Wash. Admin. Code § 182-515-1514 - Home and community based (HCB) services authorized by the developmental disabilities administration (DDA)-Client financial responsibility
(1) A client eligible for home and community
based (HCB) waiver services authorized by the developmental disabilities
administration (DDA) under WAC 182-515-1513 must pay toward the cost of care
and room and board under this section.
(a)
Post-eligibility treatment of income, participation, and participate are all
terms that refer to a client's responsibility towards cost of care.
(b) Room and board is a term that refers to a
client's responsibility toward food and shelter in an alternate living facility
(ALF).
(2) The agency
determines how much a client must pay toward the cost of care for home and
community based (HCB) waiver services authorized by the DDA when the client is
living at home, as follows:
(a) A single
client who lives at home (as defined in WAC 388-106-0010) keeps a personal
needs allowance (PNA) of up to the special income level (SIL) defined under WAC
182-513-1100.
(b) A single client
who lives at home on the roads to community living program authorized by DDA
keeps a PNA up to the SIL but must pay any remaining available income toward
cost of care after allowable deductions described in subsection (4) of this
section.
(c) A married client who
lives with the client's spouse at home (as defined in WAC 388-106-0010) keeps a
PNA of up to the SIL but must pay any remaining available income toward cost of
care after allowable deductions under subsection (4) of this section.
(d) A married couple living at home where
each client receives HCB waiver services, one authorized by DDA and the other
authorized by home and community services (HCS) is allowed the following:
(i) The client authorized by DDA keeps a PNA
of up to the SIL but must pay any remaining available income toward the
client's cost of care after allowable deductions in subsection (4) of this
section; and
(ii) The client
authorized by HCS pays toward the cost of care under WAC 182-515-1507 or
182-515-1509.
(3) The agency determines how much a client
must pay toward the cost of care for HCB wavier services authorized by DDA and
room and board when the client is living in a department-contracted ALF defined
under WAC 182-513-1100. A client:
(a) Keeps a
PNA under WAC 182-513-1105;
(b)
Pays room and board up to the room and board standard under WAC 182-513-1105;
and
(c) Pays the remainder of
available income toward the cost of care after allowable deductions under
subsection (4) of this section.
(4) If income remains after the PNA and room
and board liability under subsection (2) or (3) of this section, the remaining
available income must be paid toward the cost of care after it is reduced by
allowable deductions in the following order:
(a) An earned income deduction of the first
$65, plus one-half of the remaining earned income;
(b) Guardianship fees, conservatorship fees,
and administrative costs including any attorney fees paid by the guardian or
conservator only as allowed under chapter 388-79A WAC;
(c) Current or back child support garnished
or withheld from the client's income according to a child support order in the
month of the garnishment if it is for the current month. If the agency allows
this as a deduction from income, the agency does not count it as the child's
income when determining the family allocation amount in WAC
182-513-1385;
(d) A monthly
maintenance-needs allowance for the community spouse under WAC 182-513-1385. If
the community spouse is on long-term care services, the allocation is limited
to an amount that brings the community spouse's income to the community
spouse's PNA;
(e) A monthly
maintenance-needs allowance for each dependent of the institutionalized client,
or the client's spouse, as calculated under WAC 182-513-1385; and
(f) Incurred medical expenses which have not
been used to reduce excess resources. Allowable medical expenses are under WAC
182-513-1350.
(5) The
total of the following deductions cannot exceed the SIL defined under WAC
182-513-1100:
(a) The PNA described in
subsection (2) or (3) of this section, including room and board;
(b) The earned income deduction in subsection
(4)(a) of this section; and
(c) The
guardianship fees, conservatorship fees, and administrative costs in subsection
(4)(b) of this section.
(6) A client may have to pay third-party
resources defined under WAC 182-513-1100 in addition to the room and board and
participation.
(7) A client must
pay the client's provider the sum of the room and board amount, the cost of
care after all allowable deductions, and any third-party resources defined
under WAC 182-513-1100.
(8) A
client on HCB waiver services does not pay more than the state rate for cost of
care.
(9) When a client lives in
multiple living arrangements in a month, the agency allows the highest PNA
available based on all the living arrangements and services the client has
received in a month.
(10) Standards
described in this section 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.
Notes
WSR 13-01-017, recodified as §182-515-1514, filed 12/7/12, effective 1/1/13. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.530, section 6014 of the Deficit Reduction Act of 2005 (DRA), and 2010 1st sp.s. c 37§ 209(1). WSR 12-21-091, § 388-515-1514, filed 10/22/12, effective 11/22/12. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.575, 74.09.500, 74.09.530. WSR 08-24-069, § 388-515-1514, filed 12/1/08, effective 1/1/09. Statutory Authority: RCW 74.04.050, 74.04.057, 74.08.090, 74.09.500, 74.09.530, and Washington state 2007-09 operating budget (SHB 1128). WSR 08-11-083, § 388-515-1514, filed 5/20/08, effective 6/20/08.
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