reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-730 - Methodology for reducing a nursing facility's medicaid payment rate in order to reduce the statewide weighted average nursing facility medicaid payment rate to equal or be less than the weighted average payment rate identified in the Biennial Appropriations Act

Current through Register Vol. 24-14, July 15, 2024
(1)
				The department will determine a percentage reduction factor (PRF) that, when
				applied to all nursing facilities' rates will result in a statewide weighted
				average payment rate that is equal to or less than the weighted average payment
				rate identified in the Biennial Appropriations Act.
(2) By applying various percentages to the
				rates for all nursing facilities, the department will identify a percentage
				that reduces the statewide weighted average payment rate equal to or less than
				the weighted average payment rate identified in the Biennial Appropriations
				Act.
(3) The percentage identified
				in subsection (2) of this section will be the PRF. To reduce the statewide
				average payment rate to less than or equal to the weighted average payment rate
				identified in the Biennial Appropriations Act, the department will apply the
				PRF equally to all rate component allocations of each nursing facility's
				rate.
Statutory Authority:
					 RCW
					 74.46.431(11) and (12),
					 74.46.800, chapter 74.46 RCW, 2004
					 c 276 § 913, 2001 1st sp.s. c 8. 04-21-027, § 388-96-730, filed
					 10/13/04, effective 11/13/04. Statutory Authority: Chapter 74.46 RCW, 1999 c
					 376 § 3 amending c 309 § 207. 99-24-084, § 388-96-730, filed
					 11/30/99, effective 12/31/99.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-731 - Nursing facilities' rate reductions pursuant to RCW 74.46.421

Current through Register Vol. 24-14, July 15, 2024
Under
				  RCW
				  74.46.421, the department will reduce the
				  rate for each nursing facility when the statewide weighted average payment rate
				  for all nursing facilities exceeds or is likely to exceed the weighted average
				  payment rate identified in the Biennial Appropriations Act.
Statutory Authority:
					 RCW
					 74.46.431(11) and (12),
					 74.46.800, chapter 74.46 RCW, 2004
					 c 276 § 913, 2001 1st sp.s. c 8. 04-21-027, § 388-96-731, filed
					 10/13/04, effective 11/13/04. Statutory Authority: Chapter 74.46 RCW, 1999 c
					 376 § 3 amending c 309 § 207. 99-24-084, § 388-96-731, filed
					 11/30/99, effective 12/31/99.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-738 - What default case mix group and weight must the department use for case mix grouping when there is no minimum data set resident assessment for a nursing facility resident?

Current through Register Vol. 24-14, July 15, 2024
(1) When a
				resident:
(a) Expires before the facility
				completes the resident's initial assessment, the department must assign the
				assessment to the special care case mix group - HD2. The department must use
				the case mix weight assigned to the special care case mix group - HD2. The
				department will count the case as a medicaid resident;
(b)Is discharged to an acute care facility
				before the nursing facility completes the resident's initial assessment, the
				department must assign the assessment to the special care case mix group - HD2.
				The department must use the case mix weight assigned to the special care case
				mix group - HD2. The department will count the case as a medic-aid resident;
				or
(c) Is discharged for a reason
				other than those noted above before the facility completes the resident's
				initial assessment, the department must assign the assessment to the case mix
				group BC1 . The department will count the case as a medicaid
				resident.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-739 - How will the department determine which resident assessments are medicaid resident assessments?

Current through Register Vol. 24-14, July 15, 2024
The department must identify a medicaid resident assessment
				  through the review of the minimum data set (MDS) medicaid number field. If the
				  nursing facility completes the MDS medicaid number field with a valid medicaid
				  number or the appropriate code for medicaid pending, then the department will
				  count the case as a medicaid resident assessment.
Statutory Authority: Chapter 74.46 RCW as amended by 1998 c
					 322 §§ 22, 24 and 25 and
					 RCW
					 74.46.800. 98-20-023, § 388-96-739,
					 filed 9/25/98, effective 10/1/98.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-744 - How will the department set the therapy care rate and determine the median cost limit per unit of therapy? (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW as amended by 1998 c
					 322 § 26 and
					 RCW
					 74.46.800. 98-20-023, § 388-96-744,
					 filed 9/25/98, effective 10/1/98.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-746 - How much therapy consultant expense for each therapy type will the department allow to be added to the total allowable one-on-one therapy expense? (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW as amended by 1998 c
					 322 § 26 and
					 RCW
					 74.46.800. 98-20-023, § 388-96-746,
					 filed 9/25/98, effective 10/1/98.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-747 - Constructed, remodeled or expanded facilities (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-747, filed
					 2/14/11, effective 2/26/11. Statutory Authority: Chapter 74.46 RCW as amended
					 by 1998 c 322 § 19(12) and
					 RCW
					 74.46.800. 98-20-023, § 388-96-747,
					 filed 9/25/98, effective 10/1/98.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-748 - Financing allowance component rate allocation (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-748, filed
					 2/14/11, effective 2/26/11. Statutory Authority: Chapter 74.46 RCW, 1999 c 376
					 § 3 amending c 309 § 207. 99-24-084, § 388-96-748, filed
					 11/30/99, effective 12/31/99.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-757 - Payment for veterans' homes

