Institutional status
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WAC 182-513-1320 Determining institutional status for long-term care (LTC) services.
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WAC 182-513-1320 Determining institutional status for long-term care (LTC) services.
Effective February 17, 2017
- To attain institutional status outside a medical institution, a person must be approved for and receive:
- Home and community based (HCB) waiver services under chapter 182-515 WAC;
- Roads to community living (RCL) services under WAC 182-513-1235;
- Program of all-inclusive care for the elderly (PACE) under WAC 182-513-1230;
- Hospice services under WAC 182-513-1240(3); or
- State-funded long-term care service under WAC 182-507-0125.
- To attain institutional status in a medical institution, a person must reside in a medical institution thirty consecutive days or more, or based on a department assessment, be likely to reside in a medical institution thirty consecutive days or more.
- Once a person meets institutional status, the person's status is not affected if the person:
- Transfers between medical facilities; or
- Changes between any of the following programs: HCB waiver, RCL, PACE, hospice or services in a medical institution.
- A person loses institutional status if the person is absent from a medical institution, or does not receive HCB waiver, RCL, PACE, or hospice services, for more than twenty-nine consecutive days.
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.
- To attain institutional status outside a medical institution, a person must be approved for and receive:
Worker Responsibilities
Obtain the determination of whether the person is likely to remain institutionalized for 30 consecutive days from the department-designated social service worker or case manager.
For nursing facility cases, the HCS social service worker notifies financial of the date of request for assessment, whether the person is projected to be in a nursing facility 30 days or more and if the person meets NFLOC.
For those people who meet both 30 day or more institutionalization and NFLOC, institutional Medicaid is considered.
For individual persons who don't meet the 30 day or more institutionalization, institutional Medicaid can't be considered. Eligibility for Medicaid is determined as if the person were in their own home. If the person is eligible for another Medical program, the admission into the medical institution is considered a short stay (29 days or less). See Short Stays.
For active Apple Health clients who lose institutional medicaid status due to discharge from a medical institution or no longer receiving a HCB Waiver service, redetermine eligibility under a noninstitutional medical program.