WAC 182-513-1620 Tailored Supports for Older Adults (TSOA) - Presumptive Eligibility (PE).

Effective May 29, 2021

1. A person may be determined presumptively eligible for tailored supports for older adults (TSOA) services upon completion of a prescreening interview.
2. The prescreening interview may be conducted by either:
   1. The area agency on aging (AAA); or
   2. By a home and community services intake case manager or social worker.
3. To receive services under presumptive eligibility (PE), the person must meet:
   1. Nursing facility level of care under WAC 388-106-0355;
   2. TSOA income limits under WAC 182-513-1635; and
   3. TSOA resource limits under WAC 182-513-1640.
4. The presumptive period begins on the date the determination is made and:
   1. Ends on the last day of the month following the month of the presumptive eligibility (PE) determination if a full TSOA application is not completed and submitted by that date; or
   2. Continues through the date the final TSOA eligibility determination is made if a full TSOA application is submitted before the last day of the month following the month of the PE determination.
5. If the person applies and is not determined financially eligible for TSOA, there is no overpayment or liability on the part of the applicant for services received during the PE period.
6. The medicaid agency or the agency's designee sends written notice as described in WAC 182-518-0010 when PE for TSOA is approved or denied.
7. A person may receive services under presumptive eligibility only once within a twenty-four-month period.
8. If the department of social and health services establishes a waitlist for TSOA services under WAC 388-106-1975, PE does not apply.

WAC 182-513-1615 Tailored Supports for Older Adults (TSOA) - General Eligibility

Effective June 3, 2025

1. The person receiving care must meet the financial eligibility criteria for tailored supports for older adults (TSOA).
2. To be eligible for the TSOA program, the person receiving care must:
   1. Be age 55 or older;
   2. Be assessed as meeting nursing facility level of care under WAC 388-106-0355;
   3. Meet residency requirements under WAC 182-503-0520;
   4. Live at home and not in a residential or institutional setting;
   5. Have an eligible unpaid caregiver under WAC 388-106-1905, or meet the criteria under WAC 388-106-1910 if the person does not have an eligible unpaid caregiver;
   6. Meet citizenship or immigration status requirements under WAC 182-503-0535. To be eligible for TSOA, a person must be a:
      1. U.S. citizen under WAC 182-503-0535 (1)(c);
      2. U.S. national under WAC 182-503-0535 (1)(d);
      3. Qualifying American Indian born abroad under WAC 182-503-0535 (1)(f); or
      4. Qualified alien under WAC 182-503-0535 (1)(b) and have either met or is exempt from the five-year bar requirement for medicaid.
   7. Provide a valid Social Security number under WAC 182-503-0515;
   8. Have countable resources within specific program limits under WAC 182-513-1640; and
   9. Meet income requirements under WAC 182-513-1635.
3. TSOA applicants who receive coverage under Washington apple health programs are not eligible for TSOA, unless they are enrolled in:
   1. Medically needy program under WAC 182-519-0100;
   2. Medicare savings programs under WAC 182-517-0300;
   3. Family planning program under WAC 182-505-0115;
   4. Family planning only programs under chapter 182-532 WAC; or
   5. The kidney disease program under chapter 182-540 WAC.
4. A person who receives apple health coverage under a categorically needy (CN) or alternative benefit plan (ABP) program is not eligible for TSOA but may qualify for:
   1. Caregiver supports under medicaid alternative care (MAC) under WAC 182-513-1605; or
   2. Other long-term services and supports under chapter 182-513 or 182-515 WAC.
5. The following rules do not apply to services provided under the TSOA benefit:
   1. Transfer of asset penalties under WAC 182-513-1363;
   2. Excess home equity under WAC 182-513-1350;
   3. Client financial responsibility under WAC 182-515-1509;
   4. Estate recovery under chapter 182-527 WAC;
   5. Disability requirements under WAC 182-512-0050;
   6. Assignment of rights and cooperation under WAC 182-503-0540

WAC 182-513-1610 Tailored supports for older adults (TSOA) — Overview.

