Department of Social and Health Services - Long Term Care
| Average Annual FTEs | Near General Fund State | Other Funds | Total Funds | |
|---|---|---|---|---|
| (Dollars in Thousands) | ||||
| Current Budget | 2,459.3 | 3,205,070 | 4,705,214 | 7,910,284 |
| 2021-23 Maintenance Level | 2,489.1 | 3,170,152 | 4,737,962 | 7,908,114 |
| Difference from 2021-23 Original | 29.8 | (34,918) | 32,748 | (2,170) |
| % Change from 2021-23 Original | 1.2% | (1.1%) | 0.70% | (0.0%) |
2022 Policy Other Changes |
||||
| In-Home Provider PPE | 10.0 | 5,245 | 6,577 | 11,822 |
| Agency Provider Tax Rate Adjustment | 0.0 | 799 | 1,016 | 1,815 |
| Senior Farmer's Market Nutrition | 0.0 | 400 | 0 | 400 |
| APS Abuse Registry | 0.50 | 91 | 39 | 130 |
| State Match for Federal Grants | 0.0 | 4,042 | 0 | 4,042 |
| Sex Offender Rates | 0.50 | 1,886 | 1,887 | 3,773 |
| Tribal Medicaid Eligibility | 0.50 | 68 | 67 | 135 |
| CDE Transition Costs | 0.0 | 696 | 885 | 1,581 |
| Reduce Occupancy Penalty | 0.0 | 15,435 | 15,435 | 30,870 |
| COVID Positive Units | 0.0 | 0 | 3,400 | 3,400 |
| Acute Care Hospital Capacity | 0.0 | 0 | 3,240 | 3,240 |
| Behavioral Health Transitions | 9.7 | 3,188 | 3,188 | 6,376 |
| Increase In-Home PNA | 0.0 | 25,571 | 32,546 | 58,117 |
| Personal Needs Allowance | 0.0 | 188 | 88 | 276 |
| Case Management Ratios | 20.6 | 9,209 | 9,717 | 18,926 |
| Overpayment Project | 2.4 | 314 | 313 | 627 |
| Network Risk Mitigation | 0.0 | 482 | 384 | 866 |
| Personal Protective Equipment | 0.0 | 0 | 803 | 803 |
| DCYF Reimbursement Gap | 0.0 | 225 | 180 | 405 |
| SEIU and Liang Settlements | 0.0 | 36,048 | 45,845 | 81,893 |
| Public Health Emergency FMAP | 0.0 | (83,819) | 83,819 | 0 |
| Specialized Behavior Contracts | 0.50 | 1,886 | 1,887 | 3,773 |
| Transitional Care Center | 0.0 | 10,889 | 11,444 | 22,333 |
| Targeted Provider Rates | 0.0 | 116,482 | 205,108 | 321,590 |
| 2022 Policy Other Changes Total | 44.7 | 149,325 | 427,868 | 577,193 |
2022 Policy Comp Changes |
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| Adult Family Homes CBA | 0.0 | 8,922 | 8,212 | 17,134 |
| State Employee Benefits | 0.0 | 6 | 5 | 11 |
| WFSE General Government | 0.0 | 4,643 | 3,613 | 8,256 |
| Rep Employee Health Benefits | 0.0 | 29 | 22 | 51 |
| Non-Rep General Wage Increase | 0.0 | 865 | 681 | 1,546 |
| SEIU 1199 General Government | 0.0 | 863 | 686 | 1,549 |
| PERS & TRS Plan 1 Benefit Increase | 0.0 | 135 | 106 | 241 |
| SEIU 775 Agency Providers Parity | 0.0 | 6,028 | 7,669 | 13,697 |
| SEIU 775 In Home Providers | 0.0 | 18,787 | 23,910 | 42,697 |
| 2022 Policy Comp Changes Total | 0.0 | 40,278 | 44,904 | 85,182 |
| Total Policy Changes | 44.7 | 189,603 | 472,772 | 662,375 |
| 2022 Policy Level | 2,533.8 | 3,359,755 | 5,210,734 | 8,570,489 |
| Difference from 2021-23 Original | 74.5 | 154,685 | 505,520 | 660,205 |
| % Change from 2021-23 Original | 3.0% | 4.8% | 10.7% | 8.3% |
Policy Changes
WFSE General Government
The collective bargaining agreement includes a general wage increase of 3.25% for fiscal year 2023 and a lump sum payment for employees who were employed continuously starting on or before July 1, 2021 through June 30, 2022. (General Fund - Federal, General Fund - Medicaid Federal, General Fund - State, other funds)
SEIU 1199 General Government
The collective bargaining agreement includes a general wage increase of 3.25% for fiscal year 2023 and a retention bonus payable in two equal installments. (General Fund - Medicaid Federal, General Fund - State, General Fund - Federal, other funds)
In-Home Provider PPE
In-home care providers provide personal care to Medicaid clients in the client's home. Personal protective equipment maintains the safety of the provider and client. Funding is provided to purchase, store, and distribute PPE to in-home providers. This assumes that Federal Emergency Management Agency (FEMA) funding expires in March 2022. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - State, other funds)
Agency Provider Tax Rate Adjustment
Funding is provided to adjust the employer tax rate paid to home care agencies. An exemption lowered the tax rate used to calculate the tax costs paid on behalf of clients. This created a gap between the tax rate provided to the agencies and the employer tax paid by clients. (General Fund - Cash, General Fund - State, General Fund - Medicaid Federal, other funds)
Senior Farmer's Market Nutrition
Funding is provided to expand the senior farmer's market nutrition program to 7,100 seniors, pay for increased banking fees, and transition the program to a digital payment system. (General Fund - State)
APS Abuse Registry
Funding is provided to establish a process to review requests from providers to be removed from the Adult Protective Services (APS) vulnerable adult abuse registry. The new process will take into consideration varying degrees of harm perpetuated by an individual and any rehabilitation sought after an APS finding. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)
