Treatment of entrance fees in continuing care communities, Clients living in fraternal, religious or benevolent nursing facility
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Treatment of entrance fees in continuing care communities, Clients living in fraternal, religious or benevolent nursing facility

Revised May 13, 2013

Purpose: Treatment of entrance fees in a continuing care retirement community or life care community is considered a resource available to the client in certain conditions. How to treat life care contracts signed by the client and the facility and/or organization
WAC 182-513-1396Clients living in a fraternal, religious, or benevolent nursing facility
WAC 182-513-1397Treatment of entrance fees of individuals residing in continuing care retirement communities

WAC 182-513-1396

WAC 182-513-1396

Effective January 1, 2013

WAC 182-513-1396 Clients living in a fraternal, religious, or benevolent nursing facility

This section describes how the department determines eligibility for long-term care (LTC) services for a client living in a fraternal, religious, or benevolent nursing facility.  

  1. For a client living in a licensed nursing facility operated by a fraternal, religious, or benevolent organization, who meets all other eligibility requirements, the department approves institutional  services and noninstitutional medical assistance, if:

    1. Any contract between the client and the facility excludes such benefits on a free or prepaid basis for life; or

    2. The facility is unable to fulfill the terms of the contract and has:

      1. Voided the contract; and

      2. Refunded any of the client's existing assets to the client.

  2. For a client described in subsection (1), the department denies institutional services and noninstitutional medical assistance, if the client:

    1. Signs a contract with the organization that includes such benefits on a free or prepaid basis for life; and

    2. Surrenders income and/or resources to the organization in exchange for such benefits.

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.

WAC 182-513-1397

WAC 182-513-1397

Effective January 1, 2013

WAC 182-513-1397 Treatment of entrance fees of individuals residing in continuing care retirement communities

The following rule applies to long-term care medicaid applicants who reside in a continuing care retirement communities or life care communities that collect an entrance fee on admission from residents:

  1. Treatment of Entrance Fee. An individual's entrance fee in a continuing care retirement community or life care community is considered a resource available to the individual to the extent that:
    1. The individual has the ability to use the entrance fee, or the contract provides that the entrance fee may be used to pay for care should other resources or income of the individual be insufficient to pay for care.
    2. the individual is eligible for a refund of any remaining entrance fee when the individual dies or terminates the continuing care retirement community or life care community contract and leaves the community; and
    3. The entrance fee does not confer an ownership interest in the continuing care retirement community or life care community.

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



Residents of continuing care retirement, life care communities,  fraternal, religious or benevolent nursing facilities often sign life care contracts with the facility. These contracts offer institutional and/or medical care in exchange for the surrender of the client’s income and resources.

See WAC 182-513-1397 regarding the treatment of the entrance fee for individuals that reside in a continuing care retirement or life care community. An entrance fee is considered an available resource based on the criteria in this WAC. 

 

WORKER RESPONSIBILITIES

  1. If the client signed a contract for life care, consider the following to determine if adequate consideration was received when assets were transferred to the facility:

    1. The amount of the client’s assets surrendered under the contract

    2. The client’s cost of care up to the date of application for LTC services

  2. Follow necessary supplemental accommodation (NSA) procedures described in WAC 388-472-0040  when appropriate.

Modification Date: May 13, 2013