Current through Register Vol. 24-14, July 15, 2024
Payment rates to nursing facilities operated by the state of
				  Washington, department of veterans' affairs shall be determined in accordance
				  with chapter 74.46 RCW and this chapter as for all other
				  facilities.
Statutory Authority:
					 RCW
					 74.09.120 and
					 74.46.800. 98-20-023, §
					 388-96-757, filed 9/25/98, effective 10/1/98; 93-19-074 (Order 3634), §
					 388-96-757, filed 9/14/93, effective
					 10/15/93.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-758 - Add-on for low-wage workers

Current through Register Vol. 24-14, July 15, 2024
(1)  A
				nursing home may use the low-wage worker add-on only for in-house staff and not
				for allocated, home office, or purchased service increases. A nursing home may
				use the add-on to:
(a)  Increase wages,
				benefits, or staffing levels for certified nurse aides;
(b)  Increase wages or benefits but not
				staffing levels for dietary aides, housekeepers, laundry aides, or any other
				category of worker whose statewide average dollars-per-hour wage was less than
				fifteen dollars in calendar year 2008, according to cost report data,
				including:
(i)  Activities directors and
				assistants;
(ii)  Patient choices
				coordinators;
(iii)  Central
				supply/ward clerks;
(iv)  Expanded
				community service workers; and
(v) 
				Social workers; and
(c) 
				Address wage compression for related job classes immediately affected by wage
				increases to low-wage workers.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-759 - Standards for low-wage worker add-on

Current through Register Vol. 24-14, July 15, 2024
(1)
				 In accordance with WAC
				388-96-758, the low-wage worker
				add-on must be used to provide increases in wages or benefits, or to address
				resulting wage compression beginning on or after the date on which the addon is
				first included in the rate. The low-wage worker add-on may be used to increase
				staffing levels for certified nurse aides only. Nursing home contractors
				receiving the low-wage add-on may not use it to pay for increases for time
				periods that they were not receiving the low wage worker add-on.
(2)  Any type of traditional employee benefit
				is allowable. Such benefits typically fall in one of two categories: retirement
				and life or health insurance. However, nontra-ditional benefits are also
				allowable (for example, wellness benefits, subsidized meals, or assistance with
				daycare).
(3)  The employer's share
				of payroll taxes associated with wages and benefits may be covered with the
				add-on.
(4)  For purposes of wage
				compression, an "immediately affected" job class is one that is related to the
				low-wage worker category, either in the organizational structure (for example,
				it supervises the low-wage worker category) or by existing practice (for
				example, the facility has a benchmark of paying that job class a certain
				percentage more than the low-wage worker category). Facilities must be able to
				explain the basis of the relationship if requested. Because the statute refers
				to "resulting wage compression," a facility must use a portion of the add-on to
				increase wages or benefits before it may use any of the add-on to address any
				wage compression caused by such increase.
(5)
				 A facility may use the add-on in relation to any of the job
				categories listed in WAC
				388-96-758, regardless of whether
				the average wage it pays to its own employees is above fifteen dollars per
				hour, either before or after including the additional wages funded by the
				add-on.
(6)  Wages or benefits,
				including employee bonuses, otherwise properly paid with the add on will not be
				considered as unallowable costs under RCW 74.46.410(2) (x).
(7)  The low-wage worker add-on payments
				calculated in accordance with WAC
				388-96-758 and this section must
				be adjusted to the extent necessary to comply with
				RCW
				74.46.421.
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-759, filed
					 2/14/11, effective 2/26/11. Statutory Authority: 2008 c 329 § 206(9).
					 09-08-081, § 388-96-759, filed 3/30/09, effective
					 4/30/09.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-760 - Upper limits to the payment rate

