TSOA certification periods, change of circumstances, and renewals

Revised date

WAC 182-513-1645 Tailored Supports for Older Adults (TSOA) - Certification Periods.

WAC 182-513-1645 Tailored supports for older adults (TSOA) — Certification periods.

Effective July 1, 2017

  1. A certification period is the period of time a person is determined eligible for the tailored supports for older adults (TSOA) program. It begins on the first day of the month that the medicaid agency or the agency's designee determines the person is eligible for TSOA services, and continues through the last day of the month of the certification period.
  2. TSOA is certified for twelve months of continuous coverage regardless of a change in circumstances, unless the person:
    1. Moves out-of-state;
    2. Meets institutional status under WAC 182-513-1320;
    3. Becomes eligible for a categorically needy or alternate benefit plan Washington apple health program; or
    4. Dies.
  3. Financial eligibility for the TSOA program may not be approved prior to the date of a presumptive or full eligibility determination.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1650 Tailored Supports for Older Adults (TSOA) - Changes of Circumstances Requirements.

WAC 182-513-1650 Tailored Supports for Older Adults (TSOA) — Changes of Circumstances Requirements.

Effective July 1, 2017

  1. Changes in tailored supports for older adults (TSOA) household and family circumstances described in subsection (2) of this section must be reported to the medicaid agency or the agency's designee within thirty days of the date of the change.
  2. The following changes must be reported:
    1. A change in residential or mailing address, including if the TSOA recipient moves out-of-state;
    2. When a person admits to an institution, as defined in WAC 182-500-0050, and is likely to reside there for thirty days or longer; or
    3. The person dies.
  3. Effective date is the date of the changes. 
    1. When TSOA terminates because the recipient dies, the effective date is the date of death.
    2. When TSOA terminates because of one of the following reasons, the effective date is the first day of the month following the advance notice period described in subsection (4) of this section. The TSOA recipient:
      1. Is admitted to an institution as defined in WAC 182-503-0050, and is expected to reside there for thirty days or longer;
      2. Is approved for coverage under a home and community-based waiver program;
      3. No longer meets nursing facility level of care under WAC 388-106-0355; or 
      4. Becomes eligible for categorically need (CN) or alternative benefits plan (ABP) apple health coverage. The recipient may continue to receive authorized services through the medical alternative care (MAC) program under WAC 182-513-1600. The person may also apply for other long-term services and supports available under chapters 182-513 and 182-515 WAC.
  4. The advance notice period:
    1. Begins on the day the letter about the change is mailed; and 
    2. Is determined according to the rules in WAC 182-518-0025.
  5. When the law or regulation is the effective date of the change.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

Medicaid Alternative Care (MAC) change of circumstance

MAC recipients must report changes following the requirements under Chapter 182-504 WAC since all MAC recipients are eligible for Washington Apple Health coverage. 

MAC recipients may freely transition between the MAC program and long-term services and supports through the Community First Choice (CFC) program without filing a new financial application.  This could be because the care receiver’s needs can no longer be met under the MAC program or because the client chooses to access services that are only available under CFC. A person who needs services under a Home and Community based waiver would need to complete an Apple Health application (HCA 18-005 Application for Aged, Blind, Disabled/LTC form).

TSOA changes of circumstances  

TSOA recipients must report changes within 30 days of the date of the change; however, once a person is determined eligible for TSOA, they remain continuously eligible throughout the 12 month certification unless one of the following changes happens:

  • The person no longer meets NFLOC
  • The person is no longer a WA state resident
  • The person moves into an institution (nursing facility)
  • The person becomes eligible for CN or ABP Medicaid
  • The person passes away. 

There is no requirement to report changes in income or resources for a TSOA recipient.

Like MAC, TSOA recipients may transition to other LTSS services that they may be eligible for.  However most TSOA recipients don’t qualify for Apple Health coverage because they are spending down their resources to qualify, or their income is too high.  Also, although some TSOA recipients may qualify for Apple Health coverage, either under a medically needy program or a program with limited scope such as a Medicare Savings Program, these programs don’t provide CFC or HCB waiver services.  In both scenarios, a care receiver receiving TSOA services who needs to access Community First Choice or HCB waiver services must complete an Apple Health application to determine if they meet eligibility criteria for traditional long-term services and supports.  

