wear
away from the job((
(vi) Spousal income allocated and actually paid as participation in the cost of the spouse's community options program entry system (COPES) services;
(vii) Amounts paid for medical expenses not subject to third-party payment; and
(viii) Health insurance premiums, coinsurance or deductible charges)).
[Statutory Authority: RCW 74.39A.140, 74.39A.150. 00-04-056, § 388-71-0480, filed 1/28/00, effective 2/28/00.]