Current through Register Vol. 24-14, July 15, 2024
The average payment rate for the cost report year shall not
				  exceed the contractor's average customary charges to the general public for the
				  services covered by the payment rate for the same time period. The department
				  will pay public facilities rendering such services free of charge or at a
				  nominal charge according to the methods and standards set out in this chapter.
				  The contractor shall provide as part of the annual cost report a statement of
				  the average charges for the cost report year for services covered by the
				  payment rate and supporting computations and documentation. The contractor
				  shall immediately inform the department if its payment rate does exceed
				  customary charges for comparable services. If necessary, the department will
				  adjust the payment rate in accordance with
				  RCW
				  74.46.531.
Statutory Authority: Chapter 74.46 RCW as amended by 1998 c
					 322, RCW
					 74.46.800 and
					 74.09.120. 98-20-023, §
					 388-96-760, filed 9/25/98, effective 10/1/98. Statutory Authority:
					 RCW
					 74.46.800 and
					 74.09.120. 91-12-026 (Order 3185),
					 § 388-96-760, filed 5/31/91, effective 7/1/91. Statutory Authority:
					 RCW
					 74.09.120. 84-24-050 (Order 2172), §
					 388-96-760, filed 12/4/84; 83-19-047 (Order 2025), § 388-96-760, filed
					 9/16/83; 81-22-081 (Order 1712), § 388-96-760, filed 11/4/81. Statutory
					 Authority:
					 RCW
					 74.08.090 and
					 74.09.120. 78-06-080 (Order 1300),
					 § 388-96-760, filed 6/1/78. Statutory Authority:
					 RCW
					 74.09.120. 78-02-013 (Order 1264), §
					 388-96-760, filed 1/9/78.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-762 - Allowable land (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 74.46.800. 96-15-056, § 388-96-762,
					 filed 7/16/96, effective 8/16/96. Statutory Authority:
					 RCW
					 74.46.800 and
					 74.09.120. 93-19-074 (Order 3634),
					 § 388-96-762, filed 9/14/93, effective 10/15/93. Statutory Authority:
					 RCW
					 74.46.800. 84-12-039 (Order 2105), §
					 388-96-762, filed 5/30/84.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-766 - Notification

Current through Register Vol. 24-14, July 15, 2024
(1)
(a) The contractor must inform the department
				of its current electronic mail (e-mail) address at which it wants to receive
				rate notifications. It is the responsibility of the contractor to inform the
				department of any changes to the e-mail address at which it wants to receive
				notice of the department's actions. The department may notify each contractor
				by e-mail using the contractor's supplied email address of its prospective
				medicaid payment rate allocation and/or any actions that result in a change to
				the contractor's prospective medicaid payment rate allocation. The date of the
				department's notification e-mail will be used to determine whether the
				notification and the contractor's response met any legal requirements,
				irrespective of when the contractor read the e-mail.
(b) When the contractor seeks to appeal or
				take exception to a department action taken under authority of this chapter or
				chapter 74.46 RCW and eligible for administrative review under WAC
				388-96-901, it shall comply with
				WAC 388-96-904 when requesting an
				administrative review conference.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-767 - Appraisal values (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW, 1999 c 376 § 3
					 amending c 309 § 207. 99-24-084, § 388-96-767, filed 11/30/99,
					 effective 12/31/99. Statutory Authority:
					 RCW
					 74.46.800. 84-12-039 (Order 2105), §
					 388-96-767, filed 5/30/84.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-771 - Receivership

