Electing hospice services - DSHS agency and client

Revised date

Notification to the DSHS agency of hospice election

When a client elects hospice services, the hospice agency provides notification to the Health Care Authority (HCA) within five days of the election date using the HCA 13-746 hospice notification form. This form includes the client’s name, the effective date the client elected hospice services, the type of hospice (Medicare or Medicaid), the name of the hospice provider and the name of the facility if the client lives in a facility, including the admission date. 

The hospice agency checks for eligibility using the ProviderOne system. If the client is not active on medicaid, the hospice provider will assist the client in submitting an application (HCA 18-001 or 18-005) with the hospice notification form and release of information (DSHS 14-532). The HCS or DDA financial worker can release the eligibility determination, the award letter(s), participation, and/or other information that the hospice agency needs to bill correctly.

When a client’s hospice status changes, the hospice agency faxes a hospice notification form with the updated information HCA to be scanned into the client’s electronic record and indexed to the appropriate office. Examples include: the client revokes hospice services, the client discharges from a hospice facility or the clients dies. If a client transfers to a different hospice agency, both the old and the new providers are responsible to provide notification to HCA. Once clients do elect Hospice, covered drugs and items are limited under the Hospice program. Certain items are covered in the Hospice daily rate. (WAC 182-551-1210).

Revocation of services. (WAC 182-551-1360) The Hospice provider is responsible to notify HCA of the revocation by completing and faxing a copy of the HCA 13-746 hospice notification form. The Hospice provider is responsible to give the client a copy of the revocation statement and inform the client that the revocation statement must be presented with the client’s current medical identification card when obtaining Medicaid covered services, supplies or both. Client’s need to use this procedure until the department can remove Hospice coding out of the ProviderOne claims payment system.

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Guardianships - deductions to participation, room and board

Revised date
Purpose statement

Describe and clarify rules regarding guardianship-related deductions to a long-term services and support client’s participation or room & board (R&B).

WAC 182-513-1530 Maximum guardianship fee and related cost deductions allowed from a client's participation or room and board on or after June 1, 2018.

WAC 182-513-1530 Maximum guardianship fee and related cost de­ductions allowed from a client's participation or room and board on or after June 1, 2018.

Revised March 1, 2025

  1. General information.
    1. This section sets the maximum guardianship or conservatorship fee and related cost deductions when:
      1. A court order was entered on or after June 1, 2018; or
      2. The client under guardianship or conservatorship began receiving medicaid-fun­ded long-term services and supports on or after June 1, 2018.
    2. This section only applies to a client who is:
      1. Eligible for and receives institutional services under this chap­ter or home and community-based waiver services under chapter 182-515 WAC, and who is required to pay participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Eligible for long-term services and supports under this chapter or chapter 182-515 WAC, and who is required to pay only room and board.
    3. All requirements of this section remain in full force whether or not the agency appears at a guardianship or conservatorship proceeding.
    4. In this section, the agency does not delegate any authority in determining eligibility or post-eligibility for medicaid clients.
      1. Under the authority granted by chapter 11.130 RCW, the agency does not deduct more than the amounts allowed by this section from partici­pation or room and board.
      2. The eligibility rules under Title 182 WAC remain in full force and effect.
    5. The agency does not reduce a client's participation or room and board under this section for guardianship or conservatorship fees or related costs accumulated during any month that a client was not required to pay:
      1. Participation under WAC 182-513-1380, 182-515-1509, or 182-515-1514; or
      2. Room and board under this chapter or chapter 182-515 WAC.
    6. If the client has another fiduciary, payee, or other princi­pal-agency relationship and the agent is allowed compensation, any monthly guardianship or conservatorship fee approved under this section is reduced by the agent's compensation.
  2. Maximum guardianship fee and related cost deductions.
    1. The maximum guardianship or conservatorship fee and related cost deductions un­der this section include all guardianship or conservatorship services provided to the client, regardless of the number of guardians or conservators appointed to a client during a period of time, or whether the client has multiple guardians appointed at the same time.
    2. Maximum guardianship or conservatorship fees and related cost deductions are as follows:
      1. The total deduction for costs directly related to establish­ing a guardianship or conservatorship for a client cannot exceed $1,850;
      2. The total deduction for all guardianship and conservatorship-related costs cannot exceed $1,200 during any three-year period; and
      3. The amount of the monthly deduction for all guardianship and conservatorship fees cannot exceed $235 per month.
  3. For people under subsection (1)(b)(i) of this section – Par­ticipation deductions.
    1. After receiving the court order, the agency or its designee adjusts the client's current participation to reflect the deductions under WAC 182-513-1380, 182-515-1509, or 182-515-1514.
    2. The amounts of the participation deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.
    3. For clients who pay room and board in addition to participa­tion, if the client's amount of participation is insufficient to allow for the amounts under subsection (2) of this section, then, regardless of any provision of this chapter or chapter 182-515 WAC, the client's room and board will be adjusted to allow the amounts under subsection (2) of this section.
  4. For people under subsection (1)(b)(ii) of this section - Room and board deductions.
    1. The agency adjusts the client's room and board after receiv­ing the court order, regardless of any provision of this chapter or chapter 182-515 WAC.
    2. The amounts of the room and board deductions are the amounts under subsection (2) of this section, or the court order, whichever are less.

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.

Clarifying Information

On or after June 1, 2018

For court orders signed, or clients who begin receiving long-term services and supports (LTSS), on or after June 1, 2018, WAC 182-513-1530 applies. A client is allowed a deduction to their participation, R&B, or both, when that client is required to pay towards their cost of LTSS.

  • Participation deductions for guardianship-related fees and costs are allowed for clients required to pay participation under WAC 182-513-1380, WAC 182-515-1509, or WAC 182-515-1514;
  • R&B deductions are allowed for clients whose only liability for LTSS is R&B under chapter 182-513 WAC (for example, CFC-only, MPC, MCS, or Group 1 home and community-based service (HCBS) waiver)
  • For those clients with participation and R&B, if there is insufficient participation to deduct guardianship-related fees and costs, participation can be reduced to $0, and any remaining amounts can be deducted from R&B.
  • WAC 182-513-1530 (2)(b) maximum guardianship fees, the initial cost of establishing a guardianship can’t exceed $1,850. Subsequent attorney costs and fees after initial establishment is $1,200 in any three-year period. The allowance is either (2)(b)(i) or (2)(b)(ii), but not both. 

