reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0755 - Can a provider disagree with a final settlement report?

Current through Register Vol. 24-14, July 15, 2024
A provider has thirty days after receiving a final
					 settlement report to contest it (see WAC
					 388-835-0950 and
					 388-835-0955 ). After thirty
					 days, if the final settlement report has not been contested, it cannot be
					 reviewed.
Statutory Authority:
						RCW
						71A.16.010,
						71A.16.030,
						71A.12.030, chapter 71A.20 RCW,
						RCW
						72.01.090, and 72.33.125. 02-16-014, §
						388-835-0755, filed 7/25/02, effective 8/25/02. Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0755,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0760 - What if DSHS conducts an audit during the final settlement process?

Current through Register Vol. 24-14, July 15, 2024
(1) If DSHS
				  conducts an audit, it must issue a final settlement report to the provider
				  after the audit process is completed. Completing the audit process includes
				  exhausting or mutual terminating the reviews and/or appeals of audit findings
				  or determinations.
(2) If a
				  provider, in good faith, is disputing audit findings or determinations through
				  the administrative review or judicial appeal process, DSHS may issue a partial
				  final settlement report to recover overpayments based on audit findings or
				  determinations not being disputed.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0760,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0765 - Why is a state facility settlement important?

Current through Register Vol. 24-14, July 15, 2024
The state facility settlement is determined to establish a
					 state facility's final payment.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0765,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0770 - How is a state facility settlement calculated?

Current through Register Vol. 24-14, July 15, 2024
The settlement must be calculated as follows:
(1) If the state facility's allowable costs
				  for the report period are greater than their interim payment, the amount owed
				  to the facility is the allowable cost amount minus the interim
				  payment.
(2) If the state
				  facility's allowable costs for the report period are less than their interim
				  payment, the amount owed by the department is the interim payment minus the
				  allowable cost amount.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0770,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0775 - How is a state facility settlement implemented?

Current through Register Vol. 24-14, July 15, 2024
(1) The settlement is implemented in a
				  two-step process consisting of the facility first submitting a proposed
				  preliminary settlement to DSHS and DSHS responding with a final settlement
				  report that it submits to the state facility.
(2) The proposed preliminary settlement must
				  be:
(a) Submitted to DSHS when the state
				  facility submits their cost report.
(b) Responded to by DSHS within one hundred
				  twenty days after they receive it from the state facility. DSHS must verify the
				  accuracy of the facility's proposal and issue a preliminary settlement
				  substantiating the settlement amount.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0780 - Does DSHS have a responsibility to notify each provider regarding prospective reimbursement rates?

Current through Register Vol. 24-14, July 15, 2024
(1)
				  DSHS must give written notification to each provider regarding DSHS's
				  prospective reimbursement rate.
(2)
				  Unless specified at the time the reimbursement rate is issued, the rate will be
				  effective from the first day of the month the rate is issued until a new rate
				  becomes effective.
(3) If a rate is
				  changed because of a successful provider appeal, the effective date of the new
				  rate is the same as the effective date of the old rate.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0780,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0785 - Can DSHS increase prospective reimbursement rates?

Current through Register Vol. 24-14, July 15, 2024
(1) Except for the situations described in
				  subsection (3) and (4) of this section, DSHS prospective reimbursement rates
				  are the maximum provider payment rates for those periods to which they
				  apply.
(2) DSHS does not grant rate
				  adjustments for cost increases that are or were subject to management control
				  or negotiations. Examples include, but are not limited to, all lease cost
				  increases or any cost increases not expressly authorized in subsection (3) and
				  (4).
(3) DSHS does adjust rates for
				  any capitalized additions or replacements made as a condition for licensure or
				  certification.
(4) DSHS does adjust
				  rates for cost increases that must be incurred and cannot be met through the
				  provider's prospective rate. Examples of such cost increases are:
(a) Program changes required by
				  DSHS;
(b) Changes in staffing
				  levels or consultants at a facility required by DSHS;
(c) Changes required by a survey;
				  and
(d) Changes in revenue
				  assessments required by the state legislature.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0790 - How does a provider request a rate increase?

