WAC 182-531-0425 Collaborative Care

Effective July 11, 2025

1. Under the authority of RCW 74.09.497, and subject to available funds, the medicaid agency covers collaborative care provided in clinical care settings.
2. For the purposes of this section:
   1. Collaborative care means a specific type of integrated care where medical providers and behavioral health providers work together to address behavioral health conditions, including mental health conditions and substance use disorders.
   2. Collaborative care model is a model of behavior health integration that enhances usual primary care by adding two key services:
      1. Care management support for patients receiving behavioral health treatment; and 
      2. Regular psychiatric consultation with the primary care team, particularly clients whose conditions are not improving.
   3. Collaborative care team means a team of licensed behavioral health professionals operating within their scope of practice who participate on the clinical care team along with the collaborative care billing provider to provide collaborative care to eligible clients. The team must include a collaborative care billing provider, a behavioral health care manager, and a psychiatric consultant. Professionals making up this team include, but are not limited to:
      1. Advanced registered nurses;
      2. Substance use disorder professionals (SUDP);
      3. Substance use disorder professional trainees (SUDPT) under the supervision of a certified SUDP;
      4. Marriage and family therapists;
      5. Marriage and family therapist associates under the supervision of a licensed marriage and family therapist or equally qualified mental health practitioner;
      6. Mental health counselors;
      7. Mental health counselor associates under the supervision of a licensed mental health counselor, psychiatrist, or physician;
      8. Physicians;
      9. Physician assistants;
      10. Psychiatrists;
      11. Psychiatric advanced registered nurses;
      12. Psychologists;
      13. Registered nurses;
      14. Social workers;
      15. Social worker associate-independent clinical, under the supervision of a licensed independent clinical social worker or equally qualified mental health practitioner; and
      16. Behavioral health support specialists under the supervision of a licensed practitioner whose scope of practice includes assessment, diagnosis, and treatment of identifiable mental and behavioral health conditions. 
      17. Social worker associate-advanced, under the supervision of a licensed independent clinical social worker, advanced social worker, or equally qualified mental health practitioner;
3. The behavioral health care manager is a designated licensed professional with formal education or specialized training in behavioral health (including social work, nursing, or psychology), working under the oversight and direction of the treating medical provider.
4. The collaborative care billing provider must meet all of the following: 
   1. Be enrolled with the agency as one of the following:
      1. A physician licensed under Titles 18 RCW and 246 WAC;
      2. An advanced registered nurse practitioner licensed under Titles 18 RCW and 246 WAC;
      3. A federally qualified health center (FQHC);
      4. A rural health clinic (RHC); or
      5. A clinic that is not an FQHC or RHC that meets the requirements of Titles 70 RCW and 247 WAC.
   2. Complete, sign, and return the Attestation for Collaborative Care Model, form HCA 13-0017, to the agency; and
   3. Agree to follow the agency's guidelines for practicing a collaborative care model.
5. Providers of collaborative care must:
   1. Use a registry to track the client's clinical outcomes;
   2. Use at least one validated clinical rating scale;
   3. Ensure the registry is used in conjunction with the practice's electronic health records (EHR);
   4. Include a plan of care; and
   5. Identify outcome goals of the treatments.
6. If a provider no longer meets the agreed upon requirements in the agency's Attestation for Collaborative Care Model, form HCA 13-0017, the provider must immediately notify the agency. The agency does not pay for collaborative care if a provider does not meet the agreed upon requirements.
7. Providers are subject to post pay review by the agency. The agency may recoup payment if the provider is found to have not met the requirements for providing collaborative care as agreed to in the agency's Attestation for Collaborative Care Model, form HCA 13-0017.

WAC 182-546-4600 Ambulance transportation—Involuntary substance use disorder treatment—Ricky Garcia Act.

Effective November 8, 2018

WAC 182-516-0400 Promissory notes and loans.