Note: R&B deductions for guardianship fees and costs are allowed per rule effective June 1, 2018. Although an exception-to-rule (ETR) is no longer required to allow the deduction, Public Benefit Specialist (PBS) must code as a “Room and Board Exception” in ACES to allow the R&B deduction. The maximum deductions allowed for fees and costs are either the amounts in the rule, or the court order, whichever is less. Any exceptions to these amounts are subject to the eligibility ETR WAC 182-503-0090.

Before June 1, 2018

WAC 388-79A-001 Definitions.

WAC 388-79A-001 Definitions.

Revised June 1, 2018

The following definitions apply to this chapter:

  1. "Client" means a person who is eligible for and is receiving medicaid-funded long-term care.
  2. "Guardianship fees" or "fees" means necessary fees charged by a guardian for services rendered on behalf of a client.
  3. "Participate" or "participation" means the amount a client must pay each month toward the cost of long-term care services received each month. It is the amount remaining after the post-eligibility process under:
    1. WAC 182-513-1380 for a client residing in a medical institution, as defined under WAC 182-500-0050;
    2. WAC 182-515-1509 for a client receiving home and community services (HCS) waivered services in an alternate living facility (ALF), as defined under WAC 182-513-1100, or in an at-home setting; or
    3. WAC 182-515-1514 for a client receiving developmental disability administration (DDA) waivered services in an ALF, as defined under WAC 182-513-1100, or in an at-home setting.
  4. "Related costs" or "costs" means necessary costs paid by the guardian, including attorney fees.

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.

WAC 388-79A-005 Maximum Amount of Guardianship Fees and Related Costs for a Long-term Care Medicaid Eligible Client.

WAC 388-79A-005 Maximum amount of guardianship fees and related costs for a long-term care medicaid eligible client.

Revised March 8, 2019

  1. As mandated by RCW 43.20B.460 and in accordance with RCW 11.92.180, the maximum amount of guardianship fees and related costs must not exceed the limits of this section when the person under guardianship is:
    1. A medicaid eligible client, residing in:
      1. A medical institution, as defined under WAC 182-500-0050;
      2. An alternate living facility (ALF), as defined under WAC 182-513-1100; or
      3. An at-home setting; and
    2. Required under chapter 182-513 WAC or chapter 182-515 WAC to participate towards the cost of long-term care.
  2. The maximum amount of guardianship fees and related costs must not exceed the limits of WAC 388-79A-010​ when:
    1. The most recent court order establishing or continuing a guardianship was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  3. For all other clients not described under subsection (2) of this section, the maximum amount of guardianship fees and related costs must not exceed the limits under WAC 182-513-1530.

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.

WAC 388-79A-010 Maximum guardianship fees and related costs before June 1, 2018.

WAC 388-79A-010 Maximum guardianship fees and related costs before June 1, 2018

Revised June 1, 2018

  1. This section sets the maximum guardianship fees and related costs when:
    1. The court order was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  2. For court orders entered before June 1, 2018, where the order establishes or continues a legal guardianship for a client:
    1. Guardianship fees must not exceed $175 per month;
    2. Costs directly related to establishing a guardianship for a client must not exceed $700; and
    3. Costs to maintain the guardianship must not exceed $600 during any three-year period.

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.

WAC 388-79A-015 Procedure for allowing guardianship fees and related costs from client participation before June 1, 2018.

WAC 388-79A-015 Procedure for allowing guardianship fees and related costs from client participation before June 1, 2018.

Revised June 1, 2018

  1. This section describes the procedure for allowing guardianship fees and related costs from client participation when:
    1. A court order was entered before June 1, 2018; and
    2. The client under guardianship was receiving medicaid-funded long-term care before June 1, 2018.
  2. The medicaid agency or the agency's designee, after receiving the court order, adjusts the client's current participation to reflect the amounts, as allowed under WAC 182-513-1380, 183-515-1509, or 183-515-1514.
  3. A client's participation cannot be prospectively or retrospectively reduced to pay guardianship fees and related costs incurred:
    1. Before the client's long-term care medicaid eligibility effective date;
    2. During any time when the client was not eligible for or did not receive long-term care services; or
    3. After the client has died.
  4. The fees and costs allowed by the court at the final accounting must not exceed the amounts advanced and paid to the guardian from the client's participation if:
    1. The court, at a prior accounting, allowed the guardian to receive guardianship fees and related costs from the client's participation in advance of services rendered by the guardian; and
    2. The client dies before the next accounting.

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.

For those clients who began receiving LTSS prior to June 1, 2018, and also has a court order signed before June 1, 2018, chapter 388-79A WAC applies.

Effective June 1, 2018, chapter 388-79A was amended to end the previous requirement of notification (by the guardian) to DSHS on proposed guardianship orders, and also end the procedure to exceed the maximum deductions allowed per rule. Any clients subject to chapter 388-79A will have their deductions allowed per the signed order.

Note: R&B deductions are NOT allowed per rule under this chapter. As long as a court order is subject to chapter 388-79A WAC, an ETR must be approved to reduce R&B.

Worker Responsibilities

Upon receipt of a court order: if it was signed on or after June 1, 2018, or if the client began LTSS after June 1, 2018, allow the deductions per WAC 182-513-1530 or the court order, whichever is less.

Most (if not all) clients subject to chapter 388-79A WAC have current allowed deductions. Continue to allow these deductions until a new court order is received. Ensure an ETR is approved prior to allowing or continuing to allow a deduction to R&B.

Forward any ETR requests from the guardian to your regional guardianship designee.