Current through Register Vol. 24-14, July 15, 2024
(1) If the nursing
				home is providing care to recipients of state medical assistance, the receiver
				shall:
(a) Become the medicaid contractor for
				the duration of the receivership period;
(b) Assume all reporting responsibilities for
				new contractors;
(c) Assume all
				other responsibilities for new contractors set forth in this chapter;
				and
(d) Be responsible for the
				refund of medicaid rate payments in excess of costs during the period of
				receivership.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-776 - Add-ons to the property and financing allowance payment rate - Capital improvements (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-776, filed
					 2/14/11, effective 2/26/11. Statutory Authority:
					 RCW
					 74.46.431(11) and (12),
					 74.46.800, chapter 74.46 RCW, 2004
					 c 276 § 913, 2001 1st sp.s. c 8. 04-21-027, § 388-96-776, filed
					 10/13/04, effective 11/13/04. Statutory Authority:
					 RCW
					 74.46.800. 01-12-037, § 388-96-776,
					 filed 5/29/01, effective 6/29/01. Statutory Authority: Chapter 74.46 RCW, 1999
					 c 376 § 3 amending c 309 § 207. 99-24-084, § 388-96-776, filed
					 11/30/99, effective 12/31/99. Statutory Authority: Chapter 74.46 RCW as amended
					 by 1998 c 322 § 19(12) and
					 RCW
					 74.46.800. 98-20-023, § 388-96-776,
					 filed 9/25/98, effective 10/1/98. Statutory Authority: RCW 74.46.465.
					 97-17-040, § 388-96-776, filed 8/14/97, effective 9/14/97. Statutory
					 Authority:
					 RCW
					 74.46.800. 96-15-056, § 388-96-776,
					 filed 7/16/96, effective 8/16/96. Statutory Authority:
					 RCW
					 74.46.800 and 1995 1st sp.s. c 18. 95-19-037
					 (Order 3896), § 388-96-776, filed 9/12/95, effective 10/13/95. Statutory
					 Authority:
					 RCW
					 74.46.800. 94-12-043 (Order 3737), §
					 388-96-776, filed 5/26/94, effective
					 6/26/94.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-777 - Add-ons to the prospective rate - Initiated by the department

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				shall initiate all rate add-ons granted under this section. Contractors may not
				request and be approved a rate add-on under this section.
(2) Rate add-ons the department grants under
				the authority of this section shall be for costs to implement:
(a) Program changes that the director of
				residential care services, aging and adult services administration determines a
				rate add-on is necessary to accomplish the purpose of the change and announces
				same in a written directive to the chief of the office of rates management;
				or
(b) Changes in either the state
				or federal statutes or regulations or directives that the director of
				management services, aging and adult services administration determines
				requires a rate add-on to implement and directs in writing the chief of the
				office of rates management to implement.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-781 - Exceptional care rate add-on Covered medicaid residents

Current through Register Vol. 24-14, July 15, 2024
A nursing facility (NF) may receive an increase in its
				  direct care rate allocations for providing exceptional care to a medicaid
				  resident who:
(1)  Receives
				specialized services to meet chronic complex medical conditions and
				neurodevelopment needs of medically fragile children and resides in a NF where
				all residents are under age twenty-one with at least fifty percent of the
				residents entering the facility before the age of fourteen;
(2)  Receives expanded community services
				(ECS) ;
(3)  Is admitted to a NF as
				an extraordinary medical placement (EMP) and the department of corrections
				(DOC) has approved the exceptional direct care ;
(4)  Is ventilator or tracheotomy (VT)
				dependent and resides in a NF that the department has designated as active
				ventilator-weaning center;
(5)  Has
				a traumatic brain injury (TBI) established by a comprehensive assessment
				reporting evaluation (CARE) assessment administered by department staff and
				resides in a NF that the department has designated as capable for TBI
				patients;
(6)  Has a TBI and
				currently resides in nursing facility specializing in the care of TBI residents
				where more than fifty percent of residents are classified with TBIs based on
				the federal minimum data set assessment (MDS 3.0 or its successor) ;
				or
(7)  Is admitted to a NF from a
				hospital with an exceptional care need and medicaid purchasing administration
				(MPA) or a successor administration has approved the exceptional direct care
				payment.
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-781, filed
					 2/14/11, effective 2/26/11. Statutory Authority:
					 RCW
					 74.46.800,
					 74.46.508. 00-12-098, §
					 388-96-781, filed 6/7/00, effective
					 7/8/00.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-782 - Exceptional direct care - Payment