Effective March 2, 2018

1. General.
   1. In this section, note includes promissory note, loan or other obligation to pay.
   2. The medicaid agency or the agency's designee determines the value of outstanding principal and interest payments using amortization schedules, unless otherwise stated in this section.
2. A note as a resource.
   1. A note is a resource. The value of the note is the fair market value (FMV).
   2. The FMV of a note is the outstanding principal of the note, unless convincing evidence to the contrary is provided to the agency or the agency's designee.
   3. If the note owner provides convincing evidence to the agency or the agency's designee of a legal bar to the sale of the note, the note's FMV is zero.
3. A note as income.
   1. Interest on a note is unearned income.
   2. If the FMV of the note under subsection (2)(c) of this section is zero, the principal portion of recurring payments is unearned income.
   3. The agency or the agency's designee may budget the unearned income in equal monthly amounts at the request of the note owner, or at the agency's or the agency's designee's discretion. The budgeting period will be the note owner's certification period under chapter 182-504 WAC.
4. A note as an asset transfer under WAC 182-513-1363.
   1. Subject to (b) of this subsection:
      1. The agency or the agency's designee evaluates the purchase of a note as an asset transfer if the purchase price of the note exceeds the FMV of the note;
      2. The value of the asset transfer is the difference between the purchase price of the note and the FMV of the note at the time of purchase; and
      3. The agency or the agency's designee determines the FMV of the note at the time of purchase using subsection (2) of this section, but can also determine the FMV of the note at a time after purchase if the agency or the agency's designee determines FMV of the note has changed since the time it was purchased.
   2. The assets used to purchase a note are an uncompensated asset transfer under WAC 182-513-1363, unless the note:
      1. Prohibits the cancellation of the balance of the note upon death of the note owner; and
      2. Is paid out, in equal periodic amounts with no deferral and no balloon payments, over a term not greater than the actuarial life expectancy of that note owner.
   3. The value of the uncompensated asset transfer under (b) of this subsection is the outstanding balance of the note due as of the date of the client's application for medical assistance for institutional or home and community-based waiver services.
   4. If the purchase of a note results in a period of ineligibili­ty under both (a) and (b) of this subsection, then the period of in­ eligibility under WAC 182-513-1363 will be the period that is longer.

WAC 182-516-0145 Irrevocable trusts containing both assets of the beneficiary and third-party assets.

Effective January 27, 2019

1. For irrevocable trusts that contain both assets of the beneficiary and third-party assets, the medicaid agency or the agency's designee treats the assets of the beneficiary under the self-settled trust rule in effect as of the date of the trust's establishment:
   1. After August 11, 1993:
      1. For irrevocable self-settled trusts for a disabled client under age sixty-five, see WAC 182-516-0120;
      2. For irrevocable pooled self-settled trusts for a disabled client, see WAC 182-516-0125; and
      3. For all other trusts, see WAC 182-516-0130.
   2. Before August 11, 1993, see WAC 182-516-0135.
2. For irrevocable trusts that contain both assets of the beneficiary and third-party assets, the agency or the agency's designee treats third-party assets under the third-party trust rules under WAC 182-516-0140.

WAC 182-516-0140 Third-party trusts.

Effective March 2, 2018

1. This section governs third-party trust as defined under WAC 182-516-0001.
2. A trust containing the assets of a beneficiary's spouse may be a self-settled trust based on the date it was established. For specific rules regarding this, see WAC 182-516-0130.
3. A testamentary trust is a third-party trust created by a will where the trust is in the will and the estate is the grantor.
4. There is no requirement for a state to be named as a remainder beneficiary in third-party trusts.
5. If the beneficiary has the power to acquire the assets from the third-party trust, the trust is an available resource.
6. If the beneficiary has no power to access or control trust assets or distributions, as described under WAC 182-516-0105(4), a third-party trust is not an available resource.

WAC 182-516-0135 Self-settled trusts established before August 11, 1993.

Effective March 2, 2018

1. A revocable or irrevocable self-settled trust established before August 11, 1993, under this section is one:
   1. Established other than by will by a beneficiary or that bene­ficiary's spouse;
   2. Under which that beneficiary may be the beneficiary of all or part of the payments from the trust; and
   3. Under which the distribution of those payments is determined by one or more trustees who are permitted to exercise any discretion with respect to the distribution to the beneficiary.
2. For trusts established under subsection (1) of this section, the maximum value the trustee may distribute, under any circumstances, to the beneficiary is unearned income.
3. If a trust does not meet subsection (1)(c) of this section:
   1. The trust is an available resource to the extent that trust assets can be used for the beneficiary; and
   2. Any asset that cannot be used for the beneficiary is an un­ compensated asset transfer.
4. This section does not apply to any trust or initial trust de­cree established before April 7, 1986, for the sole benefit of an intellectually disabled client who resides in an intermediate care fa­cility for the intellectually disabled.

WAC 182-516-0130 Irrevocable self-settled trusts established on or after August 11, 1993.

