AGING AND DISABILITY SERVICES ADMINISTRATION
2008 BH "Dear Administrator" Letters
December 11, 2008
ADSA: BH #2008-0019
MEDICAID SUPPLEMENTATION
Dear Boarding Home Administrator:
We recently heard that there has been confusion on the issue of supplementation in boarding homes. The supplementation requirements have not changed. If you admit Medicaid residents you must accept Medicaid payment as payment in full for the services, items, activities, room and board required by each resident’s negotiated service agreement and department contract. The provider may only request or receive payment of supplementation to Medicaid if the supplementation is for things over and above those things already covered by the Medicaid rate.
Washington Administrative Codes (WAC) 388-105-0050 and WAC 388-105-0055 both apply to boarding home contractor supplementation. Here are the main points of the rules:
- A contractor must have a supplementation policy that is given to all prospective and current residents that the Medicaid payment plus any client/resident participation assigned by the department is payment in full; and additional payments are for services, items, activities, room and board not covered by Medicaid.
- A contractor may only request or receive supplementation if the services, activities, items, or room and board are beyond those covered in the Medicaid daily rate and beyond what is required under licensing and contracting rules. Examples of this are the family or resident requests to have a single room in a home with available semi-private rooms or the resident or family wants to use a brand name incontinent brief used instead of the generic brand or cloth briefs used by the provider.
- A contractor may not request or receive supplementation if the home only has private bedrooms unless the unit or bedroom has an amenity that some or all of the other units or private bedrooms lack. Examples of this are a bathroom attached to the bedroom for use only by the resident in that room and no other rooms have private bathrooms or the bedroom has a special view that none of the other bedrooms have.
There are other specific requirements in the rules that require the contractor to specify which units/bedrooms supplementation may be requested for; what will happen when a private pay resident converts to Medicaid and is not able or willing to pay a supplement; what needs to be in the resident’s record; and when the resident’s case manager needs to be notified. This letter only includes a brief review of the requirements; you must read the details on the internet at:
http://apps.leg.wa.gov/WAC/default.aspx?cite=388-105-0050
http://apps.leg.wa.gov/WAC/default.aspx?cite=388-105-0055
If you have questions, please contact your local RCS Field Manager.
Sincerely,
Joyce Pashley Stockwell, Director
Residential Care Services
