Preproposal statement of inquiry was filed as WSR 18-17-034.
Title of Rule and Other Identifying Information: WAC 182-13-010 Purpose, 182-13-020 Definitions, 182-13-030 Eligibility, and 182-13-040 Application for medicare supplemental coverage.
Hearing Location(s): On December 11, 2018, at 10:00 a.m., at the Health Care Authority (HCA), Cherry Street Plaza Building, Sue Crystal Conference Room 106A, 626 8th Avenue, Olympia, WA 98504. Metered public parking is available street side around building. A map is available at https://www.hca.wa.gov/assets/program/Drivingparking-checkin-instructions.pdf or directions can be obtained by calling 360-725-1000.
Date of Intended Adoption: No sooner than December 12, 2018.
Submit Written Comments to: HCA Rules Coordinator, P.O. Box 45504, Olympia, WA 98504-5504, email arc@hca.wa.gov, fax 360-586-9727, by December 11, 2018.
Assistance for Persons with Disabilities: Contact Amber Lougheed, phone 360-725-1349, fax 360-725-9727, telecommunication relay services 711, email amber.lougheed@hca.wa.gov, by December 7, 2018.
• Change references from medicare supplement coverage to medicare supplemental coverage.
• Revise several definitions in WAC 182-13-020.
• Align eligibility in WAC 182-13-030 with RCW 41.05.197.
• Clarify state residents can apply for medicare supplemental coverage thirty days before they are enrolled in Parts A and B of medicare.
• Allow residents to apply within sixty-three days instead of sixty days for coverage after becoming a new resident.
• Include guaranteed issue periods by cross-referencing RCW 48.66.045 and 48.66.055.
Statutory Authority for Adoption: RCW 41.05.197, 41.05.160.
Statute Being Implemented: RCW 41.05.197, 41.05.160.
Name of Agency Personnel Responsible for Drafting: Stella Ng, 626 8th Avenue S.E., Olympia, WA, 360-725-0852; Implementation: Barbara Scott, 626 8th Avenue S.E., Olympia, WA, 360-725-0830, and Enforcement: Scott Palafox, 626 8th Avenue S.E., Olympia, WA, 360-725-1858.
The purpose of this chapter is to establish criteria for state residents for participation in medicare ((supplement))supplemental coverage available through the HCA.
Unless otherwise specifically provided, the definitions contained in this section apply throughout this chapter.
(1) "HCA" means the Washington state health care authority.
(2) "Health plan," or "plan" means any individual or group: Policy, agreement, or other contract providing coverage for medical, surgical, hospital, or emergency care services, whether issued, or issued for delivery, in Washington or any other state. "Health Plan" or "plan" also includes any group health plan that is maintained by any state and governed by the Public Health Services Act in 42 U.S.C. Chapter 6A, self-insured coverage governed by the federal Employee Retirement Income Security Act of 1974, coverage through the Washington state health insurance ((Access Act))pool as described in chapter 48.41 RCW, ((coverage through the Basic Health Plan as described in chapter 70.47 RCW, and)) coverage through the medicaid program as described in Title 74 RCW, and coverage through the Washington state health benefit exchange as described in chapter 43.71 RCW. "Health plan" or "plan" does not mean or include: Hospital confinement indemnity coverage as described in WAC 284-50-345; disability income protection coverage as described in WAC 284-50-355; accident only coverage as described in WAC 284-50-360; specified disease and specified accident coverage as described in WAC 284-50-365; limited benefit health insurance coverage as described in WAC 284-50-370; long-term care benefits as described in chapter 48.84 RCW; or limited health care coverage ((such as dental only, vision only, or chiropractic only))(e.g., dental only).
(3) "Lapse in coverage" means a period of time greater than ((ninety))sixty-three continuous days without coverage by a health plan.
(4) "Resident" means a person who demonstrates that ((he/she lives))they live in the state of Washington ((at the time of application for, and issuance of coverage))by providing evidence of residency.
(2) ((Actually enrolled in both Parts A and B of medicare not later than the effective date of medicare supplement coverage.))Not eligible to purchase coverage as a retired or disabled employee under RCW 41.05.195.
WAC 182-13-040Application for medicare ((supplement))supplemental coverage.
(5) When replacing coverage as described in RCW 48.66.045 or when enrolling during a guaranteed issue period as described in RCW 48.66.055.