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Medicare coinsurance days

Revised date
Purpose statement

This clarification is based on the Dear Nursing Home Administrator letter NH #2010-001 sent 3/26/2010

Reimbursement rates for Medicaid clients enrolled in Medicare

For Medicaid clients enrolled in fee for service Medicare (not Medicare Advantage plans), Medicare will pay in full for up to the first twenty days of nursing facility care at the full Medicare rate. For the first day and up to eighty days thereafter (i.e. the hundred and first day), the amount paid by Medicare will be reduced by the client's coinsurance responsibility. The department will pay up to the Medicaid rate for the coinsurance days. This is described in WAC 182-502-0110 (3) and 1902 n of the Social Security Act

Reimbursement rates for Qualified Medicare Beneficiaries (QMB) only clients

QMB-only clients are not eligible for Medicaid under the categorically needy (CN) or medically needy (MN) programs, but are eligible for payment of Medicare cost sharing expenses.

(NOTE: A QMB only client may apply for a CN or MN program if Medicaid is needed beyond the Medicare days in the nursing facility).

The department will pay for Medicare coinsurance charges for QMB-only residents, up to the Medicaid nursing facility reimbursement rate. It will not be necessary for a QMB-only resident to apply for Medicaid services for payment of coinsurance expense during Medicare coinsurance days. QMB-only clients are not required to pay participation. They will not be issued a Medicaid award letter. An award letter is not required in order to bill the Department for these expenses. Providers should refer to the nursing home billing instructions at the following link for instructions on how to bill for QMB-only claims:

Health Care Authority Billing Instructions (provider guides)

Nursing Facilities Billing Instructions (provider guides)

How to bill Medicare Crossovers in ProviderOne

Reimbursement rates for Medicaid clients enrolled in Medicare Part C (Advantage) plans

For Medicaid clients enrolled in Medicare Part C plans, payment for Medicare days including coinsurance days may vary depending on the Medicare C plan. The department will pay up to the Medicaid rate for coinsurance days.

Medicaid client participation during Medicare days including coinsurance days

Facilities may not collect participation from Medicaid clients during Medicare days, including Medicare coinsurance days. Client participation which is indicated on the DSHS Medicaid award letter is only applicable for Medicaid days.

Client participation is not an eligibility factor for Medicare coverage. This includes cases where the Medicaid rate is higher than the Medicare coinsurance rate and DSHS is billed for the coinsurance up to the Medicaid rate. Clients or their representatives are responsible to report if their resources exceed Medicaid standards when clients are in Medicare status as they are not participating their monthly income toward the cost of care during Medicare days.

Please note: The department cannot use Medicaid funds to pay the recipient's coinsurance responsibility beyond the amount Medicaid would pay for the service and cannot allow nursing facilities to write off the unpaid amounts as bad debts on their Medicaid cost reports.

Nursing Home Providers may contact the Nursing Home Billing Unit at the Health Care Authority with questions regarding the billing during Medicare days.

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Income Best Estimate guide

Revised date

Proof of income

Obtain proof of income (e.g., pay stub, employer statement, tax return) from the individual to answer the following questions.

Subject Questions
Rate of pay
  • Does the individual receive a salary or an hourly wage?
    • If hourly, what is the hourly wage and how many hours does the individual work each pay period?
  • Is the individual paid by the piece?
    • If paid for piecework, how much is the individual paid for each piece and how many pieces do they normally complete each pay period?
  • Does the individual receive tips or commissions?
Pay dates
  • What are the individual's pay periods?
  • What are the individual's pay dates?
  • Is the individual paid on the same day each week?
  • Is the individual paid on specific days of each month?
Past income
  • If unable to anticipate expected hours or pay rate, look at past income:
    • Do the last 3 months represent what the individual should get?
    • Do the last 30 days represent what the individual should get?
  • Should special circumstances be considered when looking at past income?
    • If the individual has a new job, is there a partial first check?
    • Does one of the pay periods include a time the individual had leave without pay due to illness or other reasons?
    • Did one pay period include overtime because the individual worked extra hours for a sick coworker?
    • Is the income higher or lower than normal due to seasonal fluctuations?
Recent changes
  • Has the individual recently lost their job?
    • When will the individual get their last check?
    • Will the individual get any money from "cashing out" vacation, sick pay, or retirement benefits?
    • Will the individual get any severance pay, unemployment compensation, or retirement benefits?
  • Has there been a recent employment change:
    • From full-time to part-time?
    • In the number of hours worked?
    • In the individual's wage or salary?
    • From one job to another?
  • Has the individual received overtime pay or bonuses?
  • Have there been other changes that would impact eligibility or benefit level?
Changes expected during the certification period
  • Are the hours going to go up or down?
  • Is the income ending?
  • Has the individual’s job just started?
  • Will they receive more paychecks next month than they did this month?

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Institutional

Revised date
Purpose statement

Definition of medical institutions used in institutional Medicaid rule.

WAC 182-500-0050 Washington apple health definitions -- I.

WAC 182-500-0050 Washington apple health definitions -- I.

Effective April 23, 2022

"Ineligible spouse" see "spouse" in WAC 182-500-0100.

"Institution" means an entity that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more people unrelated to the proprietor. Eligibility for Washington apple health program may vary depending upon the type of institution in which an individual resides. For the purposes of apple health programs, "institution" includes all the following:

  1. "Institution for mental diseases (IMD)" -- A hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of people with mental diseases, including medical attention, nursing care and related services. An IMD may include inpatient substance use disorder (SUD) facilities of more than 16 beds which provide residential treatment for SUD.
  2. "Intermediate care facility for individuals with intellectual disabilities (ICF/IID)" -- An institution or distinct part of an institution that is:
    1. Defined in 42 CFR 440.150;
    2. Certified to provide ICF/IID services under 42 CFR 483, Subpart I; and
    3. Primarily for the diagnosis, treatment, or rehabilitation for people with intellectual disabilities or 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 182 WAC.
    1. To meet the definition of medical institution, the entity must:
      1. Be licensed as a medical institution under state law;
      2. Provide medical care, with the necessary professional personnel, equipment, and facilities to manage the health needs of the patient on a continuing basis under acceptable standards; and
      3. Include adequate physician and nursing care.
    2. Medical institutions include:
      1. "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.
      2. "Hospital"--Defined in WAC 182-500-0045.
      3. "Nursing facility (NF)"--An entity certified to provide skilled nursing care and long-term care services to medicaid recipients under Social Security Act Sec. 1919(a), 42 U.S.C. Sec. 1396r. Nursing facilities that may become certified include nursing homes licensed under chapter 18.51 RCW, and nursing facility units within hospitals licensed by DOH under chapter 70.41 RCW. This includes the nursing facility section of a state veteran's facility.
      4. "Psychiatric hospital"--An institution, or a psychiatric unit located in a hospital, licensed as a hospital under applicable Washington state laws and rules, that is primarily engaged to provide psychiatric services for the diagnosis and treatment of mentally ill people under the supervision of a physician.
      5. "Psychiatric residential treatment facility (PRTF)" -- A nonhospital residential treatment center licensed by DOH, and certified by the agency or the agency's designee to provide psychiatric inpatient services to medicaid-eligible people age 21 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.
      6. "Residential habilitation center (RHC)"--A residence operated by the state under chapter 71A.20 RCW that serves people 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 nursing facility services.
    3. 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.
    1. Public institutions include:
      1. Correctional facility -- An entity such as a state prison, or city, county, or tribal jail, or juvenile rehabilitation or juvenile detention facility.
      2. Eastern and Western State mental hospitals. (Medicaid coverage for these institutions is limited to people age 21 and younger, and people age 65 and older.)
      3. 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).
    2. 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.
"Institution review board" - A board or committee responsible for reviewing research protocols and determining whether:

