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WAC 182-527-2742  Services subject to recovery

Effective October 1, 2012

The department considers the medical services the client received and the dates when the services were provided to the client, in order to determine whether the client's estate is liable for the cost of medical services provided.  Subsection (1) of this section covers liability for Medicaid services, subjection (2) covers liability for state-only funded long-term care services, and subsection (3) covers liability for all other state-funded services.   An estate can be liable under any of these subsections.

1. The client's estate is liable for:

a. All Medicaid services provided from July 26, 1987 through June 30, 1994;

b. The following Medicaid services provided after June 30, 1994 and before July 1, 1995:

i. Nursing facility services;

ii. Home and community-based services; and

iii. Hospital and prescription drug services provided to a client while receiving nursing facility services or home and community-based services.

c. The following Medicaid services provided after June 30, 1995 and before June 1, 2004:

i. Nursing facility services;

ii. Home and community-based services;

iii. Adult day health;

iv. Medicaid personal care;

v. Private duty nursing administered by the aging and disability services administration of the department; and

vi. Hospital and prescription drug services provided to a client while receiving services described under (c)(i), (ii), (iii), (iv) or (v) of this subsection.

d. The following services provided on and after June 1, 2004 through December 31, 2009:

i. All Medicaid services, including thoses services described in subsection (c) of this section;

ii. Medicare savings programs services for individuals also receiving Medicaid;

iii. Medicare premiums only for individuals also receiving Medicaid; and

iv. Premium payments to managed care organizations.

e. The following services provided on or after January 1, 2010:

i. All Medicaid services except thoses defined under subsection (d)(ii) and (d)(iii) of this section;

ii. All institutional medicaid services described in subsection (c) of this section;

iii. Premium payments to managed care organizations; and

iv. The client's proportional share of the state's monthly contribution to the Centers for Medicare and Medicaid Services (CMS) to defray the costs for outpatient prescription drug coverage provided to a person who is eligible for medicare Part D and Medicaid.

2. The client's estate is liable for all state-only funded long-term care services and related hospital and prescription drug services provided to:

a. Home and Community Services' clients on and after July1, 1995; and

b. Division of Developmental Disabilities' clients on and after June 1, 2004.

3. The client's estate is liable for all state-funded services provided regardless of the age of the client at the time the services were provided.


This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.