Current through Register Vol. 24-18, September 15, 2024
(1)
Monthly payments. Each month residents shall pay his or her
resident contribution as defined in WAC 484-20-010 on the department
established payment due date. The amount paid shall not exceed the private rate
for the program/service area in which the resident resides. Subsections (3) and
(5) of this section list exceptions.
(2)
Personal needs allowance.
(a)
Single residents. If the
resident's monthly income equals or exceeds the established personal needs
allowance, he/she may retain the established personal needs allowance. If the
individual's monthly income is less than the established personal needs
allowance, his/her personal needs allowance shall be limited to:
(i) For residents who are medicaid
recipients, the personal needs allowance authorized by the appropriate
department of social and health services community service office; or
(ii) For residents who are not medicaid
recipients to the income which he/she receives.
(b)
Married residents or registered
domestic partners, both residing in the state veterans home. If each
individual's income equals or exceeds the established personal needs allowance,
each may retain the established personal needs allowance. If one of the
individual's monthly income is less than the established personal needs
allowance, his/her personal needs allowance shall be limited to:
(i) For residents who are medicaid
recipients, the personal needs allowance authorized by the appropriate
department of social and health services community service office; or
(ii) For residents who are not medicaid
recipients, to the income to which he/she has an individual right.
(3)
Exceptions to
monthly payments. (Note: This subsection (3) only applies to residents
who are not medicaid recipients. The department of social and health services
makes these determinations for residents who are medicaid recipients in
accordance with applicable medicaid rules.) Residents may be authorized to
retain (in addition to their personal needs allowance) monthly therapeutic
employment earnings, if the resident is participating in a therapeutic
employment program and it is documented in his/her plan of care. The amount
retained shall not exceed limits established under medical assistance
eligibility rules.
(4)
Application for benefits/entitlements.
(a) Residents are required to apply for any
and all entitlements or benefits as soon as they become eligible. Residents
and/or their representative must fully disclose all information required for
determining eligibility for all entitlements and benefits.
(b) Agency veterans benefit staff shall
assist residents to make application for entitlements and benefits.
(c) Residents who apply for medicaid and meet
medical need requirements but are over the resource limits outlined in chapter
182-513 WAC, shall be advised of their options and the consequences of being
over medicaid resource limits. Residents shall be billed at the private rate
until medicaid resource limits are met.
(5)
Support of a nonresident
spouse.
(a) If a resident is a medicaid
recipient and has a community spouse, the provisions of chapter 182-513 WAC
apply; except where preempted by federal law; shall apply to income and
resources.
(b) If a resident is not
a medicaid recipient and has a community spouse, the provisions of chapter
182-513 WAC apply; except where preempted by federal law; shall be used to
determine:
(i) Available and exempt income and
resources with regard to eligibility and resident participation;
(ii) Ownership of income and resources;
and
(iii) Participation by the
community spouse.
(6) Only subsection (4)(a) and (b) of this
section applies to residents of the colony at the Washington soldiers
home.
(7)
Resource
limits.
(a) For residents who are
medicaid recipients, resource limits are in accordance with medicaid rules
found at chapter 182-513 WAC.
(b)
For residents who are not medicaid recipients, resource limits shall be
established by the facility using the medicaid resource limit for a single or a
married individual; whichever is applicable.
(c) If a resident who is a medicaid recipient
receives or accumulates funds in excess of resource limits in (a) of this
subsection, the case shall be referred to the appropriate department of social
and health services community service office to adjust the resident
contribution and/or determine continuing medicaid eligibility. If the community
service office determines the resident is no longer eligible to receive
medicaid benefits, the resident shall pay at the private rate until medicaid
eligibility is reestablished.
(d)
If a resident who is not a medicaid recipient receives or accumulates funds in
excess of resource limits in (b) of this subsection, the resident shall pay at
the private rate until accumulated funds are reduced to the resource
limit.
(e) Exceptions to the
resource limits in (b) of this subsection may be granted on a case-by-case
basis if a resident has an approved discharge plan which includes a goal to
reestablish independent community living through either an approved
rehabilitation leave or participation in an approved vocational rehabilitation
program.
(8)
Retroactive, lump sum benefits.
(a) If a medicaid recipient receives a
retroactive, lump sum award of benefits, he/she shall be required to report the
award to the appropriate department of social and health services community
service office. If the resident continues to be eligible for medicaid, the
community service office will issue a new medicaid award letter which adjusts
the resident contribution if appropriate. If the community service office
determines the resident is no longer medicaid eligible, the award shall be
counted as income for the month(s) in which moneys would have been received and
the resident shall pay retroactively the resident contribution due from date of
admission to date of receipt of the retroactive lump sum award; except the
resident contribution will not be collected for those months during which the
resident received medicaid benefits. If the resident's resources still exceed
medicaid resource limits, the resident shall pay at the private rate until
medicaid eligibility is reestablished.
(b) If a resident who is not a medicaid
recipient receives a retroactive lump sum award, the award shall be counted as
income for the month(s) in which moneys would have been received and the
resident shall pay retroactively the resident contribution due from date of
admission to date of receipt of the retroactive lump sum award.
(9) The estate of any individual
who is a resident at the time of death will be charged for the balance of any
cost of care which the resident did not pay during his/her residency in the
state veterans home. The state veterans home shall inform the resident of the
total amount of any past due cost of care. For residents who are medicaid
recipients, recovery shall be in accordance with chapter 182-527 WAC. For any
resident who is not a medicaid recipient, recovery shall be in accordance with
a written agreement made at the time of admission.
(10) For any partial months of residency the
resident's contribution shall apply first.
Statutory Authority: RCW 43.60A.070 and chapter 72.36 RCW. 04-19-026, §
484-20-065, filed 9/9/04, effective 10/10/04; 95-07-082, §
484-20-065, filed 3/16/95, effective 4/16/95. Statutory Authority: RCW 43.60A.070 and 72.36.120. 94-04-001, §
484-20-065, filed 1/20/94, effective 2/20/94. Statutory Authority: RCW 43.60A.070. 92-17-046, §
484-20-065, filed 8/14/92, effective 9/14/92; 85-20-099 (Order 85-01), §
484-20-065, filed 10/1/85; 80-09-069 (Order 80-01), §
484-20-065, filed 7/17/80; Order 7659, §
484-20-065, filed 7/28/77.