Current through Register Vol. 24-14, July 15, 2024
(1) Any provider requesting a rate adjustment
				  must submit a:
(a) Financial analysis showing
				  the increased cost and an estimate of the rate increase needed to cover the
				  increased cost. The estimated rate increase must be computed according to
				  allowable methods;
(b) Written
				  justification for granting the rate increase; and
(c) Certification and documentation that show
				  the staffing changes and/or other improvements started or completed.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › SETTLEMENTS › Section 388-835-0795 - What requirements apply to providers who receive rate increases?

Current through Register Vol. 24-14, July 15, 2024
(1) Providers that
				  receive prospective rate increases may be required to submit quarterly reports
				  showing how the additional funds were spent. If required, a quarterly report
				  would begin on the first day of the month following the date the rate increase
				  is granted.
(2) If the additional
				  funds resulting from the rate increase are not spent on DSHS approved changes
				  or improvements approved, DSHS may ask that they be returned
				  immediately.
(3) If a facility
				  gives written notice to DSHS that it intends to close by a specific date and
				  that returning the funds would jeopardize its ability to provide for the
				  health, safety, and welfare of its residents, it may not have to return the
				  additional funds.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0795,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › ERRORS AND OMISSIONS › Section 388-835-0800 - What if DSHS discovers that a prospective rate calculation was affected by an error or omission?

Current through Register Vol. 24-14, July 15, 2024
(1) DSHS may
				  adjust prospective rates resulting from cost report errors, computational
				  errors or omissions by either DSHS or the provider.
(2) In addition to adjusting the rate, DSHS
				  must notify the provider in writing:
(a)
				  Regarding the nature and substance of each adjustment;
(b) That the effective date of each
				  adjustment is the same as the effective date of the original rate;
				  and
(c) Of any amount due to either
				  DSHS or the provider as a result of an adjustment.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › ERRORS AND OMISSIONS › Section 388-835-0805 - What if a provider discovers an error or omission that affected their cost report?

Current through Register Vol. 24-14, July 15, 2024
(1) If a provider
				  discovers an error or omission that caused their cost report to be incorrect,
				  the provider must submit amended cost report pages.
(2) Amended cost report pages must be
				  certified and accompanied by a written explanation why the amendment is
				  necessary. Amendments are not accepted by DSHS unless they comply with the
				  requirements in WAC
				  388-835-0815.
(3) If DSHS concludes that the amendment
				  changes are material, the amended pages must be audited by a field
				  audit.
(4) If DSHS concludes that
				  the amendments are incorrect or unacceptable as a result of the field audit or
				  other information it receives, any rate adjustment based on the amendments is
				  null and void. Any scheduled future rate payment increases resulting from the
				  amendments must be canceled immediately.
(5) Any rate adjustment payments must be made
				  according to the repayment provisions in WAC
				  388-835-0905.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0805,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › ERRORS AND OMISSIONS › Section 388-835-0810 - What other requirements apply to rate adjustments resulting from errors or omissions?

Current through Register Vol. 24-14, July 15, 2024
(1) No
				  adjustment can be made to a rate more than:
(a) One hundred twenty days after the field
				  audit narrative and summary is sent to the provider; or
(b) One hundred twenty days after a
				  preliminary settlement becomes a final settlement.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › ERRORS AND OMISSIONS › Section 388-835-0815 - What requirements apply to repayment of amounts owed due to errors or omissions?

Current through Register Vol. 24-14, July 15, 2024
(1) Repayment
				  (or starting repayment) of any amount owed to DSHS by a provider as a result of
				  an error or omission rate adjustment must occur:
(a) Within sixty days after the provider
				  receives a rate adjustment notification from DSHS; or
(b) According to a repayment schedule
				  developed by DSHS.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › PUBLIC REVIEW-PUBLIC DISCLOSURE › Section 388-835-0820 - What role does the public play in setting prospective reimbursement rates?