  1. Risks to subjects are minimized;
  2. Risks to subjects are reasonable in relation to anticipated benefits, if any, to subjects, and the importance of the knowledge that may reasonably be expected to result;
  3. Selection of subjects is equitable;
  4. Informed consent will be sought from each prospective subject or the subject's legally authorized representative;
  5. Informed consent will be appropriately documented;
  6. When appropriate, the research plan makes adequate provision for monitoring the data collected to ensure the safety of subjects;
  7. When appropriate, there are adequate provisions to protect the privacy of subjects and to maintain the confidentiality of data; and
  8. When some or all of the subjects are likely to be vulnerable to coercion or undue influence, such as children, prisoners, pregnant people, mentally disabled persons, or economically or educationally disadvantaged persons, additional safeguards have been included in the study to protect the rights and welfare of these subjects.

"Institutionalized spouse" see "spouse" in WAC 182-500-0100.

"Intermediate care facility for individuals with intellectual disabilities (ICF/IID)" see "institution" in this section.

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.

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Family and dependent allocation

Revised date
Purpose statement

Describes how the spousal and dependent allocation is determined in post-eligibility for institutional and HCB waiver programs.

WAC 182-513-1385 Determining the community spouse monthly maintenance needs allowance and dependent allowance in post-eligibility treatment of income for long-term care (LTC) programs.

WAC 182-513-1385 Determining the community spouse monthly maintenance needs allowance and dependent allowance in post-eligibility treatment of income for long-term care (LTC) programs.

Effective February 25, 2023

  1. This section describes how to calculate the monthly maintenance needs allowance (MMNA) in post-eligibility treatment of income for long-term care (LTC) programs for a community spouse or dependent of the institutionalized individual.
  2. The community spouse MMNA standards are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources, unless a greater amount is calculated under subsection (5) of this section. The MMNA standards may change each January and July based on the consumer price index.
  3. The community spouse MMNA is allowed only to the extent that the institutionalized spouse's income is made available to the community spouse, and is calculated as follows:
    1. The minimum MMNA as calculated in subsection (4)(a) of this section plus excess shelter expenses as calculated in subsection (4)(b) of this section;
      1. The total under (a) of this subsection cannot be less than the minimum MMNA; and
      2. If the total under subsection (4)(a) of this section exceeds the maximum MMNA, the maximum MMNA is the result under subsection (4)(a) of this section; and(b) The total under subsection (4)(a) of this section is reduced by the community spouse's gross income. The result is the MMNA.
  4. The minimum MMNA and excess shelter expense values are calculated as follows:
    1. The minimum MMNA is 150 percent of the two-person federal poverty level (FPL); and
    2. If excess shelter expenses are less than zero, the result is zero. Excess shelter expenses are calculated as follows:
      1. Add:
        1. Mortgage or rent, which includes space rent for mobile homes;
        2. Real property taxes;
        3. Homeowner's insurance;
        4. Required maintenance fees for a condominium, cooperative, or homeowner's association that are recorded in a covenant; and
        5. The food assistance standard utility allowance (SUA) under WAC 388-450-0195 minus the cost of any utilities that are included in (b)(i)(D) of this subsection.
      2. Subtract the standard shelter allocation from the total in (b)(i) of this subsection. The standard shelter allocation is 30 percent of 150 percent of the two-person FPL. The result is the value of excess shelter expenses.
  5. The amount allocated to the community spouse may be greater than the amount determined in subsection (3) of this section, but only if:
    1. A court order has been entered against the institutionalized spouse approving a higher MMNA for the support of the community spouse; or
    2. A final order has been entered after an administrative hearing has been held under chapter 182-526 WAC ruling the institutionalized spouse or the community spouse established the community spouse needs income, above the level otherwise provided by the MMNA, due to exceptional circumstances causing significant financial duress.
  6. If a final order establishes that the conditions identified in subsection (5)(b) of this section have been met, then an amount of allocated resources under subsection (3) of this section will be substituted by an amount adequate to provide such an MMNA.
  7. The agency or its designee determines the dependent allowance for dependents of the institutionalized individual or the institutionalized individual's spouse. The amount the agency allows depends on whether the dependent resides with the community spouse.
    1. For each dependent who resides with the community spouse:
      1. Subtract the dependent's income from 150 percent of the two-person FPL;
      2. Divide the amount determined in (a)(i) of this subsection by three;
      3. The result is the dependent allowance for that dependent.
    2. For each dependent who does not reside with the community spouse:
      1. The agency determines the effective MNIL standard based on the number of dependent family members in the home;
      2. Subtracts each dependent's separate income;
      3. The result is the dependent allowance for the dependents.
    3. Child support received from a noncustodial parent is the child's income.

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.

Clarifying Information

The WACs used to determine post-eligibility treatment of income (PETI), also called participation calculation:

WAC 182-515-1509 for HCS CN Waiver programs (Commonly referred as the COPES WAC)
WAC 182-515-1514 for DDD CN Waiver programs
WAC 182-513-1380 Participation (residing in medical institutions)

In post-eligibility, the community spouse and family allocation is allowed as a deduction when determining participation. The basic community spouse maintenance and family allocation standard is 150% of the 2-person FPL increases annually on July 1.