State Match for Federal Grants
Funds are provided to meet federal match requirements to access $30 million in American Rescue Plan Act funding for Older American Act services and supports. (General Fund - State)
Sex Offender Rates
Funding is provided to increase the number and type of residential setting options to deliver long-term care services and supports to a growing number of clients who are registered sex offenders. This provides a rate add-on of $153 per day. (General Fund - Local CRC Oregon, General Fund - State, General Fund - Medicaid Federal, other funds)
Tribal Medicaid Eligibility
Some Tribes provide eligibility determination and case management for Tribal members who are eligible for Medicaid Long-Term Supports and Services. Funding is provided for 1.0 FTE to engage with Tribes to offer technical assistance, coordination, training, and support on Medicaid eligibility and case management. (General Fund - State, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)
CDE Transition Costs
In April 2022, the Consumer Directed Employer will become the new administrative employer for over 45,000 individual providers who serve clients in their home. Funds will be provided from DSHS to the new CDE in April. Funding is provided to account for premiums for paid family leave. (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)
Reduce Occupancy Penalty
The COVID-19 pandemic led to a lower number of patients in skilled nursing facilities. The median occupancy is a factor used to calculate nursing facility rates. If a nursing home drops below a certain occupancy threshold, the administrative rate is lowered, resulting in a penalty for nursing homes with fewer residents. Funding is provided to lower the occupancy threshold from 90 percent to 70 percent for skilled nursing homes for purposes of the July 1, 2022 rate development. (General Fund - Cash, General Fund - State, General Fund - Medicaid Federal, other funds)
COVID Positive Units
Funds are provided for units in nursing homes specifically for patients with COVID-19. These units are separate from other nursing home residents and help create more capacity in acute care hospitals that are facing critical shortages of hospital beds due to the pandemic. (Coronavirus St Fiscal Recovery Fund - Federal)
Acute Care Hospital Capacity
The COVID-19 pandemic led to a shortage of beds in acute care hospitals. From October through December 2021, ALTSA offered incentive payments to long-term care settings to take patients from acute care hospitals who have been in the hospital for more than 30 days without a discharge plan and who no longer need acute levels of care. (Coronavirus St Fiscal Recovery Fund - Federal)
Behavioral Health Transitions
Funding is provided for 19.3 FTE staff to reduce the average number of clients per case manager from 42 to 35 clients. This will improve care for clients served under the residential support waiver and help people transition from state hospitals to home and community settings. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Increase In-Home PNA
Funds are provided to increase the in-home client personal needs allowance (PNA), which is an amount of personal income retained by Medicaid clients to pay for their personal needs, including housing costs, utilities, food, and personal incidentals. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Personal Needs Allowance
Funding is provided to increase the personal needs allowance (PNA) for Medicaid clients in residential and institutional settings. The PNA is the amount personal income retained by these clients to pay for their personal needs, including housing costs, utilities, food, and personal incidentals. (General Fund - State, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)
Case Management Ratios
Case managers conduct home visits, respond to safety concerns, and connect clients to health and community resources. Lower caseloads contribute to better health outcomes for clients and reduce the need for expensive institutional stays for clients. Funding is provided for 20.6 FTE staff to reduce the number of cases per case manager from 94 to 75 clients. (General Fund - Local CRC Oregon, General Fund - Medicaid Federal, General Fund - State, other funds)
Overpayment Project
This funding will resolve a backlog of 400,000 potential Medicaid overpayments dating back to 2016 and totaling $50 million. (General Fund - State, General Fund - Medicaid Federal, General Fund - Local CRC Oregon, other funds)
Network Risk Mitigation
Funding to replace aging hardware and bring network assets up to current security best practices in order to reduce the risk of service interruption. (General Fund - State, General Fund - Cash, General Fund - Medicaid Federal, other funds)
Personal Protective Equipment