Current through Register Vol. 24-14, July 15, 2024
(1)
				 For WAC
				388-96-781(1)
				residents, the department will pay the Oregon medic-aid rate.
(2)  For WAC
				388-96-781(4), (5), (6), and
				(7) residents, the department may establish a
				rate add-on that when added to the nursing facility's per diem medicaid rate
				does not exceed the cost of caring for the client in a hospital.
(3)  Costs related to payments resulting from
				increases in direct care component rates under subsection (2) of this section
				must be offset against the facility's examined, allowable direct care costs,
				for each report year or partial period such increases are paid. Such reductions
				in allowable direct care must be for rate setting, settlement, and other
				purposes deemed appropriate by the department.
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-782, filed
					 2/14/11, effective 2/26/11. Statutory Authority:
					 RCW
					 74.46.431(11) and (12),
					 74.46.800, chapter 74.46 RCW, 2004
					 c 276 § 913, 2001 1st sp.s. c 8. 04-21-027, § 388-96-782, filed
					 10/13/04, effective 11/13/04. Statutory Authority:
					 RCW
					 74.46.800,
					 74.46.508. 00-12-098, §
					 388-96-782, filed 6/7/00, effective
					 7/8/00.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-783 - Certificate of capital authorization (CCA) (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority:
					 RCW
					 74.46.807,
					 74.46.431, chapter 74.46 RCW, 2004
					 c 276 § 913, 2001 1st sp.s. c 8. 04-21-027, § 388-96-783, filed
					 10/13/04, effective 11/13/04.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-784 - Expense for construction interest (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-784, filed
					 2/14/11, effective 2/26/11.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-785 - Supplemental payments

Current through Register Vol. 24-14, July 15, 2024
To the extent the federal government approves such payments
				  under the state's plan for medical assistance, and only to the extent that
				  funds are specifically appropriated for this purpose in the biennial
				  appropriations act, the department shall make supplemental payments to nursing
				  facilities operated by public hospital districts. The payments shall be
				  calculated and distributed in accordance with the terms and conditions
				  specified in the biennial appropriations act. The payments shall be
				  supplemental to the component rate allocations calculated in accordance with
				  Part E of chapter 74.46 RCW and the related sections of this chapter neither
				  the provisions of Part E of chapter 74.46 RCW nor the settlement provisions of
				  this chapter apply to these supplemental payments.
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-785, filed
					 2/14/11, effective 2/26/11.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-786 - Pay for performance add-on (Repealed)

Current through Register Vol. 24-14, July 15, 2024
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-786, filed
					 2/14/11, effective 2/26/11.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-802 - Billing/payment

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				will pay nursing facility (NF) contractors for the first day of a medicaid
				resident's stay but not the last day.
(2) The department will pay a contractor for
				service rendered under the facility contract and billed in accordance with the
				department's billing procedure. The amount paid will be computed using the
				appropriate rates assigned to the contractor. For each recipient, the
				department will pay an amount equal to the appropriate rates, multiplied by the
				number of medicaid resident days each rate was in effect, less the amount the
				recipient is required to pay for his or her care as set forth by WAC
				388-96-803.
(3) A NF contractor shall not bill the
				department for service provided to a medicaid recipient until an award letter
				of eligibility for the recipient under rules established under the authority of
				chapter 74.09 RCW has been received by the facility. However a facility may
				bill and shall be reimbursed for all medical care recipients referred to the
				facility by the department prior to the receipt of the award letter of
				eligibility or the denial of such eligibility.
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-802, filed
					 2/14/11, effective 2/26/11. Statutory Authority:
					 RCW
					 74.46.800. 01-12-037, § 388-96-802,
					 filed 5/29/01, effective 6/29/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-803 - Notification of participation - Responsibility to collect - Reporting medicaid recipient's changes in income/resources - Rate payment in full for services

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				will notify a contractor of the amount each medical recipient is required to
				participate in the cost of his or her care and the effective date of the
				required participation. The contractor must collect the participation from the
				patient and to account for any authorized reductions from the
				participation.
(2) Within
				seventy-two hours of becoming aware of a change in the medicaid resident's
				income and/or resources, the NF contractor will report the change in writing to
				the home and community services office serving the area in which the NF is
				located. When reporting the change, the NF contractor will include copies of
				any available documentation of the change in the medicaid resident's income
				and/or resources.
(3) For each
				medicaid resident, the contractor shall accept the payment rates established by
				the department multiplied by the number of medicaid resident days each rate was
				in effect, less the amount the recipient is required to pay for his or her care
				as set forth in WAC
				388-96-803(1) as
				full compensation for all services provided under the contract, certification
				as specified by Title XIX, and licensure under
				chapter
				18.51 RCW. The contractor
				shall not seek or accept additional compensation from or on behalf of a
				recipient for any or all such services.
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-803, filed
					 2/14/11, effective 2/26/11. Statutory Authority:
					 RCW
					 74.46.800. 01-12-037, § 388-96-803,
					 filed 5/29/01, effective 6/29/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-805 - Suspension of payments

