STATE OF WASHINGTON



348615022860000STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICESAging and Long-Term Support AdministrationHome and Community Services DivisionPO Box 45600, Olympia, WA 98504-56001485900-88265HCS MANAGEMENT BULLETIN00HCS MANAGEMENT BULLETINH18-040 – Information June 20, 2018 TO: Area Agency on Aging (AAA) DirectorsHome and Community Services (HCS) Division Regional AdministratorsDevelopmental Disabilities Administration Staff FROM:Bea Rector, Director, Home and Community Services DivisionDebbie Roberts, Interim Deputy Assistant SecretaryDevelopmental Disabilities AdministrationSUBJECT: Guardian fees allowed for individuals who pay client responsibility toward cost of care Purpose:To inform staff of guardianship fee deduction changes in rule and their responsibilities regarding guardianship court orders. Background:Clients who are required to pay toward the cost of their care before the Department pays for services are allowed a guardianship fee deduction in the participation calculation for Home and Community Based (HCB) Waiver or Institutional services. The WAC has changed to clarify the deduction amounts allowed for guardianship fees and related costs. The new WAC still allows a participation deduction, but also now allows deductions from room and board (R&B) for all clients who have a R&B liability. The deduction limits for participation and R&B are in rule. What’s new, changed, orClarified: Effective June 1, 2018, WACs regarding the maximum amount of guardianship fees and costs for long-term care Medicaid are final. The new rules affect all guardianship court orders approved on or after June 1, 2018. Existing court orders signed prior to June 1, 2018 and the fees approved in the order remain in place until the next accounting, with an updated court order. The rules for court orders signed prior to June 1, 2018 are in chapter 388-79A WAC. The maximum amount of guardianship advance fee deduction is increased from $175 to $235 per month. The deduction for costs related to the guardianship is increased from $600 during every three-year period to $1,200. The one-time deduction for establishment of a guardianship is increased from $700 to $1,850. Effective June 1, 2018, the new rules separate what DSHS (and HCA) allow as deductions in the post-eligibility determination from what the Court determines as just and reasonable compensation and reimbursement for the guardian. In other words, the Court determines how much the guardian is entitled to for their services, but does not order specific deduction amounts from participation or R&B. DSHS (or HCA) determines the amount of the participation or R&B deduction when an approved court order is received based on the higher limits in rule. Therefore, proposed court orders no longer need to be forwarded to the regional designee. However, it is still possible guardians and their attorneys will forward proposed orders while adjusting to the new rules. Deductions from R&B within the limits of the new rules no longer require an exception to rule (ETR). We no longer take into consideration any other excluded income in determining the amount of the R&B deduction for guardianship fees and related costs (for example, clients with special income disregards and state supplemental payments will be allowed the same R&B deduction as those clients without). If the department receives a request from a guardian to consider an ETR for extraordinary fees, an ETR committee comprised of representatives from each HCS region and the DDA LTC financial team will review and determine if extraordinary fees are warranted. Guardians and attorneys will be advised to send all guardianship court orders to a centralized location:HCS/DDA HIUPO Box 45826Olympia, WA 98504-5826; or Fax to: 1-855-635-8305As guardians learn where to send orders, we may still receive orders in multiple places.? It will be very important for any office, facility or specific individuals who receive orders to send them to the HIU in order for a financial worker to process.ACTION:Action Required by HCS and DDA Financial Service Specialists:Effective June 1, 2018, HCS and DDA financial staff will allow up to the maximum fee for guardianship court orders approved on or after June 1, 2018. The financial worker will review the signed order showing that the court has reviewed guardianship accounting; workers will deduct the fees and costs approved in the order, up to the maximum amount per WAC. Guardians must request an ETR for extraordinary fees in addition to providing a signed order. If a guardian requests an ETR for extraordinary fees and related costs, send the DSHS 07-107 Exception to Rule Request