We allow this deduction to the extent income of the institutionalized spouse is made available to, or for the benefit of, the community spouse or dependent. If the institutionalized spouse refuses or we have evidence the spousal maintenance or family allocation is not made available to the spouse or dependents, we do not give the allocation. Indicate "waive spousal allowance" on the LTCX screen.

If the community spouse or dependent does not provide verification of their gross income and shelter costs needed to determine the spousal and dependent allocation, do not deny or terminate the case. Do not allow the allowance and indicate in the notice that in order to allow the possible deduction, the agency needs verification of the spousal/dependent income. Once verification is provided, we would allow the deduction the first of the following month for HCB Waivers and in the month verification is provided for institutional programs.

The dependent rule states:

A monthly maintenance needs amount for each minor or dependent child, dependent parent, or dependent sibling of your community or institutional spouse. The amount the department allows is based on the living arrangement of the dependent. If the dependent:

  1. Resides with your community spouse, the amount is equal to one-third of the community spouse allocation as described in WAC 182-513-1380 (5)(b)(i)(A) that exceeds the dependent family member's income (child support received from a noncustodial parent is considered the child's income);
  2. Does not reside with the community spouse, the amount is equal to the Standards - LTSS based on the number of dependent family members in the home less their separate income (child support received from a noncustodial parent is considered the child's income).

What is a dependent?

A dependent for deeming purposes is the same as a dependent for Federal income tax purposes. If a dependent is claimed on the community spouse or institutional spouse's personal income tax return, a family allocation can be considered.
A dependent does not need to be living with the client or the community spouse to be considered for a family allocation.

Dependent residing with the community spouse

For each dependent we take the community spouse income and family allocation standard (150% of the 2 person FPL) minus that dependents income. Then we divide that figure by 3. The result is the dependent allocation allowed for that dependent.

For more than one dependent we do the same computation indicated above for each dependent.

Example #1

COPES client living with the community spouse and 3 minor children.

Child #1 has $300 Social Security and $300 child support

Child #2 has $300 Social Security

Child #3 has $300 Social Security

Computation for the dependent deeming based on the 7/1/2009 community spouse income and family allocation of $1822. (see LTC standard chart for current CS income and family allocation):

Child #1

$1,822 (7/1/2009 CS and family allocation standard)

-$600 child's income

= $1,222 divided by 3 = $407.33 available to deem to child #1

Child #2

$1,822

- $300 child's income

= $1,522 divided by 3 = $507.33 available to deem to child #2.

Child #3

$1,822

-$300

= $1,522 divided by 3 = $507.33 available to deem to child #3

Example #2

Nursing Home client. Community spouse has a dependent sibling residing with her that is claimed on the income tax return. She also has a 19 year old and 14 year old child living with her.

Dependent #1 sibling has $100 per month gross earnings

Dependent #2 19 year old child has $500 per month gross earnings

Dependent #3 14 year old child has no income

Computation:

Dependent #1

$1,822 CS income and family allocation

- $100 income

= $1,722 divided by 3 = $574 available to deem to dependent #1

Dependent #2

$1,822

- $500 income

= $1,322 divided 3 = $440.47 available to deem to dependent #2

Dependent #3

$1,822 divided by 3 = $607.33 available to deem to dependent #3

Note: The dependent and their income is coded on the LTCX screen in ACES.

Dependent not residing with the community spouse

When the dependent does not reside with the community spouse the

calculation standard is the MNIL and based on the number of dependents minus the

dependents income.

Example #1

COPES client with 2 dependent children. Child #1 is 18 and has $100 income. Child #2 is 15 and has $300 child support income.

Calculation:

MNIL/$674.00 (Standard is based on 1/2009 standards, see LTC standard chart for current MNIL)

- both dependents total income of $400

= $274.00 available to deem to the 2 dependents

Why are the 2 calculations so different?

The calculation when the dependents are living with the community spouse are based on the spousal impoverishment act. When there is no community spouse as part of the household, the spousal impoverishment rules do not apply.

CMS standards including spousal impoverishment

Spousal Impoverishment

Things to remember about the dependent allocation

  1. If the dependent is applying for their own medical benefits, any actual income deemed from the institutional individual to the dependent is considered the dependent's income. Code the deemed income as OC under the income in ACES 3G or the UNER screen in ACES mainframe and document this deemed income from the institutional individual in the remarks.
  2. The dependent allocation follows the order of post eligibility deductions in WAC 182-513-1380 for institutional (residing in a medical institution) services, WAC 182-515-1509 for HCS CN Waiver programs, or WAC 182-515-1514 for DDD Waiver programs. The institutional individual may not have enough income to deem the maximum amount available for the family allocation based on the amount of income and the deductions allowed. For cases with a community spouse, the community spouse (CS) is allowed up to the CS income and family allocation minus the CS income before the dependent deduction. In addition the CS may get additional deeming up to the CS maintenance standard due to excess shelter.

Child Support received by the institutionalized individual

WAC 182-513-1340 (10) states child support payments received from an absent parent for a child living in the home is income of the child.

Back child support received for a child no longer living in the home is considered income.

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Eligibility for hospice as a service

Revised date

Programs that cover Hospice as a service?

A client must be eligible for a categorically needy (CN) or medically needy (MN) program to receive hospice care. Examples include but are not limited to the following:

  • CN noninstitutional medicaid in an alternative living facility (G03)
  • Health Care for Workers with Disabilities (HWD) (S08)
  • MAGI based CN with the exception of N21 or N25
  • Home and Community Based (HCB) Waivers (L21, L22)
  • Community First Choice (CFC) (L51, L52)
  • Foster care medicaid (D01, D02, D26)
  • SSI medicaid (S01)
  • SSI related (S02, S95, S99 in active status)

Note: A client who has met their spenddown under MN is eligible for hospice as a service.