Current through Register Vol. 24-14, July 15, 2024
Each year before prospective reimbursement rates are set,
					 DSHS will give all interested members of the public an opportunity to review
					 and comment on the department's proposed rate setting methods and
					 standards.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0820,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › PUBLIC REVIEW-PUBLIC DISCLOSURE › Section 388-835-0825 - What is DSHS' public disclosure responsibility regarding rate setting methodology?

Current through Register Vol. 24-14, July 15, 2024
Without identifying individual ICF/ID facilities and in
					 compliance with public disclosure statute and rule requirements, DSHS will
					 provide the public with full and complete information regarding its rate
					 setting methodology.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0825,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › BILLING PROCEDURES AND PAYMENTS › Section 388-835-0830 - How does a provider bill DSHS for services provided?

Current through Register Vol. 24-14, July 15, 2024
(1) A provider must bill DSHS each month,
				  from the first through the last day, for care provided to medical care
				  recipients by completing and returning a statement filed according to
				  department instructions.
(2) A
				  provider cannot bill DSHS for services provided to a resident until they
				  receive a DSHS resident award letter. When the provider receives the award
				  letter, they can bill for services provided since the resident's admission or
				  eligibility date.
(3) A provider
				  cannot bill DSHS for the day of a resident's death, discharge, or transfer from
				  the ICF/ID facility.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0830,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › BILLING PROCEDURES AND PAYMENTS › Section 388-835-0835 - How does DSHS pay a provider?

Current through Register Vol. 24-14, July 15, 2024
(1)
				  DSHS will reimburse a provider for billed service rendered under the ICF/ID
				  contract according to the appropriate rate assigned to the provider.
(2) For each resident, DSHS will pay an
				  amount equal to the appropriate rates multiplied by the number of resident days
				  each rate was in effect, less any amount a resident is required to pay (see WAC
				  388-835-0940 ).
(3) A provider must accept DSHS's
				  reimbursement rates as full compensation for all services the provider is
				  obligated to provide under their contract. The provider must not seek or accept
				  additional compensation any contracted services from or on behalf of a
				  resident.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0835,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › BILLING PROCEDURES AND PAYMENTS › Section 388-835-0840 - Can DSHS withhold provider payments?

Current through Register Vol. 24-14, July 15, 2024
DSHS cannot withhold a provider payment until the provider
					 is given written notification explaining why the payment is being
					 withheld.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0840,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › BILLING PROCEDURES AND PAYMENTS › Section 388-835-0845 - Can DSHS terminate medicaid Title XIX payments to providers?

Current through Register Vol. 24-14, July 15, 2024
DSHS must terminate all medicaid Title XIX payments to a
					 provider no later than sixty days after a:
(1) Contract expires, is terminated or is not
				  renewed;
(2) Facility license is
				  revoked; or
(3) Facility is
				  decertified as a Title XIX facility.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0845,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › BILLING PROCEDURES AND PAYMENTS › Section 388-835-0850 - Who is responsible for collecting from residents any amounts they may own for their care?

Current through Register Vol. 24-14, July 15, 2024
(1) DSHS will
				  notify a provider of the amount each resident is required to pay for care
				  provided under the contract and the date the payment is due.
(2) The provider is responsible for:
(a) Collecting from the resident;
				  and
(b) Accounting for, according
				  to procedures established by DSHS, any authorized reduction in the resident's
				  contribution.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › BILLING PROCEDURES AND PAYMENTS › Section 388-835-0855 - What if a resident's circumstances change causing a provider to contribute more to the resident's care?

Current through Register Vol. 24-14, July 15, 2024
(1) If a
				  provider receives documentation verifying a change in a resident's income or
				  resources that will reduce the resident's ability to contribute to the cost of
				  their care, the provider must report this information in writing to the DDA
				  regional services office within seventy-two hours.
(2) Any necessary corrections should be made
				  in the next ICF/ID statement and a copy of the supporting documentation should
				  be attached.
(3) If a provider
				  receives increased funds for a resident, the normal amount must be allowed for
				  clothing, personal, and incidental expenses and the balance must be applied to
				  the cost of care.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0855,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › RECEIVERSHIP › Section 388-835-0860 - What is the role of a receiver when an ICF/ID facility is placed in receivership?

