Medical assistance definitions -- I.
Effective July 30, 2011
"Ineligible spouse" see "spouse" in WAC 388-500-0100.
"Institution" means an entity that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor. Eligibility for medical assistance program may vary depending upon the type of institution in which an individual resides. For the purposes of medical assistance programs, "institution" includes all of the following:
(1) "Institution for mental diseases (IMD)" -- A hospital, nursing facility, or other institution of more than sixteen beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. An IMD may include inpatient chemical dependency facilities of more than sixteen beds which provide residential treatment for alcohol and substance abuse.
(2) "Intermediate care facility for the mentally retarded (ICF/MR)" -- An institution or distinct part of an institution that is:
(a) Defined in 42 CFR 440.150;
(b) Certified to provide ICF/MR services under 42 CFR 483, Subpart I; and
(c) Primarily for the diagnosis, treatment, or rehabilitation for persons with mental retardation or a related condition (see WAC 388-823-0700 for information about what qualifies as a "related condition").
(3) "Medical institution" -- An entity that is organized to provide medical care, including nursing and convalescent care. The terms "medical facility" and "medical institution" are sometimes used interchangeably throughout Title 388 WAC.
(a) To meet the definition of medical institution, the entity must:
(i) Be licensed as a medical institution under state law;
(ii) Provide medical care, with the necessary professional personnel, equipment, and facilities to manage the health needs of the patient on a continuing basis in accordance with acceptable standards; and
(iii) Include adequate physician and nursing care.
(b) Medical institutions include all of the following:
(i) "Hospice care center"--An entity licensed by the department of health (DOH) to provide hospice services. Hospice care centers must be medicare-certified, and approved by the agency or the agency's designee to be considered a medical institution.
(ii) "Hospital"--Defined in WAC 388-500-0045.
(iii) "Nursing facility (NF)"--An entity certified to provide skilled nursing care and long-term care services to medicaid recipients under Section 1919(a) of the Social Security Act. Nursing facilities that may become certified include nursing homes licensed under chapter 18.51 RCW, and nursing facility units within hospitals licensed by the department of health (DOH) under chapter 70.41 RCW. This includes the nursing facility section of a state veteran's facility.
(iv) "Psychiatric hospital"--An institution, or a psychiatric unit located in a hospital, licensed as a hospital in accordance with applicable Washington state laws and rules, that is primarily engaged to provide psychiatric services for the diagnosis and treatment of mentally ill persons under the supervision of a physician.
(v) "Psychiatric residential treatment facility (PRTF)" -- A nonhospital residential treatment center licensed by department of health, and certified by the agency or the agency's designee to provide psychiatric inpatient services to medicaid-eligible individuals twenty-one years of age and younger. A PRTF must be accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or any other accrediting organization with comparable standards recognized by Washington state. A PRTF must meet the requirements in 42 CFR 483, Subpart G, regarding the use of restraint and seclusion.
(vi) "Residential habilitation center (RHC)"--A residence operated by the state under chapter 71A.20 RCW that serves individuals who have exceptional care and treatment needs due to their developmental disabilities by providing residential care designed to develop individual capacities to their optimum. RHCs provide residential care and may be certified to provide ICF/MR services and/or nursing facility services.
(c) Medical institutions do not include entities licensed by the agency or the agency's designee as adult family homes (AFHs) and boarding homes. AFHs and boarding homes include assisted living facilities, adult residential centers, enhanced adult residential centers, and developmental disability group homes.
(4) "Public institution" means an entity that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control.
(a) Public institutions include all of the following:
(i) Correctional facility -- An entity such as a state penitentiary or county jail, (includes placement in a work release program or outside of the institution, including home detention).
(ii) Eastern and Western State mental hospitals. (Medicaid coverage for these institutions is limited to individuals age twenty-one and younger, and individuals age sixty-five and older.)
(iii) Certain facilities administered by Washington state's department of veteran's affairs (see (b) of this subsection for facilities that are not considered public institutions).
(b) Public institutions do not include intermediate care facilities, entities that meet the definition of medical institution (such as Harborview Medical Center and University of Washington Medical Center), or facilities in Retsil, Orting, and Spokane that are administered by the department of veteran's affairs and licensed as nursing facilities.
"Institution for mental diseases (IMD)" see "institution" in this section.
"Institutionalized spouse" see "spouse" in WAC 388-500-0100.
"Intermediate care facility for the mentally retarded (ICF/MR)" see "institution" in this section.