Current through Register Vol. 24-14, July 15, 2024
(1) The
				department may withhold payments to a contractor in each of the following
				circumstances:
(a) A required report is not
				properly completed and filed by the contractor within the appropriate time
				period, including any approved extension. Payments will be released as soon as
				a properly completed report is received;
(b) State auditors, department auditors, or
				authorized personnel in the course of their duties are refused access to a
				nursing facility or are not provided with existing appropriate records.
				Payments will be released as soon as such access or records are
				provided;
(c) A refund in
				connection with a settlement or rate adjustment is not paid by the contractor
				when due. The amount withheld will be limited to the unpaid amount of the
				refund and any accumulated interest owed to the department as authorized by
				this chapter;
(d) Payment for the
				final sixty days of service prior to termination or assignment of a contract
				will be held in the absence of adequate alternate security acceptable to the
				department pending settlement of all periods when the contract is terminated or
				assigned; and
(e) Payment for
				services at any time during the contract period in the absence of adequate
				alternate security acceptable to the department, when a contractor's net
				medicaid overpayment liability for one or more nursing facilities or other debt
				to the department, as determined by settlement, civil fines imposed by the
				department, third-party liabilities or other source, reaches or exceeds fifty
				thousand dollars, whether subject to good faith dispute or not, and for each
				subsequent increase in liability reaching or exceeding twenty-five thousand
				dollars. Payments will be released as soon as practicable after acceptable
				security is provided or refund to the department is made.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-808 - Change of ownership - Assignment of department's contract

Current through Register Vol. 24-14, July 15, 2024
(1) On the
				effective date of a change of ownership the department's contract with the old
				owner shall be automatically assigned to the new owner, unless:
(a) The new owner does not desire to
				participate in medicaid as a nursing facility provider;
(b) The department elects not to continue the
				contract with the new owner; or
(c)
				The new owner elects not to accept assignment and requests certification and a
				new contract. The old owner shall give the department sixty days' written
				notice of such intent to change ownership and assign. When certificate of need
				and/or section 1122 approval is required pursuant to chapter 70.38 RCW and Part
				100, Title 42 C.F.R., for
				the new owner to acquire the facility, and the new owner wishes to continue to
				provide service to recipients without interruption, certificate of need and/or
				section 1122 approval shall be obtained before the old owner submits a notice
				of intent to change ownership and assign.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-809 - Change of ownership-Final reports-Settlement securities

Current through Register Vol. 24-14, July 15, 2024
(1) When there is a change of ownership for
				any reason, final reports shall be submitted as required by WAC
				388-96-022.
(2) Upon a notification of intent to change
				ownership, the department shall determine by settlement or reconciliation the
				amount of any overpayments made to the assigning or terminating contractor,
				including overpayments disputed by the assigning or terminating contractor. If
				settlements are unavailable for any period up to the date of assignment or
				termination, the department shall make a reasonable estimate of any overpayment
				or underpayments for such periods. The reasonable estimate shall be based upon
				prior period settlements, available audit findings, the projected impact of
				prospective rates, and other information available to the department. The
				department shall also determine and add in the total of all other debts and
				potential debts owed to the department regardless of source, including, but not
				limited to, interest owed to the department as authorized by this chapter,
				civil fines imposed by the department, or third-party liabilities.
(3)For all cost reports, the assigning or
				terminating contractor shall provide security, in a form deemed adequate by the
				department, equal to the total amount of determined and estimated overpayments
				and all debts and potential debts from any source, whether or not the
				overpayments are the subject of good faith dispute including but not limited
				to, interest owed to the department, civil fines imposed by the department, and
				third-party liabilities. Security shall consist of one or more of the
				following:
(a)Withheld payments due the
				assigning or terminating contractor under the contract being assigned or
				terminated;
(b)An assignment of
				funds to the department;
(c)The new
				contractor's assumption of liability for the prior contractor's debt or
				potential debt;
(d)An authorization
				to withhold payments from one or more medicaid nursing facilities that continue
				to be operated by the assigning or terminating contractor;
(e)A promissory note secured by a deed of
				trust; or
(f)Other collateral or
				security acceptable to the department.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-901 - Disputes