Current through Register Vol. 24-14, July 15, 2024
If an ICF/ID facility is providing care to state medical
					 assistance recipients and is placed under receivership, the receiver:
(1) Becomes the medicaid provider during the
				  receivership period;
(2) Assumes
				  all new provider reporting responsibilities;
(3) Assumes all other new provider
				  responsibilities established in this chapter; and
(4) Is responsible, during the receivership
				  period, for refunding any medicaid rate payments received that exceed cost of
				  services provided.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0860,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › RECEIVERSHIP › Section 388-835-0865 - How does DSHS determine prospective reimbursement rates during receivership?

Current through Register Vol. 24-14, July 15, 2024
When establishing prospective reimbursement rates during
					 receivership, DSHS must consider:
(1)
				  Court ordered compensation, if any, for the receiver. Receiver compensation may
				  already be available through the:
(a) Return
				  on equity cost center rate, or
(b)
				  Facility administrator salary where the receiver is also the facility's
				  administrator.
(c) In order to
				  satisfy the court order when existing sources of compensation are less than the
				  compensation ordered by the court, DSHS could consider the difference as an
				  additional allowable cost when establishing prospective reimbursement
				  rates.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › RECEIVERSHIP › Section 388-835-0870 - What if the court asks DSHS to recommend a receiver's compensation?

Current through Register Vol. 24-14, July 15, 2024
If asked for a recommendation regarding receiver
					 compensation by the court, DSHS must consider the:
(1) Range of compensation for private ICF/ID
				  facility managers;
(2) Experience
				  and training of the receiver;
(3)
				  Size, location, and current condition of the facility; and
(4) Additional factors considered
				  appropriate.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0870,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › RECEIVERSHIP › Section 388-835-0875 - Can DSHS give emergency or transitional financial assistance to a receiver?

Current through Register Vol. 24-14, July 15, 2024
(1) In response
				  to a court order, DSHS must give up to thirty thousand dollars of emergency or
				  transitional financial assistance to a receiver.
(2) DSHS must recover any emergency or
				  transitional assistance given to a receiver from facility generated revenue
				  that is not obligated for facility operations.
(3) If DSHS has not fully recovered the
				  emergency or transitional assistance when the receivership ends, DSHS may file:
(a) An action against the former licensee or
				  owner to recover what is owed; or
(b) A lien against the facility or the
				  proceeds from the sale of the facility.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › RECEIVERSHIP › Section 388-835-0880 - What happens when a receivership ends?

Current through Register Vol. 24-14, July 15, 2024
When a receivership ends, DSHS may revise the facility's
					 medicaid reimbursement as follows:
(1)
				  The medicaid reimbursement rate for the former owner or licensee must be what
				  it was before receivership unless the former owner or licensee requests
				  prospective rate revisions according to the requirements of this
				  chapter.
(2) The medicaid
				  reimbursement rate for licensed replacement operators must be established
				  according to the rules in this chapter governing prospective reimbursement
				  rates for new providers.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0880,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › DISPUTE RESOLUTION › Section 388-835-0885 - What disputes between providers and DSHS can be resolved through the administrative review process?

Current through Register Vol. 24-14, July 15, 2024
A provider can use the administrative review process to
					 contest:
(1) An "errors or omissions"
				  reimbursement rate adjustment issued to the provider (see WAC
				  388-835-0845 ) or DSHS's refusal
				  to adjust a rate the provider believes is incorrect due to errors or omissions.
				  The provider must request an administrative review within thirty days of
				  receiving notification that a rate has been adjusted or that DSHS refuses to
				  adjust the rate.
(2) The way in
				  which a DSHS rule, contract provision, or policy statement was applied when
				  calculating the provider's prospective cost related reimbursement system's
				  rate.
(3) An audit finding, other
				  audit determination, a rate review or other settlement determination.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0885,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › DISPUTE RESOLUTION › Section 388-835-0890 - What disputes cannot be resolved through the administrative review and fair hearing processes?