  • Clients must meet the hospice diagnostic criteria plus medicaid eligibility criteria in order to receive hospice services.
  • Clients who are in a current base period and have not met their spend-down, do not have to reapply to get hospice but they do have to meet their spenddown before Hospice can be approved.
  • If a client is eligible for a noninstitutional CN program, the hospice provider bills the Medicaid Agency the same as any other service.
  • If the client is residing in a medical institution such as a nursing facility or hospice care center, the case must be coded as hospice on the institutional care screen in ACES 3G in order to set the hospice flag on the program in ACES.online. If income is over the Special Income Limit (SIL), the case will trickle to an MN program.

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Apple Health medical extension for families and caretaker relatives

Revised date
Purpose statement

This category describes the Health Care Extension (N02) available to parenting/caretaker (N01) adults when their N01 coverage ends due to increased earnings or collection of spousal support.

WAC 182-523-0100 Washington apple health--Medical extension

WAC 182-523-0100 Washington apple health--Medical extension.

Effective December 28, 2019

  1. A parent or caretaker relative who was eligible for and who received coverage under Washington apple health for parents and caretaker relatives, described in WAC 182-505-0240, in any three of the last six months is eligible, along with all dependent children living in the household, for twelve months' extended health care coverage if the person becomes ineligible for coverage due to increased earnings or hours of employment.
  2. A person remains eligible for apple health medical extension unless:
    1. The person:
      1. Moves out of state;
      2. Dies; or
      3. Leaves the household.
    2. The family:
      1. Moves out of state;
      2. Loses contact with the agency or its designee or the whereabouts of the family are unknown; or
      3. No longer includes an eligible dependent child as defined in WAC 182-503-0565(2).
  3. When a person or family is determined ineligible for apple health coverage under subsection (2)(a)(i) through (iii) or (b)(i) or (ii) of this section during the medical extension period, the agency or its designee redetermines eligibility for the remaining household members as described in WAC 182-504-0125 and sends written notice as described in chapter 182-518 WAC before apple health medical extension is terminated.

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.

Clarifying Information

Health Care Extension

  • Health Care Extension (N02) is CN coverage given only to parent/caretaker adults who become ineligible for Washington Apple Health Family (N01) coverage because of an increase in earned income or spousal support.
  • To qualify the adult must be eligible for Washington Apple Health Family (N01) coverage in three of the preceding six months.
  • Health Care Extension (N02) coverage is certified for twelve months. However, eligibility is not continuous. Changes in household circumstances may effect eligibility.
  • There is no renewal of the Health Care Extension (N02).

WAC 182-523-0130 Medical extension--Redetermination

WAC 182-523-0130 Medical extension--Redetermination.

Effective August 24, 2014

  1. When the agency or its designee determines the family or an individual family member is ineligible during the medical extension period, the agency or its designee must determine if they are eligible for another medical program.
  2. Children are eligible for twelve month continuous eligibility beginning with the first month of the medical extension period.
  3. When a family reports a reduction of income, the family may be eligible for the Washington apple health for parents and caretaker relatives program (described in WAC 182-505-0240) instead of medical extension benefits.
  4. When a medical extension period is ending, the family is required to complete a renewal of eligibility as described in WAC 182-504-0035.
  5. Postpartum and family planning extensions are described in WAC 182-505-0115.

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.

Clarifying Information

The individual receives a review at the end of the Health Care Extension certification period. Adults aren't eligible for consecutive N02 certifications.

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Required verification

Revised date
Purpose statement

To explain the rules and procedures when an individual applies for Apple Health coverage and the agency needs other information to determine eligibility.

WAC 182-503-0050 Verification of eligibility factors.

WAC 182-503-0050 Verification of eligibility factors.

Effective November 3, 2019

  1. General rules.
    1. We may verify the information we use to determine, redetermine, or terminate your apple health eligibility.
    2. We verify the eligibility factors listed in WAC 182-503-0505(3).
    3. Before we ask you to provide records to verify an eligibility factor, we use information available from state databases, including data from the department of social and health services and the department of employment security, federal databases, or commercially available databases to verify the eligibility factor.
    4. We may require information from third parties, such as employers, landlords, and insurance companies, to verify an eligibility factor if the information we received:
      1. Cannot be verified through available data sources;
      2. Did not verify an eligibility factor; or
      3. Is contradictory, confusing, or outdated.
    5. We do not require you to submit a record unless it is necessary to determine or redetermine your eligibility.
    6. If you can obtain verification within three business days and we determine the verification is sufficient to confirm an eligibility factor, we base our initial eligibility decision upon that record.
    7. If we are unable to verify eligibility as described in (f) of this subsection, then we may consider third-party sources.
    8. If a fee is required to obtain a necessary record, we pay the fee directly to the holder of the record.
    9. We do not deny or delay your application if you failed to provide information to verify an eligibility factor in a particular type or form.
    10. Except for eligibility factors listed in WAC 182-503-0505 (3)(c) and (d), we accept alternative forms of verification. If you give us a reasonable explanation that confirms your eligibility, we may not require additional documentation.
    11. Once we verify an eligibility factor that will not change, we may not require additional verification. Examples include:
      1. U.S. citizenship;
      2. Family relationships by birth;
      3. Social Security numbers; and
      4. Dates of birth, death, marriage, dissolution of marriage, or legal separation.
    12. If we cannot verify your immigration status and you are otherwise eligible for Washington apple health, we approve coverage and give additional time as needed to verify your immigration status.
  2. Submission timelines.
    1. We allow at least ten calendar days for you to submit requested information.
    2. If you request more time to provide information, we allow the time requested.
    3. If the tenth day falls on a weekend or a legal holiday as described in RCW 1.16.050, the due date is the next business day.
    4. We do not deny or terminate your eligibility when we give you more time to provide information.
    5. If we do not receive your information by the due date, we make a determination based on all the information available.
  3. Notice requirements.
    1. When we need more information from you to determine your eligibility for apple health coverage, we send all notices according to the requirements of WAC 182-518-0015.
    2. If we cannot determine you are eligible, we send you a denial or termination notice including information on when we reconsider a denied application under WAC 182-503-0080.
  4. Equal access and limited-English proficiency services. If you are eligible for equal access services under WAC 182-503-0120 or limited-English proficiency services under WAC 182-503-0110, we provide legally sufficient support services.
  5. Eligibility factors for nonmodified adjusted gross income (MAGI)-based programs. If you apply for a non-MAGI program under WAC 182-503-0510(3), we verify the factors in WAC 182-503-0505(3). In addition, we verify:
    1. Household composition, if spousal or dependent deeming under chapter 182-512 WAC or spousal or dependent allowance under chapters 182-513 and 182-515 WAC applies;
    2. Income and income deductions;
    3. Resources, including:
      1. Trusts, annuities, life estates and promissory notes under chapter 182-516 WAC;
      2. Real property transactions; and
      3. Financial records, as defined in WAC 182-503-0055, held by financial institutions.
    4. Medical expenses required to meet any spenddown liability under WAC 182-519-0110;
    5. All post-eligibility deductions used to determine cost of care for clients eligible for long-term services and supports under chapters 182-513 and 182-515 WAC;
    6. Transfers of assets under chapter 182-513 WAC and WAC 182-503-0055 when the program is subject to transfer of assets limitations;
    7. Shelter costs for long-term care cases where spousal and dependent allowances apply;
    8. Blindness or disability, if you claim either; and
    9. Social Security number for a community spouse if needed when you apply for long-term care.
  6. Verification for MAGI-based programs.
    1. After we approve your coverage based on your self-attestation, we may conduct a post-eligibility review to verify your self-attested information.
    2. When conducting a post-eligibility review, we attempt to verify eligibility factors using your self-attested information available to us through state, federal, and commercially available data sources, or other third parties, before requiring you to provide information.
    3. You may be required to provide additional information if:
      1. We cannot verify an eligibility factor through other data sources listed in subsection (b) of this section; or
      2. The information received from the data source is not reasonably compatible with your self-attestation.
  7. Reapplication following post-eligibility review. If your eligibility for MAGI-based apple health terminates because of a post-eligibility review and you reapply, we may request verification of eligibility factors prior to determining eligibility.

