WSR 03-20-074



(Medical Assistance Administration)

[ Filed September 29, 2003, 2:45 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 03-10-088.

Title of Rule: WAC 388-438-0110 Alien emergency medical (AEM) program.

Purpose: The proposed rule eliminates coverage for organ transplants and related services and clarifies certification periods and scope of care. This rule was adopted on an emergency basis effective July 1, 2003.

Statutory Authority for Adoption: RCW 74.04.050, 74.04.057, 74.08.090, and 74.09.530.

Statute Being Implemented: Section 1903 (v)(2)(c) of the Social Security Act.

Summary: These amendments will bring the state into compliance with federal limitations on medical services covered under emergency services for alien residents.

Reasons Supporting Proposal: Without the amendments, the state will be out of compliance with federal limitations on medical services covered under emergency services for alien residents.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Joanie Scotson, MAA, P.O. Box 5534, Olympia, WA 98504-5534, (360) 725-1330.

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

Rule is necessary because of federal law, Section 1903 (v)(2)(c) of the Social Security Act.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose and Summary above.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. This proposed rule does not impact small businesses.

RCW 34.05.328 does not apply to this rule adoption. RCW 34.05.328 (5)(b)(vii) exempts DSHS client eligibility rules for medical and financial assistance. The proposed rule amends eligibility for covered medical services for aliens.

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on November 4, 2003, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by October 31, 2003, phone (360) 664-6094, TTY (360) 664-6178, e-mail

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail, by 5:00 p.m. on November 4, 2003.

Date of Intended Adoption: Not sooner than November 5, 2003.

September 25, 2003

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION(Amending WSR 02-17-030, filed 8/12/02, effective 9/12/02)

WAC 388-438-0110   The alien emergency medical (AEM) program.   (1) The alien emergency medical (AEM) program is a required federally-funded program. It is for aliens who are ineligible for other Medicaid programs, due to citizenship or alien status requirements described in WAC 388-424-0005 and 388-424-0010.

(2) Except for the social security number, citizenship, or alien status requirements, an alien must meet categorical Medicaid eligibility requirements as described in:

(a) WAC 388-505-0110, for an SSI-related person;

(b) WAC 388-505-0220, for family medical programs;

(c) WAC 388-505-0210, for a child under the age of nineteen; or

(d) WAC 388-523-0100, for medical extensions.

(3) When an alien has monthly income ((which)) that exceeds the CN medical standards, the department will consider AEM medically needy coverage for children or for adults who are age sixty-five or over or who meet SSI disability criteria. See WAC 388-519-0100.

(4) To qualify for the AEM program, the alien must meet one of the criteria described in subsection (2) of this section and have:

(a) ((An)) A qualifying emergency medical condition as described in WAC 388-500-0005; or

(b) Been approved by the department ((as requiring)) for, and receiving, nursing facility or COPES level of care.

(5) The alien's date of arrival in the United States is not used when determining eligibility for the AEM program.

(6) The department does not deem a sponsor's income and resources as available to the client when determining eligibility for the AEM program. The department counts only the income and resources a sponsor makes available to the client.

(7) Under the AEM program, a person receives CN scope of care, as described in WAC 388-529-0100. Covered services are limited to those medical services necessary for treatment of the person's emergency medical condition. The following services are not covered:

(a) Organ transplants and related services;

(b) Prenatal care, except labor and delivery; and

(c) School-based services.

(8) A person whose income exceeds the CN income standard has spend down liability and MN scope of care.

(9) A person determined eligible for the AEM program is certified for three months. The number of three-month certification periods is not limited, but, the person must continue to meet eligibility criteria in subsection (2) and (3) of this section.

(10) A person is not eligible for the AEM program if they entered the state specifically to obtain medical care.

[Statutory Authority: RCW 74.08.090, 74.08A.100, 74.09.080, and 74.09.415. 02-17-030, 388-438-0110, filed 8/12/02, effective 9/12/02. Statutory Authority: RCW 74.08.090 and C.F.R. 436.128, 436.406(c) and 440.255. 01-05-041, 388-438-0110, filed 2/14/01, effective 3/17/01. Statutory Authority: RCW 74.08.090, 74.04.050, 74.04.057, 74.09.530, 42 C.F.R. 435.139 and 42 C.F.R. 440.255. 99-23-082, 388-438-0110, filed 11/16/99, effective 12/17/99. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. 98-16-044, 388-438-0110, filed 7/31/98, effective 9/1/98.]

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