Current through Register Vol. 24-14, July 15, 2024
(1)  When a
				contractor wishes to contest the way in which the department applied a statute
				or department rule to the contractor's circumstances, the contractor must
				pursue the administrative review process prescribed in WAC
				388-96-904.
(a)  Adverse actions taken under the
				authority of this chapter or chapter 74.46 RCW subject to administrative review
				under WAC
				388-96-904 include but are not
				limited to the following:
(i)  Determining a
				nursing facility payment rate;
(ii)
				 Calculating a nursing facility settlement;
(iii)  Imposing a civil fine on the nursing
				facility;
(iv)  Suspending payment
				to a nursing facility; and
(v) 
				Conducting trust fund and accounts receivable audits.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-904 - Administrative review - Adjudicative proceeding

Current through Register Vol. 24-14, July 15, 2024
(1)
(a) A
				contractor seeking an administrative review of an adverse action or
				determination of the department taken under authority of this chapter or
				chapter 74.46 RCW and eligible for administrative review under WAC
				388-96-901, shall file a written
				request for an administrative review conference with the office of rates
				management within twenty-eight calendar days after receiving notice of the
				department's action or determination.
(b) When the department has sent written
				notice by United States mail, it shall deem the contractor to have received the
				department's notice five calendar days after the date of the notification
				letter, unless proof of the date of receipt of the department's notification
				letter exists, in which case the actual date of receipt shall be used to
				determine timeliness of the contractor's request for an administrative review
				conference. When the department has electronically mailed (e-mail) written
				notice, the date of the department's notification e-mail will be the date of
				receipt by the contractor irrespective of when the contractor reads the
				e-mail.
(c) The contractor's
				request for administrative review shall:
(i)
				Be signed by the contractor or by a partner, officer, or authorized employee of
				the contractor;
(ii) State the
				particular issues raised; and
(iii)
				Include all necessary supporting documentation or other information.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-905 - Case mix accuracy review of MDS nursing facility resident assessments

Current through Register Vol. 24-14, July 15, 2024
(1) The department
				shall perform periodic nursing facility on-site accuracy reviews of minimum
				data set (MDS) assessments of nursing facility residents, for the purpose of
				verifying the accuracy of facility case mix data used to establish and update
				medicaid payment rates, and for other purposes the department may deem
				appropriate.
(2) Contractors, their
				representatives, and authorized nursing facility personnel may ask questions
				and raise concerns with the quality assurance nurse (QAN) or other designated
				department representative at the time a case mix accuracy review is conducted.
				Contractors, their representatives and authorized nursing facility personnel
				should attempt to resolve any differences and provide additional documentation,
				information or clarification prior to the case mix accuracy review exit
				conference.
(3) Upon completing a
				case mix accuracy review, the QAN shall hold an exit conference to inform the
				facility of the QAN's observations and preliminary findings. MDS inaccuracies,
				if any, will be identified and the findings that substantiate these
				inaccuracies shall be described.
(4) Within five working days after the case
				mix accuracy review exit conference is held, the nursing facility district
				manager (DM) for the facility's district shall send the case mix accuracy
				review decision letter to the nursing facility administrator at the facility
				address. The case mix accuracy review decision letter shall be sent certified
				mail, return receipt requested, shall describe in detail the QAN's findings,
				and shall identify the:
(a) Resident
				assessments that were reviewed;
(b)
				RUG-III or other applicable case mix grouping that was determined for the
				resident assessments reviewed;
(c)
				Changes in assigned classification, if any, that were made for residents whose
				assessments were reviewed;
(d)
				Right of the contractor to appeal any disagreement with the case mix accuracy
				review decision to the department's case mix accuracy review administrator or
				his or her delegate:
(i) Where to send an
				appeal request; and
(ii) The time
				limit for requesting an appeal.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-906 - Section captions

Current through Register Vol. 24-14, July 15, 2024
Section captions as used in this chapter do not constitute
				  any part of the rule.
Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c
					 34, and 2010 1st sp.s. c 37 § 958. 11-05-068, § 388-96-906, filed
					 2/14/11, effective 2/26/11.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-915 - Capital component - Square footage

