Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-513 - Client not in own home-Institutional medical
Section 182-513-1240 - The hospice program
Universal Citation: WA Admin Code 182-513-1240
Current through Register Vol. 24-18, September 15, 2024
(1) General information.
(a) The hospice program provides
palliative care to people who elect to receive hospice services and are
certified as terminally ill by their physician.
(b) Program rules governing election of
hospice services are under chapter 182-551 WAC.
(c) A person may revoke an election to
receive hospice services at any time by signing a revocation
statement.
(d) Transfer of asset
rules under WAC
182-513-1363 do not apply to the
hospice program in any setting, regardless of which apple health program the
person is eligible to receive.
(2) When hospice is a covered service.
(a) A person who receives coverage under a
categorically needy (CN), medically needy (MN), or alternative benefits plan
(ABP) program is eligible for hospice services as part of the program specific
benefit package.
(b) A person who
receives coverage under the alien emergency medical (AEM) program under WAC
182-507-0110 may be eligible for
payment for hospice services if preapproved by the agency.
(c) A person who receives coverage under the
medical care services (MCS) program is not eligible for coverage of hospice
services.
(3) When HCB waiver rules are used to determine eligibility for hospice.
(a) A person who is not otherwise eligible
for a CN, MN, or ABP noninstitutional program who does not reside in a medical
institution, may be eligible for CN coverage under the hospice program by using
home and community based (HCB) waiver rules under WAC
182-515-1505 to determine
financial eligibility.
(b) When HCB
waiver rules are used, the following exceptions apply:
(i) A person on the hospice program may
reside in a medical institution, including a hospice care center, 30 days or
longer and remain eligible for hospice services; and
(ii) A person residing at home on the hospice
program who has available income over the special income limit (SIL), defined
under WAC
182-513-1100, is not eligible for
CN coverage. If available income is over the SIL, the agency or its designee
determines eligibility for medically needy coverage under WAC
182-519-0100.
(c) When HCB waiver rules are
used, a person may be required to pay income and third-party resources (TPR) as
defined under WAC
182-513-1100 toward the cost of
hospice services. The cost of care calculation is described under WAC
182-515-1509.
(d) When a person already receives HCB waiver
services and elects hospice, the person must pay any required cost of care
towards the HCB waiver service provider first.
(4) Eligibility for hospice services in a medical institution:
(a) A person who elects
to receive hospice services, resides in a medical institution for 30 days or
longer, and has income:
(i) Equal to or less
than the SIL is income eligible for CN coverage. Eligibility for institutional
hospice is determined under WAC
182-513-1315; or
(ii) Over the SIL may be eligible for MN
coverage under WAC
182-513-1245.
(b) A person eligible for hospice
services in a medical institution may have to pay toward the cost of nursing
facility or hospice care center services. The cost of care calculation is under
WAC 182-513-1380.
(5) Changes in coverage. The agency or its designee redetermines a person's eligibility under WAC 182-504-0125 if the person:
(a) Revokes the election of hospice services
and is eligible for coverage using HCB waiver rules only, described in
subsection (3) of this section; or
(b) Loses CN, MN, or ABP
eligibility.
(6) Personal needs allowance and income and resource standards for hospice and home and community based (HCB) waiver programs are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.
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