Chapter 388-106 Long-term care services.

The following providers may provide MAC and TSOA services:(1) Durable medical equipment vendors and adult day health providers that have a core provider agreement with the health care authority; and(2) Providers who are contracted with the department to provide goods and services…

(1) The department will implement a statewide waitlist if program expenditures or enrollment exceeds availability of demonstration funding.(2) If the department implements a waitlist for new MAC and TSOA applicants:(a) We will stop conducting presumptive eligibility determination…

(1) The department will deny or terminate MAC or TSOA services if you are not eligible for services pursuant to WAC 388-106-1905, 388-106-1910, and 388-106-1945.(2) The department may deny or terminate your MAC or TSOA services if, after exhaustion of standard case management act…

Yes, you may request an administrative hearing based on the rules outlined in WAC 388-106-1305 to contest the department's decisions regarding MAC or TSOA services except for presumptive eligibility determinations described in WAC 388-106-1905(2) and 388-106-1910(2).[Statutory Au…

Yes. You, as the care receiver, may choose to apply for traditional medicaid long term services and supports such as community first choice, community option program entry system (COPES), new freedom, and residential support waiver, instead of services under the MAC program. You …

"Aging and long-term support administration (ALTSA)" is an administration within the department of social and health services that promotes choice, independence, and safety through innovative services and partnerships with tribes, advocates, providers, and caregivers to support s…

You are eligible to apply for services under the civil transitions program if you:(1) Are referred to ALTSA from the BHA starting December 1, 2023;(2) Have been determined by a court as not competent to stand trial due to a diagnosis of dementia, a traumatic brain injury, or an i…

(1) If you meet the criteria in WAC 388-106-2005 but are not functionally eligible for medicaid personal care level of care under WAC 388-106-0210 or nursing facility level of care under WAC 388-106-0355, or you are not financially eligible for Washington apple health, you may re…

If you are referred to ALTSA for services under the civil transitions program and you are both functionally eligible for long-term services and supports under chapter 388-106 WAC and financially eligible for medicaid-funded long-term services and supports, you are eligible for an…

The legislature has appropriated specific funding for the civil transitions program for the provision of conditional services. If you meet the criteria in WAC 388-106-2005 you are eligible for conditional services as described below, subject to available funding.(1) If you do not…

The following types of providers can provide conditional services under the civil transitions program:(1) Individual providers (IPs) who provide services to clients in their own home as defined in WAC 388-106-0040 and 388-106-0010.(2) Home care agencies that provide services to c…

You can receive conditional services under the civil transitions program:(1) In your own home as defined in WAC 388-106-0030, or an interim setting while you secure permanent housing; and(2) While you are out of your home accessing the community or working while:(a) within the st…

Within available funds, the department will authorize conditional services under the civil transitions program when you have:(1) Completed an assessment of your functional eligibility using the comprehensive assessment reporting evaluation (CARE) tool under WAC 388-106-0050;(2) A…

(1) If, at the time of your initial assessment you were found ineligible for medicaid-funded long-term services and supports, your civil transitions program conditional services, except supportive housing, will end the earlier of:(a) The date you are found both functionally and f…

You have a right to an administrative hearing if you disagree with a decision made by the department about your eligibility for services under the civil transitions program. The department will notify you in writing of the right to contest a decision and provide you with informat…

If you receive conditional services under the civil transitions program, an exception to rule under WAC 388-440-0001 will not be granted.[Statutory Authority: RCW 10.77.202, 74.08.090, and 74.09.520. WSR 24-16-002, § 388-106-2050, filed 7/24/24, effective 8/24/24.]

(1) Subject to available state only funds, the department of social and health services (DSHS) pays for certain fees and costs for professional guardianship and conservatorship services for eligible persons as described in WAC 388-106-2110.(2) The amounts paid and which services …

(1) "Aging and long-term support administration" or "ALTSA" means an administration within DSHS.(2) "Client" means a person who is an applicant for, or recipient of, any Washington apple health program, including managed care and long-term care. See definitions for "applicant" an…

(1) To be eligible to participate as a contractor in the program a person must:(a) Hold certification as a professional guardian and conservator approved by the state of Washington supreme court;(b) Be in good standing with the certified professional guardian and conservator revi…

(1) An acute care hospital may submit a referral to home and community services under the following circumstances:(a) Acute care hospital clinicians have determined that the person likely needs a guardian or conservator;(b) The acute care hospital has a good faith belief that the…

(1) Within available resources, home and community services will accept a person into the guardianship and conservatorship assistance program if DSHS determines that the person meets the eligibility requirements, the referral packet is complete, and there is a program slot availa…

A referring acute care hospital may request that DSHS reconsider its decision to accept a person onto the guardianship and conservatorship assistance program. A request for reconsideration must be supported by the referring acute care hospital submission of supplemental documenta…

DSHS will provide an applicant or participant in the program, and their guardian or conservator as applicable, with written notice about department decisions about eligibility for acceptance onto, or continuation on, the program.[Statutory Authority: RCW 43.17.060, 43.20B.030, an…

The person who is the subject of a referral for acceptance into or a recipient of services under the guardianship and conservatorship assistance program may request an administrative hearing to contest a department decision that they are not eligible for acceptance or continuatio…

If DSHS or the guardian or conservator discovers that the person's estate has available and adequate resources to pay for guardianship fees or costs, the payments made under this program on behalf of the client are overpayments to the extent a court determines that the person's e…

If a client ceases to remain financially eligible as required by WAC 182-513-1315 (1)-(3) while occupying a program slot, their program slot can be held for up to a maximum of 90 days from the date it is discovered the client is overresourced. This process is referred to as a "pr…

Services provided under this program are exempt from estate recovery as outlined in WAC 182-527-2742. [Statutory Authority: RCW 43.17.060, 43.20B.030, and 74.08.090. WSR 24-16-044, § 388-106-2150, filed 7/30/24, effective 8/30/24.]

Services provided under this program are exempt from the exception to rule process in WAC 388-440-0001.[Statutory Authority: RCW 43.17.060, 43.20B.030, and 74.08.090. WSR 24-16-044, § 388-106-2155, filed 7/30/24, effective 8/30/24.]

Services provided under this program are paid by state only funds. While DSHS is paying for services under this contract for a client, there will be no reduction in the amount a client must pay towards client responsibility to account for costs and fees associated with establishi…

This program only pays for guardianship and conservatorship services of one contractor per case. In the event that the court orders a split appointment amongst multiple contracted providers, DSHS will only pay the guardian.[Statutory Authority: RCW 43.17.060, 43.20B.030, and 74.0…