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STATE OF WASHINGTONDEPARTMENT OF SOCIAL AND HEALTH SERVICES
Aging and Long-Term Support AdministrationHome and Community Services Division
PO Box 45600, Olympia, WA 98504-5600
H20-003 – InformationJanuary 3, 2020
TO: Home and Community Services (HCS) Division Regional Administrators
Developmental Disabilities Administration (DDA) Regional Administrators
Area Agency on Aging (AAA) Directors
FROM: Bea Rector, Director, Home and Community Services Division
Debbie Roberts, Deputy Assistant Secretary, Developmental Disabilities Administration
SUBJECT: January 2020 Changes with COLA
PURPOSE: To notify staff of their responsibilities regarding client payments for services starting January 1, 2020.
BACKGROUND: Many clients are required to pay toward the cost of their care before the Department pays for services. The Department determines this amount for all long-term care services.
HCS and DDA residential clients, other than Adult Protective Services (APS) residential clients, pay toward their cost of room and board. HCS staff see Chapter 8, Residential Services, in the Long-Term Care Manual for details on room and board. DDA staff see DDA Policy 6.06 Client Responsibility for details on room and board. The client’s total contribution for room and board and the cost of their personal care services is indicated on the provider’s authorization in ProviderOne. Clients receive correspondence from ProviderOne that reflects their social service authorizations and details related to applied client responsibility.
WHAT’S NEW, CHANGED, OR CLARIFIED:
Effective January 1, 2020, the following benefits will increase: Social Security Benefits by 1.6%
Railroad Retirement (RR) and Veteran’s (VA) Benefits by 1.6%
Some pensions, such as federal civil service pensions by 1.6%
Home & Community Services, 2018BJE
HCS MANAGEMENT BULLETIN
Effective January 1, 2020, the following standards will increase: Special Income Level (SIL)
Categorically Needy Income Level (CNIL)
Medically Needy Income Level (MNIL)
Federal Benefit Rate (FBR)
Maintenance allowance for in-home waiver recipient with community spouse
Residential room and board standard
Community spouse maintenance allocation
Federal spousal resource transfer maximum
Home Equity Limit
Medical Institution Personal Needs Allowance (PNA)
HCS and DDA Waiver Residential PNA
Effective January 1, 2020: ACES will:
Auto update SSA and SSI income amounts for most clients.
Recalculate client responsibility for January 2020 and generate COLA letters and translations, if necessary, for HCS and DDA waivers, PACE, SSI-related residential MPC, CFC, and Roads to Community Living clients.
ACES will not: Generate a letter for any clients receiving MAGI-based coverage who receive
MPC or CFC in a residential setting.
Generate a letter for any clients active on Medical Care Services (A01/A05) coverage group in a residential setting.
VA and RR benefits must be manually updated in ACES. Clients with cases requiring manual updates will receive a postcard reminder (see attached memo) in early January advising them to report their new income amounts.
The new room and board amount for all HCS and DDA residential settings is $713. This amount is determined by using the following formula of the Federal Benefit Rate: $783 - $70 = $713. Current residential authorizations with R&B rate of $701 are automatically updated to $713 by ProviderOne by January 1, 2020 for clients in the following programs:
SSI-related residential MPC
CFC
HCS and DDA waivers
PACE
Roads to Community Living
Service authorizations must be entered before the month of service begins for Client Responsibility to calculate correctly and send the correct letters timely to clients and providers.
ACTION: Action Required by Case Managers: Calculate and update client responsibility using the calculator attached below on
the financial screen in CARE for clients on the following programs:o HCS Waivers/MPC/CFC Fast Tracko DDA and HCS MAGI-based coverage groups (N-track)o DDA and HCS Non-citizens on the ABD Cash/HEN programs (A01/A05)–
AFHo DDA and HCS State-funded LTC Program for Non-Citizens if receiving
MAGI coverage (N21 and N25 coverage groups)o DDA State Funded Group Homes
Send the Client Responsibility Notice (DSHS 18-720 for HCS or DSHS 18-692 for DDA) to these clients informing them of the amount they have to pay for room and board.
o If the client is active on basic food or cash, the social service specialist must verify the income by looking at the income verified in ACES.
o If the client is only active on a MAGI-based program, the case manager may use the client’s self-attested income found in ACES online on the client level screen under Health Plan Finder Income.
HCS - Do not increase client responsibility while a bed hold is in place. Include client responsibility information in your bed hold request. Bed hold staff will check ACES to verify correct client responsibility before reopening services.
Action Required by Public Benefit Specialists: Manually update cases for clients:
o Who have Veteran’s, Railroad Retirement, or SSA/SSI benefits that were not auto updated by ACES.
o With a community spouse with income that needs to be updated.
Note: Adhoc reports in Barcode can be printed for the Veteran's and Railroad Retirement pensions. A Barcode tickle has been sent for SSA/SSI clients not auto updated by ACES (COL3).
Update Food Stamp Medical Expense (FSME) for at-home HCS or DDA waiver clients who pay client responsibility in excess of $35.00 and receive Basic Food.
Update room and board (R&B) exception to rule (ETR) amounts for a monthly maintenance needs allowance (MMNA), update the spouses unearned income type of AN (MMNA ETR Amount) as well.
RELATED REFERENCES:
ATTACHMENT(S): January 2020 Medical Income and Resources Standards Chart:
Reports for Manual Updates Memo:
Medical Coverage Group Chart:
January 2020 Client Responsibility Calculator
CONTACT(S): Jennifer Ferguson, Office Chief, LTC Financial Eligibility & Policy (360) 725-3406 [email protected]
Marcell Birdsall, Unit Manager, DDA LTC and Specialty Program Teams(360) [email protected]
Graham Zuch, HCS ACES Program Manager(206) 341-7781 [email protected]
Dustin Quinn Campbell, Payment Policy and Systems Unit Manager(360) [email protected]
Lonnie Keesee, Acting DDA Eligibility and Payment Systems Unit Manager(360) [email protected]
