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PDFWAC 388-96-781

Exceptional care rate add-on—Covered medicaid residents.

A nursing facility (NF) may receive an increase in its direct care rate allocations for providing exceptional care to a medicaid resident who:
(1) Receives specialized services to meet chronic complex medical conditions and neurodevelopment needs of medically fragile children and resides in a NF where all residents are under age twenty-one with at least fifty percent of the residents entering the facility before the age of fourteen;
(2) Receives expanded community services (ECS);
(3) Is admitted to a NF as an extraordinary medical placement (EMP) and the department of corrections (DOC) has approved the exceptional direct care;
(4) Is ventilator or tracheotomy (VT) dependent and resides in a NF that the department has designated as active ventilator-weaning center;
(5) Has a traumatic brain injury (TBI) established by a comprehensive assessment reporting evaluation (CARE) assessment administered by department staff and resides in a NF that the department has designated as capable for TBI patients;
(6) Has a TBI and currently resides in nursing facility specializing in the care of TBI residents where more than fifty percent of residents are classified with TBIs based on the federal minimum data set assessment (MDS 3.0 or its successor); or
(7) Is admitted to a NF from a hospital with an exceptional care need and medicaid purchasing administration (MPA) or a successor administration has approved the exceptional direct care payment.
[Statutory Authority: RCW 74.46.800, 74.46.561(1). WSR 17-22-037, § 388-96-781, filed 10/24/17, effective 11/24/17. Statutory Authority: Chapter 74.46 RCW, 2010 1st sp.s. c 34, and 2010 1st sp.s. c 37 § 958. WSR 11-05-068, § 388-96-781, filed 2/14/11, effective 2/26/11. Statutory Authority: RCW 74.46.800, 74.46.508. WSR 00-12-098, § 388-96-781, filed 6/7/00, effective 7/8/00.]
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