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.

Clarifying information

The agency requires only the information that is needed both to determine eligibility and is readily available. "Readily available" means that the individual can get the information within three business days. If the verification costs money, the agency must pay for it or get the information another way.

For more on what information is needed to determine eligibility, see General verification.

Worker responsibilities

  1. Whenever possible, obtain verification by crossmatches and interfaces.
  2. Do not request a specific form or type of document for verification. Instead, ask for what is needed to determine eligibility. Give or send the individual any departmental or approved local-office forms that provide the information needed to determine eligibility. For example, do not request a Stop Work form; request verification of the date the individual received their last paycheck and the amount of the last paycheck. Offer the Stop Work form for the individual's convenience.
  3. For regular SSI-related Medicaid, do not request verification of resources when no resources are listed on the application or review form.

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AREP screens for long-term care cases

Revised date
Purpose statement

For LTSS services, an ACES award letter is required in order for the provider to bill correctly and receive the correct amount of participation from the individual. Each change in service, participation or living arrangement requires a new award letter. Authorized representative (AREP) screens are also completed when the individual has an AREP such as a guardian, power of attorney, attorney, protective payees or other representative handling the individual's affairs. In addition to the individual's representative and advocates, some institutions need to be indicated on the AREP screen for correct payment and billing through SSPS, or Provider One. State Institutions that bill through Financial Service Administration (FSA) are also indicated on the AREP screen.

WAC 182-500-0010 Medical assistance definitions -- A.

WAC 182-500-0010 Medical assistance definitions -- A.

Effective November 25, 2023

"Administrative renewal" means the agency uses electronically available income and resources data sources to verify and recertify a person's Washington apple health benefits for a subsequent certification period. A case is administratively renewed when the person's self-attested income and resources are reasonably compatible (as defined in WAC 182-500-0095) with the information available to the agency from the electronic data sources and the person meets citizenship, immigration, Social Security number, and age requirements.

"After-pregnancy coverage (APC)" means full-scope Washington apple health (medicaid) health care coverage for people up to 12 months after the month their pregnancy ends under WAC 182-505-0115.

"Agency" or "medicaid agency" means the Washington state health care authority (HCA).

"Agency's designee" means any entity expressly designated by the agency to act on its behalf.

"Allowable costs" are the documented costs as reported after any cost adjustment, cost disallowances, reclassifications, or reclassifications to nonallowable costs which are necessary, ordinary and related to the outpatient care of medical care clients or not expressly declared nonallowable by applicable statutes or regulations. Costs are ordinary if they are of the nature and magnitude which prudent and cost-conscious management would pay.

"Alternative benefits plan" means the range of health care services included within the scope of service categories described in WAC 182-501-0060 available to persons eligible to receive health care coverage under the Washington apple health modified adjusted gross income (MAGI)-based adult coverage described in WAC 182-505-0250.

"Ancillary services" means additional services ordered by the provider to support the core treatment provided to the patient. These services may include, but are not limited to, laboratory services, radiology services, drugs, physical therapy, occupational therapy, and speech therapy.

"Apple health for kids" is the umbrella term for health care coverage for certain groups of children that is funded by the state and federal governments under Title XIX medicaid programs, Title XXI Children's Health Insurance Program, or solely through state funds (including the program formerly known as the children's health program). Funding for any given child depends on the program for which the child is determined to be eligible. Apple health for kids programs are included in the array of health care programs available through Washington apple health (WAH).

"Attested income" or "attested resources" means a self-declared statement of a person's income or resources made under penalty of perjury to be true. (See also "self-attestation.")

"Authorization" means the agency's or the agency's designee's determination that criteria are met, as one of the preconditions to the agency's or the agency's designee's decision to provide payment for a specific service or device. (See also "expedited prior authorization" and "prior authorization.")

"Authorized representative" is defined under WAC 182-503-0130.

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.

Clarifying information

Who can be an authorized representative

"Authorized representative" means a family member, friend, organization, or someone acting responsibly on behalf of a person who is designated by the person to act on his or her behalf in all matters relating to an application or renewal of Washington apple health or other ongoing communications with agency or its designee. The authorization must be made in writing, including on an application or eligibility review form, and signed by the person unless the person's medical condition prevents such written authorization. Authority to act on behalf of an applicant or beneficiary under state law can substitute for the person's authorization. The power to act as an AREP ends when the person or a court-appointed guardian of the person informs the agency or its designee that the representative is no longer authorized to act on his or her behalf, or when the agency learns of a change in the legal authority upon which the authorization is based.

