WAC 182-513-1405

Effective January 1, 2013

WAC 182-513-1405 Definitions

Emergency WAC effective 1/1/2014

For the purposes of this section, the following terms have the meanings given them.  Additional definitions can be found at Chapter 182-500 WAC and WAC 182-513-1301.

"Issuer" means any entity that delivers, issues for delivery or provides coverage to, a resident of Washington, any policy that claims to provide asset protection under the Washington long-term care partnership act, chapter 48.85 RCW.  Issuer as used in this chapter specifically includes insurance companies, fraternal benefit societies, health care service contractors, and health maintenance organizations. 

"Long-term care services" means services received in a medical institution, or under a home and community based waiver authorized by home and community services (HCS) or developmental disabilities administration (DDA).  Hospice services are considered long-term care services for the purposes of the long-term care partnership when medicaid eligibility is determined under chapter 182-513 or 182-515  WAC. 

"Protected assets" means assets that are designated as excluded or not taken into account upon determination of long-term care medicaid eligibility described in WAC 182-513-1315.  The protected or excluded amount is up to the dollar amount of benefits that have been paid for long-term care services by the qualifying long-term care partnership policy on the medicaid applicant's or client's behalf.  The assets are also protected or excluded for the purposes of estate recovery described in chapter 182-527 WAC, in up to the amount of benefits paid by the qualifying policy for medical and long-term care services. 

"Qualified long-term care insurance partnership" means an agreement between the Centers for Medicare and Medicaid Services (CMS), and the health care authority (HCA) which allows for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a long-term care policy that has been determined by the Washington state insurance commission to meet the requirements of section 1917 (b) (1) (c) (iii) of the act.  These policies are described in chapter 284-83 WAC.

"Reciprocity Agreement" means an agreement between states approved under section 6021 (b) of the Deficit Reduction Act of 2005, Public Law 109-171 (DRA) under which the states agree to provide the same asset protections for qualified partnership policies purchased by an individual while residing in another state and that state has a reciprocity agreement with the state of Washington.

 

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.