Equally, existing clients who receive traditional LTSS may also choose to stop receiving those services and receive MAC or TSOA services instead.  Since there are many factors that may influence a person’s  decision, staff must take time to explain the options available and any consequences of making that decision, such as, the loss of Apple Health coverage if someone were to choose TSOA services.

Worker Responsibilities

Staff will follow HCS Equal Access guidelines and provide advance and adequate notice prior to terminating a MAC or TSOA case, unless the person has passed away. If a person moves to an institutional or residential setting, the T02 AU will need to be closed in ACES. If the client requests institutional medicaid coverage and is approved, the case will be historically closed in ACES, but there is no overpayment established for TSOA services provided through the advance notice period. If the client does not apply for medicaid coverage for an institutional stay, T02 can be reopened for the remainder of the T02 financial certification period; the client cannot receive TSOA services while in the institutional or residential setting. It is the responsibility of the AAA MTD Case Manager to confirm that services are not authorized during the admission.

Example: A client is active on T02 and an SSI-related spenddown S99 (met or unmet). The client admits to a nursing facility and is admitted for 40 days. The client chooses to not apply for an institutional medicaid (L02). They plan on private paying for the nursing facility stay and use the bill to meet their spenddown liability. The T02 be reopened when the client discharges home if the discharge is within the clients original T02 financial certification period; the client should not receive a TSOA service while admitted to an institution.

WAC 182-513-1655 Tailored Supports for Older Adults (TSOA) - Renewals.

WAC 182-513-1655 Tailored supports for older adults (TSOA) — Renewals.

Effective July 1, 2017

  1. A person who receives tailored supports for older adults (TSOA) services must complete a renewal of all eligibility factors for the program at least every twelve months.
  2. Forty-five days prior to the end of the certification period, notice is sent with the HCA 18-008 application for TSOA form. Complete the TSOA renewal in any of the following ways:
    1. Complete the TSOA application form, sign it, and mail it to P.O. Box 45826, Olympia, WA 98605 by the due date on the letter;
    2. Complete the TSOA application form, sign it, and fax it to 1-855-635-8305 by the due date on the letter;
    3. Renew online at Washington connection at https://www.washingtonconnection.org by the due date on the letter; or
    4. Call your local home and community services office at the telephone number on the letter by the due date on the letter.
  3. During the renewal process, the medicaid agency or the agency's designee reviews all eligibility factors to determine ongoing eligibility for TSOA, and may request additional verification of eligibility factors under WAC 182-503-0050 if unable to verify information through existing data sources. If additional information is needed, the agency or the agency's designee sends written notice under WAC 182-518-0015.
  4. If the agency or the agency's designee is unable to complete the renewal or determine eligibility for TSOA beyond the certification period, prior to ending eligibility for TSOA, the agency or the agency's designee sends a written termination notice as described in WAC 182-518-0025.
  5. A person who is terminated from TSOA for failure to renew has thirty days from the termination date to submit a completed renewal. If still eligible, TSOA is reopened without a break in eligibility.
  6. Equal access services as described in WAC 182-503-0120 are provided for anyone who needs help meeting the requirements of this section.
  7. Anyone who disagrees with an action regarding TSOA eligibility may ask for a hearing under chapter 182-526 WAC.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

TSOA Renewals must be completed once every 12 months and may be completed by phone, online, or on paper.  At the time of renewal, the person must still be receiving services under the TSOA program.

MAC renewals are based upon the certification period of the program the person is eligible under.

Follow HCS equal access policies to contact the person to complete the renewal.

Worker Responsibilities

Renewal notices are generated 45 days prior to the end of the certification period. When the renewal is received, review all eligibility factors and confirm with the AAA case manager whether the person is still receiving TSOA or MAC services. 

If this is the first renewal, verify whether resources over the standard have been transferred to the community spouse. 

For MAC clients who are only eligible for S02 coverage as a SIPI spouse under WAC 182-513-1660, verify MAC services are still being received.  If not, terminate S02 coverage and redetermine the person’s eligibility under medically needy coverage if eligible.

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