DDA Residential Habilitation Centers (RHC)
Purpose: This section describes the processes between the DDA RHCs, LTC specialty financial worker and Office of Financial Recovery (OFR).
Residential Habilitation Centers (RHC)
- Residential Habilitation Centers (RHC)
- Fircrest School
- Lakeland Village
- Rainier School
- Yakima Valley School
The RHCs are federally certified as Intermediate Care Facilities for individuals with Intellectual Disabilities (ICF/ID), Nursing Facilities (NF) or a combination of both.
LTC Specialty Financial Worker-Eligibility
- Determines eligibility requirements for institutional medicaid described in WAC 182-513-1315.
- Determines resource eligibility for institutional medical described in WAC 182-513-1350.
- Determines excess resources in the month of application described in WAC 182-513-1350 and applies any excess resource toward the cost of care in the admittance month. For recipients, excess resources are countable resources which are available for resident's use when over the $2,000 resource limit and have not been exhausted by the first moment of the first day of the following month.
- Determines income and post eligibility (participation determination) described in WAC 182-513-1380. The financial worker inputs the information to the ACES system and issues an award letter. The income and post eligibility section has information on guardianships.
- Sends the award letter with a copy of the notice of financial responsibility (NFR) by certified mail return receipt requested (CMRRR) to the POA, payee/guardian, OFR and the resident's RHC facility.
LTC specialty unit financial - changes
WAC 182-504-0120 (subsection 11) When institutional medical assistance participation changes, we calculate the new participation amount beginning with the month income or allowable expense changes.
The financial worker has 10 days to act on changes reported. Issue the appropriate award letter if there is a participation change or change of benefit.
Excess Resources. The LTC financial worker reviews the individual's resources as of the first moment of the first day of the month. If the resources exceed the $2,000 resource limit, but are below the state cost of care for the month, a new award letter to update the individual's responsibility toward the cost of care for that month. The resources are indicated on the appropriate screens in ACES for the month. Make sure the resource screens in ACES are updated for the ACES ongoing month to account for the application of excess resources being applied toward the cost of care.
Lump sums and long-term care The financial worker:
- Determines the type/source of the lump sum payment.
- If the lump sum is a retroactive SSDI/SSI payment, exclude the income as a resource for 9 months. Set a barcode tickler to review case and request resource verification in the 9th month.
- If the payment is an unanticipated lump sum from another source, request a resource statement from the RHC and individual/guardian as of the first of the month following the receipt of the lump sum.
- If the lump sum amount plus the individual's available income exceeds the monthly projected cost of care, send a notice of termination (giving 10 days advance notice) for LTC and medical benefits.
- If the financial worker determines there is an overpayment and the individual no longer has the available funds to pay the adjustment, an overpayment needs to be established by the financial worker and sent to OFR.
Discharge from an RHC
- The LTC specialty worker will determine the impact on participation when there is a change in the individual's living situation. If the individual is discharging to another institution. the LTC worker will determine how to split the participation appropriately between the two facilities by coding ACES correctly in the month of change. If the individual discharges home or to a residential setting, the LTC worker will issue an amended award letter adjusting the participation to the highest PNA allowed in that month.
- The LTC PNA chart includes instruction regarding how a PNA is chosen when the individual changes from one setting or service to another.
Death of an Individual
- The LTC Specialty worker will update the individual's death in the appropriate months in ACES and issue an adjusted participation notice for the month of death along with a condolence notice.
- Social Security has a rule that the month payment is supposed to be returned in the month in which the beneficiary dies. ADS HQ staff has contacted SSA as this policy appears inconsistent. Some are allowed to keep their SSA check and some are requested by SSA to return the check. The rule for participation adjustment is if the financial worker receives verification from social security that the SSA check received in the month of death has been returned, the financial worker will adjust the participation to reflect -0- SSA received in the month and issue a new award letter.
LTC Specialty Financial - Hearings
If a hearing is received by the LTC specialty financial worker, the financial worker will notify OFR. Notify OFR when there is a hearing decision.
The financial worker will contact the Regional Administrative Hearing coordinator regarding the requirement to notify the LTC specialty unit and the RHC when a hearing request is received on a DDA RHC case.
An individual must receive continued assistance, if all of the conditions in chapter 182-526 WAC. Advance notice is not required for changes to participation.
Adequate notice is mailed less than ten days before the effective date.
Advance notice is not required to change an individual's participation toward the cost of care, since no reduction, suspension, or termination of services will result. A change in the participation is not considered an adverse action.
Note: Notify Ken Washington of OFR-Estate Recovery via a DMS tickler when a trust is imaged in the electronic case record. This includes all trusts including pooled trusts.
Set up the following DMS tickler:
Document type for tickler: TD (use for either a trust or annuity)
Subject: Trust (if a trust) or Annuity (if an annuity)
Ready date: Default date is fine
Make sure the trust is indicated on the appropriate navigation tree under resources in ACES 3G. Add in the remarks behind the resource screen that OFR has been notified of the trust in the ECR.