Current through Register Vol. 24-14, July 15, 2024
DSHS' administrative review and fair hearing processes
					 cannot be used to challenge the adequacy of any prospective or settlement
					 reimbursement rate or rate component, either individually or
					 collectively.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0890,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › DISPUTE RESOLUTION › Section 388-835-0900 - How does a provider request an administrative review?

Current through Register Vol. 24-14, July 15, 2024
(1) A provider challenging an audit or
				  settlement determination has a maximum of thirty days after receiving the
				  finding or decision to file a written request for an administrative
				  review.
(2) Written requests must
				  be filed with the:
(a) Office of financial
				  recovery services when the provider challenges an audit finding (adjusting
				  journal entries or AJEs) or other audit determination; or
(b) DDA assistant secretary when the provider
				  challenges a rate, desk review, or other settlement determination.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › DISPUTE RESOLUTION › Section 388-835-0905 - What happens after a provider requests an administrative review?

Current through Register Vol. 24-14, July 15, 2024
(1) After receiving
				  a provider's request, DSHS must schedule a conference between the provider and
				  appropriate department representatives.
(2) Unless both parties agree, in writing, to
				  a specific later date, the conference must be scheduled at least fourteen days
				  after DSHS notifies the provider that a conference will be held and no later
				  than ninety days after DSHS receives the provider's review request.
(3) The conference may be conducted by
				  telephone unless DSHS or the provider requests, in writing, that it be held in
				  person.
(4) The provider and DSHS
				  representatives must participate in the conference.
(5) Either at the conference or before, the
				  provider must give DSHS any documentation:
(a)
				  Requested by DSHS that the provider is required to maintain for audit purposes
				  under WAC
				  388-835-0270; and
(b) The provider intends to use to support
				  their position.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › DISPUTE RESOLUTION › Section 388-835-0910 - What if a provider disagrees with the administrative review decision?

Current through Register Vol. 24-14, July 15, 2024
(1) If they
				  disagree with the administrative review decision, a provider has a right to
				  request an adjudicative proceeding within thirty days of receiving the
				  decision.
(2) To request an
				  adjudicative proceeding, a provider must:
(a)
				  File a written request with the office of administrative hearings
				  (OAH);
(b) Sign the request or have
				  it signed by the facility administrator;
(c) State as specifically as possible the
				  issues and regulations involved;
(d) State the reasons for disagreeing with
				  the administrative review decision; and
(e) Attach a copy of the contested decision
				  and any documentation the provider will use to support their
				  position.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › DISPUTE RESOLUTION › Section 388-835-0915 - Can DSHS withhold an undisputed overpayment amount from a current ICF/ID payment?

Current through Register Vol. 24-14, July 15, 2024
DSHS is authorized to withhold from an ICF/ ID's current
					 payment all amounts found by a preliminary or final settlement to be
					 overpayments if they are not identified by the ICF/ID as overpayments and
					 challenged in an administrative or judicial review.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0915,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › DISPUTE RESOLUTION › Section 388-835-0920 - Can DSHS withhold a disputed overpayment amount from a current ICF/ID payment?

Current through Register Vol. 24-14, July 15, 2024
Once administrative and judicial review processes are
					 complete, contested overpayments retained by an ICF/ ID may be withheld from
					 the ICF/ID's current payment but only to the extent DSHS's position or claims
					 are upheld.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0920,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS › Section 388-835-0925 - What is the purpose of this section?

Current through Register Vol. 24-14, July 15, 2024
The purpose of this chapter is to regulate the costs of
					 care of intellectually/physically deficient persons.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0925,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS › Section 388-835-0930 - How is the payment for residential facilities set?