The following facilities do not need to be listed on the AREP screen as notices are generated based on the provider number indicated on the INST screen in ACES. Do not indicate these facilities on the AREP screen in ACES:

  1. Nursing Facilities
  2. State veteran nursing facilities
  3. Hospice care centers (link includes hospice agencies and care centers)
  4. Hospice agencies when the individual is residing in a nursing home.
  5. HCS Waiver, CFC or MPC services case managed by HCS social worker, AAA or Developmental Disabilities Administration case manager do not need to be listed on the AREP screen. These notices are generated to the HCS SW, AAA or DDA CM electronically via the barcode system. The HCS SW, DDA and AAA CM receives the notice via their ECR To Do list. The SW or CM makes necessary changes to SSPS based on the notice received The DSHS 14-443 indicates who is case managing the case.

Institutions or services that DO need to be indicated on the AREP screen.

In addition to the individual's representative and advocates, some facilities or case managers need to be indicated on the AREP screen for correct payment and billing.

  1. Hospice outside of a nursing facility or hospice care center when an individual is receiving hospice outside of a medical institution and not on a DDA or HCS Waiver. Find additional information about hospice including the hospice care center addresses.
  2. New Freedom: King and Pierce County
  3. Program of All-Inclusive Care for the Elderly (PACE) - King County on the AREP screen indicate: Providence Elder Place Attn: PEP Biller PO Box 389672 Seattle WA 98138-9672
  4. The DSHS Economic Services Administration Office of Financial Recovery PO Box 9768 Olympia WA 98507 must be on the AREP screen if the client is residing in one of the following state owned facilities:
    1. Fircrest School Shoreline, Washington (DDA Residential Habilitation Centers-RHC)
    2. Lakeland Village Medical Lake, Washington (DDA RHC)
    3. Rainier School Buckley, Washington (DDA RHC)
    4. Yakima Valley School Selah, Washington (DDA RHC)
    5. Eastern State Hospital, (Institution for the Mental Disease-IMD)
    6. Western State Hospital, (IMD)
    7. Child Study and Treatment Center (IMD)

It is important to update or remove the information on the AREP screen if the individual changes services. (Example DDA individual at RHC discharges home to a DDA Waiver).

WAC 182-500-0010 Medical assistance definitions -- A.

WAC 182-500-0010 Medical assistance definitions -- A.

Effective November 25, 2023

"Administrative renewal" means the agency uses electronically available income and resources data sources to verify and recertify a person's Washington apple health benefits for a subsequent certification period. A case is administratively renewed when the person's self-attested income and resources are reasonably compatible (as defined in WAC 182-500-0095) with the information available to the agency from the electronic data sources and the person meets citizenship, immigration, Social Security number, and age requirements.

"After-pregnancy coverage (APC)" means full-scope Washington apple health (medicaid) health care coverage for people up to 12 months after the month their pregnancy ends under WAC 182-505-0115.

"Agency" or "medicaid agency" means the Washington state health care authority (HCA).

"Agency's designee" means any entity expressly designated by the agency to act on its behalf.

"Allowable costs" are the documented costs as reported after any cost adjustment, cost disallowances, reclassifications, or reclassifications to nonallowable costs which are necessary, ordinary and related to the outpatient care of medical care clients or not expressly declared nonallowable by applicable statutes or regulations. Costs are ordinary if they are of the nature and magnitude which prudent and cost-conscious management would pay.

"Alternative benefits plan" means the range of health care services included within the scope of service categories described in WAC 182-501-0060 available to persons eligible to receive health care coverage under the Washington apple health modified adjusted gross income (MAGI)-based adult coverage described in WAC 182-505-0250.

"Ancillary services" means additional services ordered by the provider to support the core treatment provided to the patient. These services may include, but are not limited to, laboratory services, radiology services, drugs, physical therapy, occupational therapy, and speech therapy.

"Apple health for kids" is the umbrella term for health care coverage for certain groups of children that is funded by the state and federal governments under Title XIX medicaid programs, Title XXI Children's Health Insurance Program, or solely through state funds (including the program formerly known as the children's health program). Funding for any given child depends on the program for which the child is determined to be eligible. Apple health for kids programs are included in the array of health care programs available through Washington apple health (WAH).

"Attested income" or "attested resources" means a self-declared statement of a person's income or resources made under penalty of perjury to be true. (See also "self-attestation.")

"Authorization" means the agency's or the agency's designee's determination that criteria are met, as one of the preconditions to the agency's or the agency's designee's decision to provide payment for a specific service or device. (See also "expedited prior authorization" and "prior authorization.")

"Authorized representative" is defined under WAC 182-503-0130.

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.

In addition to the individual's representative and advocates, some facilities or case managers need to be indicated on the AREP screen for correct payment and billing.

  1. Hospice outside of a nursing facility or Hospice Care Center when an individual is receiving Hospice outside of a medical institution and not on a DDA or HCS Waiver.  The Department of Health website has additional information about Hospice Care Centers including the Hospice Care Center addresses.
  2. New Freedom-King and Pierce Co.
  3. Program of All-inclusive Care for the Elderly (PACE) - King Co. on the AREP screen indicate: Providence Elder Place Attn: PEP Biller PO Box 389672 Seattle WA 98138-9672
  4. The DSHS Office of Financial Recovery PO Box 9768 Olympia WA 98507 must be on the AREP screen if the client is residing in one of the following state owned facilities:
    1. Fircrest School Shoreline, Washington (DDA Residential Habilitation Centers-RHC)
    2. Lakeland Village Medical Lake, Washington (DDA RHC)
    3. Rainier School Buckley, Washington (DDA RHC)
    4. Yakima Valley School Selah, Washington (DDA RHC
    5. Eastern State Hospital, (Institution for the Mental Disease-IMD)
    6. Western State Hospital, (IMD)
    7. Child Study and Treatment Center (IMD)

It is important to update or remove the information on the AREP screen if the individual changes services. (Example - DDA individual at RHC discharges home to a DDA Waiver).

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