Effective July 1, 2017

1. The tailored supports for older adults (TSOA) program is a federally funded program approved under section 1115 of the So­cial Security Act. It enables the medicaid agency and the agency's designees to deliver person-centered long-term services and supports (LTSS) to a person who:
   1. Meets nursing facility level of care described in WAC 388-106-0355; and
   2. Meets the functional requirements under WAC 388-106-1900 through 388-106-1990.
2. For the purposes of TSOA, the applicant is the person receiv­ing care even though services may be authorized to the person provid­ing care. TSOA does not provide Washington apple health coverage.

WAC 182-513-1605 Medicaid alternative care (MAC) — Eligibility.

Effective July 1, 2017

1. The person receiving care must meet the financial eligibility criteria for medicaid alternative care (MAC).
2. To be eligible for MAC services, the person receiving care must:
   1. Be age 55 or older;
   2. Be assessed as meeting nursing facility level of care under WAC 388-106-0355, and choose to receive services under the MAC program instead of other long-term services and supports;
   3. Meet residency requirements under WAC 182-503-0520;
   4. Live at home and not in a residential or institutional setting;
   5. Have an eligible unpaid caregiver under WAC 388-106-1905;
   6. Meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a) or (b); and
   7. Be eligible for either:
      1. A noninstitutional medicaid program, which provides categorically needy (CN) or alternative benefit plan (ABP) scope of care under WAC 182-501-0060; or
      2. An SSI-related CN program by using spousal impoverishment protections institutionalized (SIPI) spouse rules under WAC 182-513-1660.
3. An applicant whose eligibility is limited to one or more of the following programs is not eligible for MAC:
   1. The medically needy program under WAC 182-519-0100;
   2. The medicare savings programs under WAC 182-517-0300;
   3. The family planning program under WAC 182-505-0115;
   4. The family planning only programs under chapter 182-532;
   5. The medical care services (MCS) program under WAC 182-508-0005;
   6. The alien emergency medical (AEM) program under WAC 182-507-0110 through 182-507-0120;
   7. The state funded long-term care for noncitizens program under WAC 182-507-0125;
   8. The kidney disease program under chapter 182-540 WAC; or
   9. The tailored supports for older adults (TSOA) program under WAC 182-513-1610.
4. The following rules do not apply to services provided under the MAC benefit:
   1. Transfer of asset penalties under WAC 182-513-1363;
   2. Excess home equity under WAC 182-513-1350; and
   3. Estate recovery under chapter 182-527 WAC.

WAC 182-513-1600 Medicaid Alternative Care (MAC)

Effective July 1, 2017

Medicaid alternative care (MAC) is a Washington apple health benefit authorized under section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver an array of person-centered long-term services and supports (LTSS) to unpaid caregivers caring for a medicaid-eligible person who meets nursing facility level of care under WAC 388-106-0355.

1. For services included with the MAC benefit package, see WAC 388-106-1900 through 388-106-1990.
2. For financial eligibility for MAC services, see WAC 182-513-1605.

WAC 182-526-0540 Correction of clerical errors in an initial order.

Effective March 16, 2017

1. A clerical error is a mistake that does not change the intent of the initial order.
2. The administrative law judge (ALJ) may correct clerical errors in the initial order by entering a corrected initial order. The ALJ may correct clerical errors in response to a request by one of the parties.
3. Some examples of clerical error are:
   1. Missing or incorrect words or numbers;
   2. Dates inconsistent with the decision or evidence in the record such as using May 3, 2004, instead of May 3, 2014; or
   3. Math errors when adding the total of an overpayment.
4. If the ALJ does not agree that the initial order contains one or more clerical errors, the ALJ enters a written order denying the request for a corrected order.

WAC 182-526-0405 Stipulations.