Current through Register Vol. 24-14, July 15, 2024
The department sets the payment for residential facilities
					 by the methodology noted in chapter 388-835 WAC.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0930,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS › Section 388-835-0935 - How much of a resident's income is exempt from paying their care?

Current through Register Vol. 24-14, July 15, 2024
Residents whose total resources are insufficient to pay the
					 actual cost of care must be entitled to a monthly exemption from income in the
					 amount of twenty-five dollars.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0935,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS › Section 388-835-0940 - What if the estate of a resident is able to pay all or a portion of their monthly cost?

Current through Register Vol. 24-14, July 15, 2024
(1) If DSHS finds
				  that the estate of a resident is able to pay all or a portion of their monthly
				  costs for care, support, and treatment, they must serve a written notice of
				  finding of responsibility (NFR) on the:
(a)
				  Guardian of the resident's estate; or
(b) If a guardian has not been appointed,
				  resident's spouse or parent or other person acting in a representative capacity
				  and in possession of the resident's property; and
(c) The superintendent of the state
				  school.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS › Section 388-835-0945 - If a resident or guardian is served by DSHS with a NFR when is payment due?

Current through Register Vol. 24-14, July 15, 2024
If a resident or guardian is served by DSHS with an NFR,
					 payment is due thirty days after receiving the notice.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0945,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS › Section 388-835-0950 - May a resident or guardian request a hearing if they disagree with the NFR?

Current through Register Vol. 24-14, July 15, 2024
If a resident or guardian disagrees with the NFR, they have
					 the right to ask for a hearing under
					 chapter
					 34.05 RCW. They must file
					 a written hearing request within thirty days of receipt with the secretary of
					 DSHS, ATTN: Determination Officer, P.O. Box 9768, Olympia, WA
					 98504.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0950,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-835 - ICF/ID program and reimbursement system › COST OF CARE OF MENTALLY DEFICIENT PERSONS RESIDING IN STATE INSTITUTIONS › Section 388-835-0955 - What information must be included in the request for a hearing?

Current through Register Vol. 24-14, July 15, 2024
The request for hearing must include:
(1) A specific statement of the issues and
				  law involved;
(2) The grounds for
				  contesting the department decision; and
(3) A copy of the NFR being
				  contested.
Statutory Authority:
						RCW
						71A.20.140. 01-10-013, § 388-835-0955,
						filed 4/20/01, effective 5/21/01.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-837 - Residential habilitation center (RHC) ICF/ID program › Section 388-837-9005 - What is the purpose of this chapter?

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of this chapter is to
				establish rules authorized by Title 71A RCW for RHC ICF/ID programs, rules
				that:
(a) Regulate the purchase and provision
				of services in state operated intermediate care facility for those with an
				intellectual disability (ICF/ ID); and
(b) Assure adequate ICF/ID care, service, and
				protection are provided through certification procedures; and
(c) Establish standards for providing
				habilitative training, health-related care, supervision, and residential
				services to eligible persons.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-837 - Residential habilitation center (RHC) ICF/ID program › Section 388-837-9010 - Must a client who is admitted by a residential habilitation center's ICF/IID be in need of and receiving active treatment services?

Current through Register Vol. 24-14, July 15, 2024
(1) An individual
				who is admitted by a residential habilitation center's intermediate care
				facility for individuals with intellectual disabilities must be in need of and
				receiving active treatment services.
(2) Active treatment services means a
				continuous active treatment program, which includes aggressive, consistent
				implementation of a program of specialized and generic training, treatment,
				health services, and related services described in
				42 C.F.R.
				483.400 through
				483.480,
				that is directed toward:
(a) The acquisition
				of the behaviors necessary for the client to function with as much
				self-determination and independence as possible; and
(b) The prevention or deceleration of
				regression or loss of current optimal functional status.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-837 - Residential habilitation center (RHC) ICF/ID program › Section 388-837-9015 - What does a transfer from one RHC to another RHC mean?

