This section contains the following HCB Waiver services:
- Community options program (COPES)
- New Freedom consumer directed services (New Freedom)
- Program of all-inclusive care for the elderly (PACE)
Institutional standards used in determining initial and post eligibility (participation) in long term care change annually. Depending on the standard, these changes occur in January, April, July and August. See the Institutional standard chart for current standards used in long term care. This chart indicates the formula for the standard and when the standard last changed.
Personal needs allowance (PNA) for clothing, personal items and incidentals (CPI):
Personal needs allowance (PNA) for clothing, personal items and incidentals (CPI). Client's are allowed the highest personal needs allowance in a given month based on living arrangement, authorized service and marital status. If a client resided at home the first day of the month and went into a nursing home the same day, we would allow the in home PNA because they were residing in a home setting at least one moment during that given month. If a client went from a nursing home to an adult family home on HCB waiver services the first day of the month, we would allow the ALF PNA as it is the highest allowed. If that client were then discharged home from the ALF on the last day of the month, the benefit would be recalculated allowing the in home PNA
Medical Expenses used to reduce participation
To reduce participation, deduct medical expenses not already used to reduce excess resources as described in WAC 182-513-1350.
Income and Deduction changes in HCB Waivers. Method 3 effective 8/29/2014
WAC 182-504-0120 (12) Effective 8/29/2014 a change in income or deductions is effective the first of the month following the date the change was reported rather than the month the income or deduction changed (Method 1). Method 1 is used for clients residing in medical institutions. Method 3 is used for HCB Waivers.
When a change in income, or allowable expenses, changes the amount the client pays toward participation for a home and community-based waiver or service, we calculate the new participation amount effective the first of the month following the date the change was reported. The exception is if the change occurs due to the loss of an income source that is to last 2 months or longer and is reported timely.
Any change to an HCB Waiver client's income or post eligibility deductions that affect cost of care take effect in the ongoing month in ACES.
- With the exception of loss of an income source or the lowering of income
- The change takes effect the actual month of change.
- We will make these historical changes in ACES.
- To be considered a loss or reduction of income:
- We must have a timely report of the change to income
- We must have verification that this change is to last two months or longer;
- Otherwise, it is a "change" in income that takes effect the following month.
What if a loss or lower of income is not reported timely?
- Financial will not make historical adjustments in ACES.
- Treat as an underpayment, or "client reimbursement".
- Send the DSHS 07-104 in barcode to let the case manager know what the client's income or deduction actually was, and what we had in ACES. Indicate what the correct participation should have been for each month and that change was not reported timely.
- The case manager/social worker will determine if the provider is to be paid more, if the client is owed any money or if there is a client overpayment.
Training information on Method 3 can be found on the financial program SharePoint under training, policy changes.
Note: Facility daily rates reported to financial by the social worker need to be made effective in the month the daily rate change occurred. Make these changes historical as it will affect the calculation in Provider One if there is a split participation month.
Overview of HCB Waivers
DDA home and community based (HCB) waivers
Additional clarification and worker responsibilities can be found in the Participation in a medical facility section.
See General eligibility for Long Term Care