12-22-057

WSR 12-22-057

EMERGENCY RULES

HEALTH CARE AUTHORITY

(Medicaid Program)

[ Filed November 6, 2012, 11:21 a.m. , effective November 6, 2012, 11:21 a.m. ]

     Effective Date of Rule: Immediately.

     Purpose: During the revision of the hospice rules under WSR 12-09-079, the agency incorrectly added "medical care services" (MCS) as an eligible program under WAC 182-551-1200 [(1)](d). To comply with the agency's federal Transitional Bridge 1115 Waiver, the agency is striking MCS from the list of eligible programs for hospice services.

     Citation of Existing Rules Affected by this Order: Amending WAC 182-551-1200.

     Statutory Authority for Adoption: RCW 41.05.021.

     Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest; that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule; and that in order to implement the requirements or reductions in appropriations enacted in any budget for fiscal year 2009, 2010, 2011, 2012 or 2013, which necessitates the need for the immediate adoption, amendment, or repeal of a rule, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the fiscal needs or requirements of the agency.

     Reasons for this Finding: The existing rule is not in compliance with the agency's Transitional Bridge 1115 Waiver with the Centers for Medicare and Medicaid Services (CMS) which lists hospice services as not covered for MCS clients. This jeopardizes the agency's federal funding for MCS services under the waiver. Also, the Washington state legislature did not authorize funding to cover hospice services for MCS clients.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.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 1, 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: November 6, 2012.

Kevin M. Sullivan

Rules Coordinator

OTS-5138.1

AMENDATORY SECTION(Amending WSR 12-09-079, filed 4/17/12, effective 5/18/12)

WAC 182-551-1200   Client eligibility for hospice care.   (1) A client who elects to receive hospice care must be eligible for one of the following medical assistance programs, subject to the restrictions and limitations in this chapter and other WAC:

     (a) Categorically needy (CN);

     (b) Children's health care as described in WAC 388-505-0210;

     (c) Medically needy (MN); or

     (d) ((Medical care services as described in WAC 182-508-0005 (within Washington state or designated border cities); or

     (e))) Alien emergency medical (AEM) as described in WAC 388-438-0110, when the medical services are necessary to treat a qualifying emergency medical condition.

     (2) A hospice agency is responsible to verify a client's eligibility with the client or the client's department of social and health services (DSHS) home and community services (HCS) office or community services office (CSO).

     (3) A client enrolled in one of the medicaid agency's managed care organizations (MCO) must receive all hospice services, including facility room and board, directly through that MCO. The MCO is responsible for arranging and providing all hospice services for an MCO client.

     (4) A client who is also eligible for medicare hospice under part A is not eligible for hospice care through the medicaid agency's hospice program. The medicaid agency does pay hospice nursing facility room and board for these clients if the client is admitted to a nursing facility or hospice care center (HCC) and is not receiving general inpatient care or inpatient respite care. See also WAC 182-551-1530.

     (5) A client who meets the requirements in this section is eligible to receive hospice care through the medicaid agency's hospice program when all of the following is met:

     (a) The client's physician certifies the client has a life expectancy of six months or less.

     (b) The client elects to receive hospice care and agrees to the conditions of the "election statement" as described in WAC 182-551-1310.

     (c) The hospice agency serving the client:

     (i) Notifies the medicaid agency's hospice program within five working days of the admission of all clients, including:

     (A) Medicaid-only clients;

     (B) Medicaid-medicare dual eligible clients;

     (C) Medicaid clients with third party insurance; and

     (D) Medicaid-medicare dual eligible clients with third party insurance.

     (ii) Meets the hospice agency requirements in WAC 182-551-1300 and 182-551-1305.

     (d) The hospice agency provides additional information for a diagnosis when the medicaid agency requests and determines, on a case-by-case basis, the information that is needed for further review.

[Statutory Authority: RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. 12-09-079, § 182-551-1200, filed 4/17/12, effective 5/18/12. 11-14-075, recodified as § 182-551-1200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520. 05-18-033, § 388-551-1200, filed 8/30/05, effective 10/1/05. Statutory Authority: RCW 74.09.520, 74.08.090, 42 C.F.R. 418.22 and 418.24. 99-09-007, § 388-551-1200, filed 4/9/99, effective 5/10/99.]