182-513-1615  <<  182-513-1620 >>   182-513-1625

WAC 182-513-1620

Tailored supports for older adults (TSOA)Presumptive eligibility (PE).

(1) A person may be determined presumptively eligible for tailored supports for older adults (TSOA) services upon completion of a prescreening interview.
(2) The prescreening interview may be conducted by either:
(a) The area agency on aging (AAA); or
(b) A home and community services intake case manager or social worker.
(3) To receive services under presumptive eligibility (PE), the person must meet:
(a) Nursing facility level of care under WAC 388-106-0355;
(b) TSOA income limits under WAC 182-513-1635; and
(c) TSOA resource limits under WAC 182-513-1640.
(4) The PE period begins on the date the determination is made and:
(a) Ends on the last day of the month following the month of the PE determination if a full TSOA application is not completed and submitted by that date; or
(b) Continues through the date the final TSOA eligibility determination is made if a full TSOA application is submitted before the last day of the month following the month of the PE determination.
(5) If the person applies and is not determined financially eligible for TSOA, there is no overpayment or liability on the part of the applicant for services received during the PE period.
(6) The medicaid agency or the agency's designee sends written notice as described in WAC 182-518-0010 when PE for TSOA is approved or denied.
(7) A person may receive only one PE period within a consecutive twenty-four-month period.
(8) If the department of social and health services establishes a waitlist for TSOA services under WAC 388-106-1975, then PE does not apply.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-11-123, § 182-513-1620, filed 5/22/19, effective 6/22/19. Statutory Authority: RCW 41.05.021, 41.05.160, 2016 1st sp.s. c 36 § 213 (1)(e), section 1115 of the Social Security Act, and 42 C.F.R. §§ 431.400 through 431.428. WSR 17-12-019, § 182-513-1620, filed 5/30/17, effective 7/1/17.]
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