Current through Register Vol. 24-14, July 15, 2024
A transfer means the discharge of a resident from the current
				  RHC in which the resident resides and the admission of that resident to another
				  RHC.
Statutory Authority: Chapter 71A.20 RCW,
					 RCW
					 71A.12.080,
					 71A.20.140, 2003 1st sp.s. c 25
					 § 205. 04-16-018, § 388-837-9015, filed 7/23/04, effective
					 8/23/04.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-837 - Residential habilitation center (RHC) ICF/ID program › Section 388-837-9020 - Do residents have a right to a hearing when transferring from a residential habilitation center (RHC) to another RHC?

Current through Register Vol. 24-14, July 15, 2024
Notwithstanding hearing rights set forth in WAC
				  388-825-120(1)(d),
				  there is no right to an adjudicative proceeding for a resident when the
				  department concludes that the facility where the resident resides cannot
				  provide services due to:
(1)
				Decertification of the RHC;
(2)
				Revocation of the RHC's certification; or
(3) An emergency suspension of the RHC's
				certification;
(4) Partial closure
				of the RHC; or
(5) Closure of the
				RHC.
Statutory Authority: Chapter 71A.20 RCW,
					 RCW
					 71A.12.080,
					 71A.20.140, 2003 1st sp.s. c 25
					 § 205. 04-16-018, § 388-837-9020, filed 7/23/04, effective
					 8/23/04.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-837 - Residential habilitation center (RHC) ICF/ID program › Section 388-837-9030 - What rights are available to a resident regarding a proposed transfer from one RHC to another RHC?

Current through Register Vol. 24-14, July 15, 2024
(1) A
				resident, their guardian, next-of-kin, or responsible party must be notified in
				writing at least thirty days before any transfer occurs.
(2) The transfer notice must include the
				reason for the proposed transfer.
(3) A resident, their guardian, next of kin,
				or responsible party has a right to an informal administrative review before
				the assistant secretary or designee.
Statutory Authority: Chapter 71A.20 RCW,
					 RCW
					 71A.12.080,
					 71A.20.140, 2003 1st sp.s. c 25
					 § 205. 04-16-018, § 388-837-9030, filed 7/23/04, effective
					 8/23/04.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-837 - Residential habilitation center (RHC) ICF/ID program › Section 388-837-9040 - What rights are available to a resident regarding a proposed transfer from an RHC to the community, per RCW 71A.20.080?

Current through Register Vol. 24-14, July 15, 2024
(1) A resident, or the resident's authorized
				representative has a right to a hearing regarding the proposed transfer from an
				RHC to the community, per
				RCW
				71A.20.080 and under
				chapter
				34.05 RCW and chapter
				388-02 WAC. DSHS must send a hearing request form with the notice of
				transfer.
(2) If the resident
				requests a hearing within the thirty-day time period, DSHS may not transfer the
				resident until a hearing decision is reached or appeal rights have been
				exhausted unless the transfer is warranted by the resident's health or safety
				needs or the welfare of the other residents.
(3) If the secretary or the secretary's
				designee concludes that the transfer is not appropriate, no further action is
				to be taken to transfer unless there is a change in the situation or
				circumstances surrounding the transfer request. If there is a change in the
				situation or circumstances, the request may be resubmitted.
(4) If the secretary or the secretary's
				designee affirms the decision to transfer the resident and no petition for
				judicial review is filed within thirty days, DSHS may proceed with the planned
				action.
(5) If the secretary or
				secretary's designee affirms the decision to transfer the resident and a
				petition for judicial review has been filed, any proposed transfer must be
				delayed until the appeal process is complete unless a delay jeopardizes the
				resident's health or safety or the welfare of other residents, or as otherwise
				provided in
				RCW
				71A.20.080.
Statutory Authority: Chapter 71A.20 RCW,
					 RCW
					 71A.12.080,
					 71A.20.140, 2003 1st sp.s. c 25
					 § 205. 04-16-018, § 388-837-9040, filed 7/23/04, effective
					 8/23/04.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-840 - Work programs for residents of residential habilitation centers in the division of developmental disabilities › Section 388-840-005 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The regulations provide guidelines for the operation of work
				  programs at residential habilitation centers or for programs contracted on
				  behalf of residents of residential habilitation centers within the division of
				  developmental disabilities as required under
				  RCW
				  43.20A.445.
99-19-104, recodified as § 388-840-005, filed 9/20/99,
					 effective 9/20/99. Statutory Authority:
					 RCW
					 71A.20.060. 91-17-005 (Order 3230), §
					 275-41-005, filed 8/9/91, effective
					 9/9/91.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-840 - Work programs for residents of residential habilitation centers in the division of developmental disabilities › Section 388-840-010 - Definition

