Institutional Status

	EAZ	Search for:

Acronyms Revisions WAC Number Index Site Map WCCC DSHS Home

Institutional Status

Revised October 29, 2007

Purpose:

WAC 388-513-1320 Determining institutional status for long-term care (LTC) services

WAC 388-513-1320
WAC 388-513-1320
Effective January 8, 2000

WAC 388-513-1320 Determining institutional status for long-term care (LTC) services
Institutional status is an eligibility requirement for LTC services.

To attain institutional status, a client must:

Be approved for and receiving waivered or hospice services; or

Reside or be likely to reside in a medical facility for a continuous period of:

Ninety days for a child seventeen years of age or younger receiving inpatient chemical dependency and/or inpatient mental health treatment; or

Thirty days for:

An SSI-related client;

A child not described in subsection (1) (b) (i); or

A client related to medical eligibility as described in WAC 388-513-1315 (10), (11), or (12).

A client’s institutional status is not affected by a:

Transfer between medical facilities; or

Change from one kind of long-term care services to another.

A client loses institutional status when the client:

Is absent from the medical facility for at least thirty consecutive days; or

Does not receive waivered or hospice services for at least thirty consecutive days.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information
The term, "institutional status," refers to a minimum period of time for which a client requires LTC services. A client attains this status when the need for inpatient services is equal to or greater than the number of days defined in WAC 388-513-1320. A client who is approved for waivered or hospice services and is receiving such services has also achieved institutional status.

A client attains institutional status when he/she:

Resides continuously in a nursing facility/hospital/state institution for 30 days or longer; or

Is likely to remain in a nursing facility/hospital/state institution for 30 consecutive days or longer.

Receives waiver program services through DDD or HCS.

Medical Institutions

Not every facility is considered a medical institution. Assisted living, adult family home, boarding home, DDD Group homes are not considered medical institutions, but clients can be receiving an institutional (Waiver) program in these facilities.

This is a list of medical institutions:

Hospital

Institution for the Mentally Diseased (IMD)

Intermediate Care Facilities for the Mentally Retarded (ICF-MR)

Nursing Facility (NF)

Veteran's Home-nursing facility section

Hospice Care Center

Residential Habilitation Centers (RHC)

NOTE:
"Likely to remain" means there is a reasonable expectation the client will be in a nursing facility/hospital/state institution/hospice care center for 30 consecutive days or longer. Once made, the determination holds, even if the client does not actually remain institutionalized for 30 consecutive days. For nursing facilities, the HCS social worker gives the best projection possible as to whether the client is projected to be in the facility 30 days or more.

A client loses institutional status when he/she is absent from a medical institution for at least 30 days , or

Does not receive waiver program services for at least 30 days from DDD or HCS.

NOTE: Hospice services can be received in a medical facility or in conjunction with waiver services. They are a group of services provided to a client who is terminally ill. Hospice services do not constitute a waiver program but waiver rules can be used for hospice medicaid eligibility. If residing in a medical institution 30 days or more (nursing facility, hospital, hospice care center) institutional rules must be used See hospice.

Worker Responsibilities
Obtain the determination of whether the client is likely to remain institutionalized for 30 consecutive days from the department-designated social worker (SW).

For nursing facility cases, the HCS SW notifies financial of the date of request for assessment, whether the client is projected to be in a nursing facility 30 days or more and if the client meets nursing facility level of care (NFLOC).

For clients who meet both 30 day or more institutionalization and NFLOC, institutional Medicaid is considered.

For clients who do not meet the 30 day or more institutionalization, institutional Medicaid cannot be considered. Eligibility for Medicaid is determined as if the client were in their own home. If the client is eligible for another Medical program, the admission into the medical institution is considered a short stay (30 days or less). SEE SHORT STAYS.

ACES PROCEDURES
See Long Term Care and Waivered Services

EAZ