WSR 11-16-101

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES

[ Filed August 3, 2011, 9:18 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 11-08-066.

Title of Rule and Other Identifying Information: WAC 388-438-0125 State-funded long-term care services program.

Hearing Location(s): Office Building 2, Auditorium, DSHS Headquarters, 1115 Washington, Olympia, WA 98504 (public parking at 11th and Jefferson. A map is available at http://www1.dshs.wa.gov/msa/rpau/RPAU-OB-2directions.html or by calling (360) 664-6094), on September 6, 2011, at 10:00 a.m.

Date of Intended Adoption: Not sooner than September 7, 2011.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 1115 Washington Street S.E., Olympia, WA 98504, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on September 6, 2011.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by August 23, 2011, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at jennisha.johnson@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The Washington state legislature enacted ESHB 1086 on February 18, 2011, which states "the department is authorized to place long-term care clients residing in nursing homes and paid for with state only funds into less restrictive community care settings while continuing to meet the client's care needs."

The state provides nursing facility care for approximately forty-five state-only alien medical clients who are discharged from hospitals with acute/long-term medical conditions. Of the forty-five state-only funded nursing home slots, forty will be moved into adult family homes. The proposed rules define where long-term care services may be provided to be eligible for department reimbursement and expand the availability of care for these clients.

Reasons Supporting Proposal: These rules are necessary to follow ESHB 1086. These rules will allow the department to continue to provide medical coverage to maintain current levels of medical care and a consistent level of services for these clients.

Statutory Authority for Adoption: RCW 74.04.057, 74.08.090, and 74.09.510.

Statute Being Implemented: RCW 74.08.090.

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: Jason R. P. Crabbe, P.O. Box 45504, Olympia, WA 98504-5504, (360) 725-1346; Implementation and Enforcement: Lori Rolley, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2271.

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

A cost-benefit analysis is not required under RCW 34.05.328. Under RCW 34.05.328 (5)(b), rules with content dictated by statute do not require a cost-benefit analysis.

July 29, 2011

Katherine I. Vasquez

Rules Coordinator

4260.6
AMENDATORY SECTION(Amending WSR 10-19-085, filed 9/17/10, effective 10/18/10)

WAC 388-438-0125   ((Alien nursing facility)) State-funded long-term care services program (((state-funded))).   (1) The state-funded ((alien nursing facility)) long-term care services program is subject to caseload limits determined by legislative funding. Services cannot be authorized for eligible persons prior to a determination by the aging and disability services administration (ADSA) that caseload limits will not be exceeded as a result of the authorization.

(2) Long-term care services are defined in this section as services provided in one of the following settings:

(a) In a person's own home, as described in WAC 388-106-0010;

(b) Nursing facility, as defined in WAC 388-97-0001;

(c) Adult family home, as defined in RCW 70.128.010;

(d) Assisted living facility, as described in WAC 388-513-1301;

(e) Enhanced adult residential care facility, as described in WAC 388-513-1301;

(f) Adult residential care facility, as described in WAC 388-513-1301.

(3) Long-term care services will be provided in one of the facilities listed in subsection (2)(b) through (2)(f) of this section unless nursing facility care is required to sustain life.

(4) To be eligible for the state-funded ((alien nursing facility)) long-term care services program described in this section, an adult nineteen years of age or older must meet all of the following conditions:

(a) Meet the general eligibility requirements for medical programs described in WAC 388-503-0505 (2) and (3)(a), (3)(b), (3)(e), and (3)(f);

(b) Reside in ((a nursing facility as defined in WAC 388-97-0001)) one of the settings described in subsection (2) of this section;

(c) Attain institutional status as described in WAC 388-513-1320;

(d) Meet the functional eligibility described in WAC 388-106-0355 for nursing facility level of care;

(e) Not have a penalty period due to a transfer of assets as described in WAC 388-513-1363, 388-513-1364, 388-513-1365, and 388-513-1366;

(f) Not have equity interest in a primary residence ((of)) more than ((five hundred thousand dollars as)) the amount described in WAC 388-513-1350 (7)(a)(ii); and

(g) Any annuities owned by the adult or spouse must meet the requirements described in chapter 388-561 WAC.

(((3))) (5) An adult who is related to the supplemental security income (SSI) program as described in WAC 388-475-0050 (1), (2), and (3) must meet the financial requirements described in WAC 388-513-1325, 388-513-1330, and 388-513-1350.

(((4))) (6) An adult who does not meet the SSI-related criteria in subsection (2) of this section may be eligible under the family institutional medical program rules described in WAC 388-505-0250 or 388-505-0255.

(((5))) (7) An adult who is not eligible for the state-funded ((alien nursing facility)) long-term care services program under categorically needy (CN) rules may qualify under medically needy (MN) rules described in:

(a) WAC 388-513-1395 for adults related to SSI; or

(b) WAC 388-505-0255 for adults related to family institutional medical.

(((6))) (8) All adults qualifying for the state-funded ((alien nursing facility)) long-term care services program will receive CN scope of medical coverage described in WAC 388-501-0060.

(((7))) (9) The department determines how much an individual is required to pay toward the cost of care using the following rules:

(a) For an SSI-related individual residing in a nursing home, see rules described in WAC 388-513-1380.

(b) For an SSI-related individual residing in one of the other settings described in subsection (2) of this section, see rules described in WAC 388-515-1505.

(c) For an individual eligible under the family institutional program, see WAC 388-505-0265.

(((8))) (10) A person is not eligible for state-funded ((nursing facility)) long-term care services if that person entered the state specifically to obtain medical care.

(((9))) (11) A person eligible for the state-funded ((alien nursing facility)) long-term care services program is certified for a twelve month period.

[Statutory Authority: RCW 74.04.050, 74.08.090, and 2009 c 564 1109, 201, 209. 10-19-085, 388-438-0125, filed 9/17/10, effective 10/18/10.]

Washington State Code Reviser's Office