and Notice to the guardian. Completed forms must be returned to the HIU. A link to the DSHS form can be sent to the guardian via e-mail: requests will be reviewed by the guardianship ETR committee, comprised of HCS and DDA designees. The HCS regional designees are:Region 1: Dan ReesRegion 2: Jyvette DobsonRegion 3: Ian HorlorThe DDA designees are: Marcell BirdsallJerine Barnes Lynda Trimble. Notify your regional designee when a proposed or signed order is received that orders the department to do something outside of guardianship WACs, such as:Instructing the department to ignore a client’s income in order for guardian fees and costs to be paid prior to participation or room and board Instructing the department to approve an ETR for deductions higher than the MNIL for institutionalized clientsInstructing the department to approve an ETR for extraordinary feesThe ETR committee will send the decision to the HIU and create a barcode tickler to appropriate worker or pool. The financial worker will document the decision in the ACES narrative, take any needed case actions and send a notice about the ETR decision to the guardian. Action Required by DDA Case Managers, DDA institutions:Guardianship orders received in DDA offices and DDA institutions will be sent to the imaging unit (HIU) at the address above by the next business day. Guardianship orders will no longer be sent to regional administrators, facilities or a specific person. Once sent to the HIU, orders will be indexed in Barcode to the financial worker of record or a particular pool in the office where the case is located.? The Barcode matrix is also programmed to assign guardianship court orders and letters of guardianship to DDA CRM’s. Court orders and letters of guardianship will be forwarded to the Barcode To-Do lists of fiscal analysts at RHC’s.? Guardians must request an ETR for extraordinary fees in addition to providing a signed order. If a guardian contacts a CRM, QAM or RHC staff to request an ETR for extraordinary fees, that staff person should send the guardian a DSHS 07-107 Exception to Rule Request and Notice: completed 07-107 forms must be sent to the HIU. Action Required by both HCS and DDA social workers/ case managersCertain residential cases with R&B are determined by residential case managers:MAGI casesABD cash grantThe social worker or case manager needs to subtract court ordered guardianship deduction up to the maximum allowed for guardianship court orders received on or after June 1, 2018 on MAGI or ABD cash cases. Action required by the Guardianship Exception to Rule committeeThe ETR committee will review each DSHS 07-107 Exception to Rule Request and Notice and indicate the decision on the DSHS 07-107 form. Each completed 07-107 will be sent as hotmail to the HIU. A committee designee will also create a barcode tickler to the appropriate financial worker or pool and document the ETR decision on the guardianship Financial Eligibility and Policy (FEP) SharePoint tool. RELATED REFERENCES:Amended:WAC 182-513-1530 Maximum guardianship fee and related cost deductions allowed from a client’s participation or R & B on or after 6/1/2018. WAC 182-513-1515 Maximum guardianship fees and related costs before 6/1/2018. (This WAC is recodified to WAC 388-79A-010 effective 6/1/2018)WAC 182-513-1525 Procedure for allowing guardianship fees and related costs from client participation before 6/1/2018. (This WAC is recodified to WAC 388-79A-015 effective 6/1/2018)New section:WAC 388-79A-001 DefinitionsWAC 388-79A-005 Maximum amount of guardianship fees and related costs for a long-term care medicaid eligible client. Repealed:WAC 182-513-1505 PurposeWAC 182-513-1510 DefinitionsWAC 182-513-1520 Procedure to revise award letter after 6/15/1998, but before 9/1/2003. Title 182 filing: (CR103P) - WSR 18-10-024Title 388 filing: (CR103P) - WSR 18-10-024The Apple Health manual will be updated with the WAC revision: There are no changes in WACs that determine participation in the cost of care:WAC 182-513-1380 Determining the cost of care in an institution (participation) rules have not changed.Chapter 182-515 Eligibility and determining the cost of care for HCB Waiver (participation) rules have not changed. CONTACTS: Catherine Kinnaman, Office Chief, LTC Financial Eligibility & Policy (360) 725-2318 Catherine.kinnmanan@dshs. Marcie Birdsall, Unit Manager, DDA LTC specialty team (360) 725-3248 Marcell.Birdsall@dshs.Lonnie Keesee, DDA Interim Eligibility and Payment Systems Unit Manager (360) 407-1547 Lonnie.Keesee@dshs. Jamie Tong, HCS Waiver Program Manager (360) 725-3293 Jamie.Tong@dshs. ................
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