Current through Register Vol. 24-14, July 15, 2024
(1) "Compensate"
				means the resident's receipt of money for work done at a work
				program.
(2) "Department" means the
				Washington state department of social and health services.
(3) "Division" means the developmental
				disabilities division of the department of social and health
				services.
(4) "Prevailing wage"
				means the amount paid to a nondisabled worker in a nearby industry or
				surrounding community for essentially the same type, quality, and quantity of
				work or work requiring comparable skills.
(5) "Residential habilitation center (RHC)"
				means a residential habilitation center operated by the developmental
				disabilities division.
(6) "Work
				program" means a directed vocational activity or series of related activities
				provided on a systematic, organized basis for developing and maintaining
				individual resident work skills, and providing remuneration to resident
				employees. Work programs must result in:
(a)
				Benefit to the economy of the facility; or
(b) A contribution to the facility's
				maintenance; or
(c) Produce
				articles or services for sale.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-840 - Work programs for residents of residential habilitation centers in the division of developmental disabilities › Section 388-840-015 - Establishment of new work programs

Current through Register Vol. 24-14, July 15, 2024
The requirements of
				  RCW
				  43.20A.445 shall be followed before the
				  department establishes new residential habilitation center work
				  programs.
99-19-104, recodified as § 388-840-015, filed 9/20/99,
					 effective 9/20/99. Statutory Authority:
					 RCW
					 71A.20.060. 91-17-005 (Order 3230), §
					 275-41-015, filed 8/9/91, effective
					 9/9/91.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-840 - Work programs for residents of residential habilitation centers in the division of developmental disabilities › Section 388-840-020 - Protection of residents

Current through Register Vol. 24-14, July 15, 2024
(1) When a
				resident participates in a work program, the resident shall be employed in work
				and subjected to work conditions where reasonable precautions are taken to
				ensure the resident's health and safety.
(2) Resident work programs shall be
				consistent with the resident's individual habilitation plan
				objectives.
99-19-104, recodified as § 388-840-020, filed 9/20/99,
					 effective 9/20/99. Statutory Authority:
					 RCW
					 71A.20.060. 91-17-005 (Order 3230), §
					 275-41-020, filed 8/9/91, effective
					 9/9/91.
Washington Administrative Code › Title 388 - Social and Health Services, Department of › DEVELOPMENTAL DISABILITIES SERVICES › Chapter 388-840 - Work programs for residents of residential habilitation centers in the division of developmental disabilities › Section 388-840-025 - Compensation for persons participating in work programs

Current through Register Vol. 24-14, July 15, 2024
(1) The department shall compensate a person
				participating in a work program at the prevailing minimum wage except when an
				appropriate certificate has been obtained by the RHC or contract program in
				accordance with current regulations and guidelines issued under the Fair Labor
				Standards Act (29 C.F.R. Ch. V, 525 and 529) as amended.
(2) The department shall not be required to
				compensate a person participating in the shared domiciliary activities of
				maintaining the person's own immediate household or residence.
99-19-104, recodified as § 388-840-025, filed 9/20/99,
					 effective 9/20/99. Statutory Authority:
					 RCW
					 71A.20.060. 91-17-005 (Order 3230), §
					 275-41-025, filed 8/9/91, effective
					 9/9/91.