WSR 15-16-039 EMERGENCY RULES DEPARTMENT OF SOCIAL AND HEALTH SERVICES (Developmental Disabilities Administration) [Filed July 28, 2015, 9:12 a.m., effective August 6, 2015] Effective Date of Rule: August 6, 2015.
Purpose: Federal regulation 42 C.F.R. §431.232(d) does not allow medicaid benefits to continue at their previous level following an evidentiary hearing decision to reduce or terminate those benefits. Therefore, this emergency rule is to ensure the administration has language in rule that conforms to the C.F.R. regarding continuing benefits.
Citation of Existing Rules Affected by this Order: Amending WAC 388-825-145.
Statutory Authority for Adoption: RCW 71A.12.030, 34.05.350 (1)(b), 74.08.080, 42 C.F.R. §431.232, 42 C.F.R. §431.230.
Other Authority: RCW 71A.12.030, 34.05.350 (1)(b), 74.08.080, 42 C.F.R. §431.232, 42 C.F.R. §431.230.
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: 42 C.F.R. §431.232(d) requires the state to discontinue medicaid benefits following an initial administrative order that affirms the state's decision to reduce or terminate those benefits. WAC 388-825-0135(2) currently allows continued benefits (including medicaid benefits) past the initial order. This emergency rule is necessary to conform DSHS rules with federal requirements.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 1, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: July 24, 2015.
Katherine I. Vasquez
Rules Coordinator
AMENDATORY SECTION (Amending WSR 08-04-072, filed 2/4/08, effective 3/6/08)
WAC 388-825-145 Will my benefits continue if I request an administrative hearing?
(1) If you request an administrative hearing regarding the department's decision to transfer you from a residential habilitation center to the community under RCW 71A.20.080, the rules in WAC 388-825-155 apply.
(2) If you request an administrative hearing ((within the ten-day notice period, as described in chapter 388-458 WAC, unless one or more of the conditions in WAC 388-825-150 applies, the department will take no action until there is a final decision on your appeal of the department's decision to:
(a) Terminate your eligibility for services;
(b) Reduce or terminate your services;
(c) Reduce or terminate the payment of SSP set forth in chapter 388-827 WAC; or
(d) Disenroll you from a DDD home and community based services waiver under WAC 388-845-0060, including a disenrollment from a waiver and enrollment in a different waiver)) regarding the department's decision to reduce or terminate your services, and you request the hearing before the date specified on the notice of the action, and none of the conditions in WAC 388-825-150 applies, the department will not reduce or terminate those services unless and until an administrative law judge issues an initial order or a review judge issues a final order that reduces or terminates those services. This subsection also applies to the department's decision to disenroll you from a DDA home and community based services waiver under WAC 388-845-0060.
(3) The department will take no action until there is a final decision on your appeal of the department's decision to remove or transfer you to another residential service unless one or more of the conditions in WAC 388-825-150 applies.
(4) The department will take no action until there is a final decision on your appeal to terminate your provider of choice unless one or more of the circumstances described in WAC 388-825-150 applies.
(5) After the administrative hearing, you may have to pay back up to sixty days of the continued benefits you get((, as described in chapter 388-410 WAC,)) if the administrative hearing decision ((is in favor of the department)) determines your benefits should be less than the continued benefits you have received.
Reviser's note: The unnecessary underscoring in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040. |