Current through Register Vol. 24-14, July 15, 2024
(1)
				 Allowable nursing home square footage is the external dimensions
				of the building utilized and licensed as a nursing home less all unallowable
				square footage as outlined in subsection (2) of this section. Allowable nursing
				home square footage includes the following:
(a)
				 All necessary, ordinary, and reasonable space on the campus or
				adjacent to the campus utilized by the residents and staff of the nursing home
				including in administrative and support capacities; and
(b)  Basements to the extent they are
				utilized for administrative or support functions including the storage of
				equipment and records.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-916 - Capital component - Facility age

Current through Register Vol. 24-14, July 15, 2024
(1)
				 The average age of a facility is the actual facility age reduced
				for significant renovations.
(2) 
				For the rate beginning July 1, 2016, the department must use renovations data
				back to 1994 as submitted on facility cost reports to determine an initial
				age.
(3)  Beginning July 1, 2016:
(a)  Facilities must all be re-aged to one
				year older on December 31st of each year.
(b)
				 Facility ages must be reduced during review of the cost report if
				the value of the renovation completed in any calendar year exceeds two thousand
				dollars times the number of licensed beds. In order to calculate the new age,
				the cost of the renovation must be divided by the accumulated depreciation per
				bed in the year of the renovation to determine the equivalent number of new
				replacement beds. The new age for the facility is a weighted average with the
				replacement bed equivalents reflecting an age of zero and the existing licensed
				beds, minus the new bed equivalents, reflecting their age in the year of the
				renovation.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-96 - Wage equity funding › Section 388-96-917 - Direct care - County wage information

Current through Register Vol. 24-14, July 15, 2024
(1)
				 The department must calculate a county wide wage index each
				rebase year by utilizing the most recent average wage data available from the
				federal bureau of labor statistics for registered nurses, licensed practical
				nurses, and certified nursing assistants.
(2)
				 For each county, the department must calculate an average
				combined wage for all three disciplines based on the percentage of total wages
				by discipline from the prior year cost report. Each wage must be multiplied by
				the relative utilization percentage for that discipline. The total of all three
				disciplines is the average wage in that county.
(3)  The department must calculate the
				statewide average combined wage for all three disciplines based on the average
				percentage of total wages by discipline from the prior year cost
				report.
(4)  The county index is
				determined by dividing the county average wage in a given county by the
				statewide average wage.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-97 - Nursing homes › Subchapter I - RESIDENT RIGHTS, CARE AND RELATED SERVICES › Admission, Transfer and Discharge › Section 388-97-0020 - Nursing facility care

Current through Register Vol. 24-14, July 15, 2024
The nursing facility must provide items, care, and
						services in accordance with this chapter and with federal regulations under 42
						C.F.R. § 483.1 through 483.206, or successor laws, and other applicable
						federal requirements.
Statutory Authority:
						  Chapters
						  18.51 and
						  74.42 RCW and 42 C.F.R. 489.52.
						  08-20-062, § 388-97-0020, filed 9/24/08, effective
						  11/1/08.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-97 - Nursing homes › Subchapter I - RESIDENT RIGHTS, CARE AND RELATED SERVICES › Admission, Transfer and Discharge › Section 388-97-0040 - Discrimination prohibited

Current through Register Vol. 24-14, July 15, 2024
(1) A nursing
					 facility must establish and maintain identical policies and practices regarding
					 transfer, discharge, and the provision of services covered under the state
					 medicaid plan for all individuals regardless of source of payment.
(2) A nursing facility must not require or
					 request:
(a) Residents or potential residents
					 to waive their rights to medicare or medicaid;
(b) Oral or written assurance that residents
					 or potential residents are not eligible for, or will not apply for medicare or
					 medicaid benefits; and
(c) A third
					 party guarantee of payment to the facility as a condition of admission or
					 expedited admission, or continued stay in the facility. However, the facility
					 may require an individual who has legal access to a resident's income or
					 resources available to pay for facility care to sign a contract, without
					 incurring personal financial liability, to provide facility payment from the
					 resident's income or resources.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-97 - Nursing homes › Subchapter I - RESIDENT RIGHTS, CARE AND RELATED SERVICES › Admission, Transfer and Discharge › Section 388-97-0060 - Nursing facility admission and payment requirements

Current through Register Vol. 24-14, July 15, 2024
Refer to WAC
						388-106-0350 through
						388-106-0360.
Statutory Authority:
						  Chapters
						  18.51 and
						  74.42 RCW and 42 C.F.R. 489.52.
						  08-20-062, § 388-97-0060, filed 9/24/08, effective
						  11/1/08.