Personal protective equipment helps contain the spread of COVID-19 and reduce infection rates. Funding is provided to purchase, store, and distribute PPE to DSHS employees. This assumes that Federal Emergency Management Agency (FEMA) funding expires in March 2022. (General Fund - Medicaid Federal, General Fund - Cash, Coronavirus St Fiscal Recovery Fund - Federal, other funds)
DCYF Reimbursement Gap
Funds to maintain current information technology (IT) service levels as the Department of Children, Youth, and Families moves to an internally managed network from a DSHS-managed network. (General Fund - Medicaid Federal, General Fund - State, General Fund - Local CRC Oregon, other funds)
SEIU and Liang Settlements
Funds are provided to settle the cases of Liang, et al, v. Washington DSHS, et al, and SEIU 775 v. Washington DSHS, et al. (General Fund - Medicaid Federal, General Fund - State, General Fund - Cash, other funds)
Public Health Emergency FMAP
The federal Families First Coronavirus Relief Act authorized additional federal matching funds (FMAP) for the duration of the public health emergency. State funds are reduced and Medicaid is increased to reflect an additional 6.2 percent federal Medicaid matching rate from January through June 30, 2022. This includes appropriations related to unanticipated receipt number 0025. (General Fund - Medicaid Federal, General Fund - Cash, General Fund - Local CRC Oregon, other funds)
Specialized Behavior Contracts
Funding is provided to increase the number and type of residential setting options to deliver long-term care services and supports to a growing number of clients who are registered sex offenders. This provides a rate add-on of $153 per day for specialized behavior support contracts. (General Fund - Medicaid Federal, General Fund - Local CRC Oregon, General Fund - State, other funds)
Transitional Care Center
Funding is provided for the Transitional Care Center in Seattle for a new contract beginning December 1, 2021. It includes a higher daily rate, smaller total client capacity, and elimination of the rate to hold empty beds. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Targeted Provider Rates
Funding is provided to continue the COVID-19 rate enhancements that expired on December 31, 2021 to contracted providers. The rate enhancements are reduced by 20 percent every two quarters in fiscal year 2023 and fiscal year 2024. This includes appropriations related to unanticipated receipt number 0027. (General Fund - State, General Fund - Local CRC Oregon, General Fund - Medicaid Federal, other funds)
Adult Family Homes CBA
Funding is provided for implementation of an agreement reached between the governor and the adult family home council under the provisions of chapter 41.56 RCW for fiscal year 2023. (General Fund - State, General Fund - American Rescue Plan Act (ARPA), General Fund - Medicaid Federal, other funds)
State Employee Benefits
Health insurance funding is provided for state employees who are not covered by the healthcare coalition. The insurance funding rate is $936 per employee per month for fiscal year 2022 and $1,130 per employee per month for fiscal year 2023. (General Fund - Federal, General Fund - Medicaid Federal, General Fund - State, other funds)
Rep Employee Health Benefits
Health insurance funding is provided as part of the master agreements for employees who bargain for health benefits as part of a coalition of unions. The insurance funding rate is $936 per employee per month for fiscal year 2022 and $1,130 per employee per month for fiscal year 2023. (General Fund - Federal, General Fund - Medicaid Federal, General Fund - State, other funds)
Non-Rep General Wage Increase
A general wage increase of 3.25%, effective July 1, 2022, is provided for state employees who are not represented by a union or who are covered by a bargaining agreement that is not subject to financial feasibility determination. (General Fund - Federal, General Fund - Medicaid Federal, General Fund - State, other funds)
PERS & TRS Plan 1 Benefit Increase
For eligible Public Employees' and Teachers' Retirement Systems Plan 1 members, this item provides an increase of 3%, up to a maximum of $110 per month. (General Fund - Medicaid Federal, General Fund - State, General Fund - Federal, other funds)
SEIU 775 Agency Providers Parity
Funding is provided to for the homecare agency parity impacts of the agreement between the governor and the service employees international union healthcare 775nw. (General Fund - Medicaid Federal, General Fund - American Rescue Plan Act (ARPA), General Fund - State, other funds)
SEIU 775 In Home Providers
Funding is provided for the implementation of an agreement reached between the governor and the adult family home council under the provisions of chapter 41.56 RCW for fiscal year 2023. (General Fund - Medicaid Federal, General Fund - American Rescue Plan Act (ARPA), General Fund - State, other funds)