Effective March 3, 2018

1. This section governs irrevocable self-settled trusts established on or after August 11, 1993, that do not meet the rules under either WAC 182-516-0120 or 182-516-0125.
2. A trust established on or after August 1, 2003, is a self-settled trust if:
   1. The assets of the trust are at least partially from the bene­ficiary or the beneficiary's spouse, or would have been owned by the beneficiary or the beneficiary's spouse unless diverted by the beneficiary, the beneficiary's spouse, the court, or someone acting on be­half of the beneficiary or the beneficiary's spouse;
   2. The trust is not established by will; and
   3. The trust was established by:
      1. The beneficiary or that beneficiary's spouse;
      2. A person, including a court or administrative body, with le­ gal authority to act in place or on behalf of the beneficiary or that beneficiary's spouse; or
      3. A person, including a court or administrative body, acting at the direction or upon the request of the beneficiary or that beneficiary's spouse.
3. A trust established from August 11, 1993, to July 31, 2003, is a self-settled trust if:
   1. The assets of the trust are at least partially from the bene­ficiary, or would have been owned by the beneficiary unless diverted by the beneficiary, the court, or someone acting on behalf of the beneficiary;
   2. The trust is not established by will; and
   3. The trust was established by:
      1. The beneficiary;
      2. A person, including a court or administrative body, with le­gal authority to act in place or on behalf of the beneficiary; or
      3. A person, including a court or administrative body, acting at the direction or upon the request of the beneficiary.
4. This section applies only to the assets contributed to a trust:
   1. Under subsection (2) of this section, by either the benefi­ciary or that beneficiary's spouse; or
   2. Under subsection (3) of this section, by the beneficiary.
5. The medicaid agency or the agency's designee applies the rules of this section without regard to:
   1. The purpose for establishing a trust;
   2. Whether the trustees have or may exercise any discretion un­der the terms of the trust;
   3. Restrictions on when or whether distributions may be made from the trust; and
   4. Restrictions on the use of distributions from the trust.
6. Treatment of payments or benefits from trusts established un­ der this section.
   1. Subject to subsection (7) of this section, if there are any circumstances under which payment or benefit from the trust could be made to or for the benefit of the beneficiary, the portion of the principal from which, or the income on the principal from which, payment to the beneficiary could be made is an available resource to the beneficiary, and the payment or benefit from that portion:
      1. Is unearned income when payment or benefit is to or for the benefit of the beneficiary; and
      2. Is an uncompensated asset transfer, if payment or benefit is for any other purpose.
   2. If there are no circumstances under which any payment or any benefit from the trust could be made to or for the benefit of the ben­eficiary, the part of the trust or income of that trust, from which payment or benefit cannot be made, is an uncompensated asset transfer.
7. For the purposes of subsection (6)(a) of this section, "available resource" means a resource after the resource exclusions under chapter 182-512 WAC are applied; however, for an institutional­ized individual, the resource exclusion for the home under WAC 182-512-0350 does not apply.
8. If unearned income under subsection (6)(a)(i) of this section was from an available resource under subsection (6)(a) of this section, then the value of the available resource will be reduced by the amount of unearned income under subsection (6)(a)(i) of this section.

WAC 182-516-0125 Irrevocable pooled self-settled trusts for a disabled client established on or after August 11, 1993.

Effective March 2, 2018

1. This section governs how the agency or the agency's designee treats pooled self-settled trusts, for a disabled client established under 42 U.S.C.1396p(d)(4)(c) on or after August 11, 1993, for medicaid eligibility purposes.
2. A pooled self-settled trust established on or after August 11, 1993, is not an available resource if:
   1. The beneficiary is disabled under WAC 182-512-0050 (1)(c) when the trust is established;
   2. The trust is irrevocable;
   3. An account in the trust was established for the sole benefit of that beneficiary;
   4. An account in the trust was established by that beneficiary, the beneficiary's parent, grandparent, legal guardian, or by a court;
   5. The trust was established by and is managed by a nonprofit association;
   6. A separate account is maintained for each beneficiary of the trust, but, for the purposes of the investment and management of funds, the trust pools these accounts; and
   7. The trust says that:
      1. Upon the death of the beneficiary, or, for trust accounts es­tablished on or after August 1, 2003, when the trust account terminates or the beneficiary's disability ends, the funds will remain in the trust to benefit other disabled beneficiaries; or
      2. The states that have spent medicaid funds for the beneficia­ry will receive all amounts remaining in the trust account for that beneficiary up to the amount of medicaid funds spent for the beneficiary.
         1. For trust accounts established from August 11, 1993, to July 31, 2003, the trust must pay the states when the beneficiary dies.
         2. For trust accounts established on or after August 1, 2003, the trust must pay the states when the beneficiary dies, the trust terminates, or the beneficiary's disability ends.
3. The medicaid agency or the agency's designee does not apply a penalty period to a beneficiary for asset transfers into a trust, described under subsection (2) of this section, when the beneficiary is under age sixty-five as of the date of the transfer.
4. Assets in trusts under subsection (2) of this section continue to be unavailable resources, even after the beneficiary turns age sixty-five.
5. Asset transfers to the trust from the beneficiary, after the beneficiary turns age sixty-five, may be subject to a transfer penalty under WAC 182-513-1363.
6. If a trust does not meet the requirements under subsection (2) of this section, see WAC 182-516-0130.