Effective February 1, 2013

1. A stipulation is an agreement among two or more parties that certain facts or evidence is correct or authentic.
2. If an administrative law judge (ALJ) accepts a stipulation, the ALJ must enter it into the record.
3. A stipulation may be made before or during the hearing.
4. A party may change or reject a stipulation after it has been made.
5. To change or reject a stipulation, a party must show the administrative law judge that:
   1. The party did not intend to make the stipulation or was mistaken when making it; and
   2. Changing or rejecting the stipulation does not harm the other parties.

WAC 182-526-0355 People who may attend the hearing.

Effective March 16, 2017

1. All parties and their representatives may attend a hearing under this chapter.
2. Witnesses may be excluded from the hearing if the administrative law judge (ALJ) finds good cause to do so.
3. The ALJ may also exclude other people from all or part of the hearing.

WAC 182-526-0320 Subpoenas.

Effective March 16, 2017

1. An administrative law judge (ALJ), the health care authority hearing representative, and an attorney for a party may issue subpoenas. If a party is not represented by an attorney, that party may ask the ALJ to issue a subpoena on the party's behalf. The ALJ may schedule a prehearing conference to decide whether to issue a subpoena.
2. An ALJ may deny a party's request for a subpoena. For example, an ALJ may deny a request for a subpoena when the ALJ determines that a witness has no actual knowledge regarding the facts or that the documents are not relevant.
3. There is no cost when OAH issues a subpoena on behalf of a party, but the party may have to pay for:
   1. Serving the subpoena;
   2. Complying with the subpoena; and
   3. Witness fees according to RCW 34.05.446(7).
4. Any person who is at least eighteen years old and not a party to the hearing may serve a subpoena.
5. Service of a subpoena is complete when the server:
   1. Gives the witness a copy of the subpoena; or
   2. Leaves a copy at the residence of the witness with a person over the age of eighteen.
6. To prove that a subpoena was served on a witness, the person serving the subpoena must sign a written, dated statement including:
   1. Who was served with the subpoena;
   2. When the subpoena was served;
   3. The address where the subpoena was served; and
   4. The name, age, and address of the person who served the subpoena.
7. A party may request that an ALJ quash (set aside) or change the requirements of a subpoena at any time before the deadline given in the subpoena.
8. An ALJ may set aside or change a subpoena if it is unreasonable.
9. Witnesses with safety or accommodation concerns should contact the office of administrative hearings (OAH) upon receipt of a subpoena.

WAC 182-526-0255 Notice of hearing or notice of prehearing conference.

Effective March 16, 2017

1.  
   1. A notice of hearing or a notice of prehearing conference is a written notice issued by the office of administrative hearings (OAH) that must include the:
      1. Names of all parties to whom the notice is sent and, if known, the names and addresses of their representatives;
      2. Name, mailing address, and telephone number of the administrative law judge (ALJ), if known;
      3. Date, time, place, and nature of the hearing or prehearing conference;
      4. Legal authority and jurisdiction for the hearing; and
      5. Date of the hearing request.
   2. A notice of hearing or prehearing conference must include a statement that the appellant's failure to attend the prehearing conference or hearing may result in the loss of the right to a hearing.
   3. If the appellant fails to appear, the ALJ may enter an order of default.
2. Limited-English proficiency. The notice must include a statement that, if the appellant needs a qualified interpreter because they or any of their witnesses are people with limited-English proficiency, OAH will provide an interpreter at no cost to that party.
3. The notice must state whether the hearing or prehearing conference is to be held by telephone or in person, and how to request a change in the way it is held.
4. The notice of hearing or prehearing conference informs the appellant:
   1. How to indicate any special needs for the appellant or their witnesses, including the need for an interpreter in a primary language or for sensory impairments;
   2. How to contact OAH if a party has a safety concern; and
   3. That the appellant may request a qualified interpreter if the appellant or any of the appellant's witnesses are people with limited-English proficiency, and that OAH provides such interpreters at no cost to the appellant.