HEALTH CARE AUTHORITY
[Filed March 2, 2021, 8:25 a.m.]
Preproposal statement of inquiry was filed as WSR 20-20-105.
Title of Rule and Other Identifying Information: WAC 182-557-0500 Involuntary disenrollment from a health home.
Hearing Location(s): On April 6, 2021, at 10:00 a.m. In response to the coronavirus disease 2019 (COVID-19) public health emergency, the agency will not provide a physical location for this hearing. This promotes social distancing and the safety of the citizens of Washington state. A virtual public hearing, without a physical meeting space, will be held instead. To attend the virtual public hearing, you must register at the following link https://attendee.gotowebinar.com/register/1443618498460852747, Webinar ID 560-087-099. After registering, you will receive a confirmation email containing the information about joining the webinar.
Date of Intended Adoption: Not sooner than April 7, 2021.
Submit Written Comments to: Health Care Authority (HCA), Rules Coordinator, P.O. Box 42716, Olympia, WA 98504-2716, email firstname.lastname@example.org, fax 360-586-9727, by April 6, 2021.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-586-9727, telecommunication[s] relay service 711, email email@example.com, by March 19, 2021.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The agency is proposing a new rule regarding the disenrollment of health home enrollees for cause to align with agency policy.
Reasons Supporting Proposal: See purpose.
Rule is not necessitated by federal law, federal or state court decision.
Agency Comments or Recommendations, if any, as to Statutory Language, Implementation, Enforcement, and Fiscal Matters: Not applicable.
Name of Proponent: HCA, governmental.
Name of Agency Personnel Responsible for Drafting: Melinda Froud, P.O. Box 42716, Olympia, WA 98504-2716, 360-725-1408; Implementation and Enforcement: Glenda Crump, P.O. Box 45502, Olympia, WA 98504-5502, 360-725-1338.
A school district fiscal impact statement is not required under RCW 28A.305.135
A cost-benefit analysis is not required under RCW 34.05.328
. RCW 34.05.328
does not apply to HCA rules unless requested by the joint administrative rules review committee or applied voluntarily.
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. This rule does not impose any costs on businesses.
March 2, 2021
WAC 182-557-0500Involuntary disenrollment from a health home.
(1) Involuntary disenrollment for health and safety concerns. If a qualified health home or care coordinator believes there are unresolved health or safety concerns with a health home client, the medicaid agency reviews the health home's written request for involuntary disenrollment of the client from the health home program.
(a) Concerns about health and safety include, but are not limited to:
(i) Inappropriate or threatening behavior, such as inappropriate sexual or physical behavior;
(ii) Illegal or criminal activity;
(iii) Harassment; or
(iv) Environmental hazards, such as methamphetamine laboratories, dangerous animals, poor sanitation, or an unsafe home structure.
(b) The agency does not approve requests to end enrollment that are solely due to uncooperative or disruptive behavior resulting from a client's special needs, disability, or behavioral health condition, except when continued enrollment in the health home seriously impairs the health home's ability to furnish services to the client or other clients.
(c) Health homes requesting disenrollment must provide documentation of any reasonable modifications attempted or made in light of a client's special needs, disability, or behavioral health condition.
(d) A client's involuntary disenrollment is for one year, beginning on the first day of the month following the date on the notice of involuntary disenrollment.
(2) Disenrollment request. The agency grants a request from a qualified health home to involuntarily disenroll a client when the request is submitted to the agency in writing and includes documentation for the agency to determine that the criteria under subsection (1) of this section is met.
(3) Client notification and appeal rights. The agency notifies the qualified health home of the agency's decision within ten business days. If the request is approved, the agency sends a written notice of involuntary disenrollment to the client. The notice includes:
(a) The client's administrative hearing rights as described in chapter 182-526 WAC;
(b) The specific factual basis for disenrolling the client;
(c) The applicable provision under subsection (1) of this section, and any other applicable rule on which the disenrollment is based; and
(d) Any other information required by WAC 182-518-0005.
(4) Reenrollment. The agency may reenroll a client with a qualified health home within one year if:
(a) All of the concerns that led to the involuntary disenrollment are resolved; and
(b) The client continues to meet the health home eligibility criteria in this chapter.