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

H20-052 – Policy & ProcedureJune 9, 2020

TO: Home and Community Services (HCS) Division Regional AdministratorsArea Agency on Aging (AAA) Directors

FROM: Bea Rector, Director, Home and Community Services Division

SUBJECT: Streamlined Financial Eligibility for Individuals Discharging from Acute Care Hospitals

PURPOSE: To notify staff of new temporary processes to streamline financial eligibility for individuals discharging from acute care hospitals. The goal of Streamlined Eligibility (SE) is to speed up transition of individuals to home and community based settings, who need long-term services and supports (LTSS) and are no longer in need of hospital care.

BACKGROUND: On March 18, 2020, Home and Community Services (HCS) implemented a statewide emergency plan around the need to surge activities at acute care hospitals to determine eligibility, develop client service plans, and find viable community alternatives. The surge plan was implemented with one of the goals to transition individuals in need of long-term services and supports out of hospitals as quickly as possible due to COVID-19.

In response to the President’s declaration that a public health emergency exists due to COVID-19, the Centers for Medicare and Medicaid Services (CMS) has approved various flexibilities designed to expedite access to Medicaid services. This includes flexibilities relating to eligibility determinations for long-term services and supports that were approved under Washington’s request for a disaster-related 1115 demonstration waiver. Using this option, HCS developed a process for Streamlined Eligibility (SE) in order to support the surge work and continue efforts to transition individuals out of hospitals as quickly as possible once surge activities have ended.

WHAT’S NEW, CHANGED, OR CLARIFIED:

When an individual is ready to be discharged from an acute care hospital to an in-home or residential setting, financial staff will first use this flexibility to streamline the application and eligibility process.

During the COVID-19 emergency, Public Benefits Specialists (PBS) have the

Home & Community Services, 2018BJE

HCS MANAGEMENT BULLETIN

flexibility to accept a client’s self-attestation as verification to income, resources, and other eligibility factors to expedite application processing. Effective 6/1/2020 Public Benefits Specialists may also use self-attestation for a disability determination when it’s required for determining eligibility. This process is limited to acute care hospital discharges at this time.

A new form HCA 19-0054 Hospital Certification of Potentially-Disabling Condition has been developed for use when a client self-attests to a disability, and has a potentially disabling condition that is expected to last 12 months or longer. The acute care hospital will complete the new form whenever the public benefits specialist determines that a disability determination is required to access long-term services and supports.

ACTION: For HCS Public Benefits Specialists:

1) Streamlined Eligibility Determination

a. Regional intake staff will submit the acute care hospital referral to the Public Benefits Specialist (PBS).

b. Review ACES and if the client is active CN or ABP Medicaid, submit the 07-104 in Barcode to HCS Social Services advising that the client is financially eligible for applicable services.

If client is not active but appears eligible for ABP, submit application for client in the Health Benefit Exchange.

For clients that need a financial eligibility determination or will require a waiver service at discharge, use an HCA 18-005 Washington Apple Health Application for LTC/ABD Coverage or an interactive interview declaration for the eligibility determination.

c. Review the application to ensure client indicates a disability, or confirm self-attested disability during the interview process.

d. Complete the financial interview and accept the client’s self-attestation as verification to income, resources, and other eligibility factors to expedite application processing.

e. If needed, send a 07-104 to Social Services, requesting a completed HCA Form 19-0054 Hospital Certification of Potentially Disabling Condition from the acute care hospital.

f. If the medical professional indicates, the client has a potentially disabling condition, move forward with the financial eligibility application using the self-attested disability determination.

g. Record the presumptive disability decision in ACES.

Disability/Incapacitated/Psychiatric section: Disability/Incapacity Type: Disabled (D)

Approval Source: Attested Disability (PA) Approval and Established Date: Date on form 19-0054 End Date: 90 days from application date, using MM/YYYY.

h. Notify the HCS Case Manager that a non-grant medical assistance (NGMA) disability determination is still required for ongoing eligibility, but do not delay approving coverage if the client is otherwise eligible.

i. If the acute care hospital indicates that the client does not meet the definition of having a potentially disabling condition, notify the HCS Case Manager that a non-grant medical assistance (NGMA) disability determination is required for initial eligibility.

j. Approve Medicaid when the client is financially and functionally eligible and has discharged.

k. Set an ODI tickle in Barcode for the final NGMA disability determination. Take appropriate case action when decision is received.

RELATED REFERENCES: N/A

ATTACHMENT(S):

CONTACT(S): HCS:

Amanda Aseph, Financial Policy Analyst360.725.3486Amanda.Aseph@dshs.wa.gov

Mallori Woolnough, MTD Program Manager360.725.3248Mallori.Woolnough@dshs.wa.gov