WAC 182-516-0120 Irrevocable self-settled trusts for a disabled client under age sixty-five established on or after August 11, 1993.

Effective March 2, 2018

1. This section governs how the agency or the agency's designee treats self-settled trusts, for a disabled client under age sixty-five established under 42 U.S.C. 1396p(d)(4)(a) on or after August 11, 1993, for medicaid eligibility purposes.
2. A self-settled trust established on or after August 11, 1993, is not an available resource if:
   1. The beneficiary is under age sixty-five and disabled under WAC 182-512-0050 (1)(c) when the trust is established;
   2. The trust is irrevocable;
   3. The trust was established for the sole benefit of that bene­ficiary;
   4. The trust was established by the beneficiary's parent, the beneficiary's grandparent, the beneficiary's legal guardian, by a court, or on or after December 13, 2016, the beneficiary; and
   5. The trust says that the states that have spent medicaid funds for the beneficiary will receive all amounts remaining in the trust up to the amount of medicaid funds spent for the beneficiary.
      1. For trusts established from August 11, 1993, to July 31, 2003, the trust must pay the states when the beneficiary dies.
      2. For trusts established on or after August 1, 2003, the trust must pay the states when the beneficiary dies, the trust terminates, or the beneficiary's disability ends.
3. The medicaid agency or the agency's designee does not apply a penalty period to a beneficiary for asset transfers into a trust, described under subsection (2) of this section, when the beneficiary is under age sixty-five as of the date of the transfer.
4. Assets in trusts under subsection (2) of this section contin­ue to be unavailable resources, even after the beneficiary turns age sixty-five.
5. Asset transfers to the trust from the beneficiary, after the beneficiary turns age sixty-five, may be subject to a transfer penalty under WAC 182-513-1363.
6. If a trust does not meet the requirements under subsection (2) of this section, see WAC 182-516-0130.

WAC 182-516-0115 Revocable self-settled trusts established on or after August 11, 1993.

Effective March 2, 2018

1. This section applies to revocable trusts that are self-settled and established on or after August 11, 1993.
2. This section does not apply to assets in a revocable trust established before August 11, 1993.
3. A revocable trust is a self-settled trust if:
   1. The assets of the trust are at least partially from the bene­ficiary or the beneficiary's spouse;
   2. The trust is not established by will; and
   3. The trust was established by:
      1. The beneficiary or that beneficiary's spouse;
      2. A person, including a court or administrative body, with legal authority to act in place or on behalf of the beneficiary or that beneficiary's spouse; or
      3. A person, including a court or administrative body, acting at the direction or upon the request of the beneficiary or that beneficiary's spouse.
4. The medicaid agency or the agency's designee treats assets in a revocable self-settled trust under this section as follows:
   1. Assets are subject to the resource exclusions under chapter 182-512 WAC; however, for an institutionalized individual, the resource exclusion for the home under WAC 182-512-0350 does not apply; and
   2. Assets not excluded under chapter 182-512 WAC are available resources.
5. Payments from assets in the trust under this section to or for the benefit of the beneficiary are unearned income of the beneficiary.
6. If unearned income under subsection (5) of this section was from an available resource under subsection (4) of this section, then the value of the available resource will be reduced by the amount of unearned income under subsection (5) of this section.
7. Any payments from the revocable trust, other than payments under subsections (5) and (6) of this section, are uncompensated asset transfers.