Clarifying information

There are two start dates for LTSS, the Medicaid eligibility date and the LTSS start date:

Medicaid eligibility begins, the first day of the month the client is eligible for LTSS.

The LTSS authorization date, which is described in WAC 388-106-0045 , WAC 388-106-0360 and RCW 74.42.056 . If there is a transfer penalty as described in WAC 182-513-1363 , the LTSS start date begins the day after the transfer penalty ends.

The LTSS start date is the date the client is both financially and functionally eligible. The authorization can't be backdated for HCB waiver, CFC, or MPC unless social services has fast-tracked services and the client is subsequently found financially eligible. Social services indicates the start date for HCB waiver on the DSHS 14-443 (communication from social services to HCS PBS), or the DSHS 15-345 (communication from DDA case manager to the DDA PBS).

For Hospice as a Medicaid program, the hospice authorization date is based on the receipt of the 13-746 (HCA/Medicaid hospice notification). The hospice provider is required to submit this form within 5 business days of a hospice election on all active and pending Medicaid cases. If the 13-746 is not received timely, count back 5 business days from the date of receipt to determine the authorization date.

The LTSS authorization date can be backdated for nursing facility services up to 3 months prior to the date of application for a new applicant of Medicaid as long as the client is nursing facility level of care (NFLOC) and financially eligible.

The LTSS start date for nursing facility services on an active Medicaid recipient is based on the first date the admission is reported to DSHS as long as the client meets all other eligibility factors. If the nursing facility admission is on a weekend or holiday, the authorization date is the date of admission as long as DSHS is notified by the next business day.