HIV AIDS Resource Guide/HIV-AIDS Resource Guide.iso/STAT/STATE/WASH-AC.ASC

Text File | 1993-01-14 | 15KB | 440 lines

/* The WASHINGTON ADMINISTRATIVE CODE addresses health insurance
and insurance discrimination; treatment; and training for school
employees. */



Chapter 246-130 WAC

HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION TREATMENT



WAC

246-130-001    Purpose.

246- 30-010    Definitions.

246-130-020    Services.

246-130-030    Reimbursements.

246-130-040    Financial eligibility.

246-130-050    Transfer of resources without adequate
consideration.

246-130-060    Fiscal information.

246-130-070    Patient participation.



WAC 246-130-001  Purpose. The department shall administer federal
and state funds appropriated to assist a person in need of
Zidovudine, or other drugs and treatments available in the
future. These drugs are used for the treatment of various stages
of infection with HIV.



WAC 246-130-010  Definitions. The following words and phrases
have the following meaning in chapter 246-130 WAC unless the
context clearly indicates otherwise:

(1)  "AIDS" means acquired immunodeficiency syndrome.

(2)  "APDP" means AIDS prescription drug program.

(3)  "Department" or "DOH" means the Washington state department
of health.

(4)  "HIV" means human immunodeficiency virus.

(5)  "NPIG" means National Poverty Income Guidelines as under
sections 652 and 673 (2) of the Omnibus Budget Reconciliation Act
of 1981 (Public Law 9735) and as updated annually in the Federal
Register on February 16.

(6)  "Patient share" means the amount of cost borne by the
patient.



WAC 246-130-020  Services. To the extent federal or state funds
are appropriated for the purpose of APDP approved drugs and
treatments, the department shall reimburse a participating
pharmacy, or health care provider, and clinic for costs of
dispensing APDP approved drugs and treatments to an eligible
individual suffering from infection with HIV.



WAC 246-130-030  Reimbursements. Individuals desiring
reimbursement for APDP approved drugs and treatments must provide
evidence of financial eligibility as established by WAC 246-130-
040. The department will make reimbursement, reduced by the
patient share computed in accordance with WAC 246-130-070, to
eligible participants who, in the department's judgment,
demonstrate the greatest need or the most likely benefit from the
treatments.



WAC 246-130-040  Financial eligibility. (1) The department will
consider a patient eligible if he or she:

(a)  Has resources at or below the exemptions listed under
subsection (3) of this section; and

(b)  Is not eligible for any other resources providing similar
benefits to meet the costs of the treatment; and

(c)  Has gross monthly income at or below three hundred seventy
percent of the NPIG; and

(d)  The total cost of program covered medications is in excess
of the patient's share as computed in accordance with WAC 246-130-
070.

(2)  The department shall consider the following in determining
resources:

(a)  Savings, property, and other assets;

(b)  Government and private medical insurance programs, including
Medicaid, providing partial or full coverage for drug and
treatments needed in the treatment of infection with HIV; and

(c)  Local funds raised for the purpose of providing financial
support for a specified patient.

(3)  The following exemptions shall not be considered in
determining a patient's resources to pay for treatments covered
by these regulations:

(a)  A home, defined as real property owned by' a patient as a
principal place of residence, together with the property
surrounding and contiguous thereto not to exceed five acres;

and

(b)  Commercial property, or property used for the purpose of
producing income, except to the extent that its value exceeds the
sum of ten thousand dollars;

(c)  Household furnishings;

(d)  An automobile; and

(e)  Savings, property, or other liquid assets, to the extent the
value thereof does not exceed the sum of ten thousand dollars.



WAC 246-130-050  Transfer of resources without adequate
consideration. The department shall:

(1)  Consider an individual ineligible for the program if the
person knowingly and willfully assigns or transfers nonexempt
resources at less than fair market value for the purpose of
qualifying or continuing to qualify for the program within two
years preceding the date of application.

(2)  Require expiration of two years before the individual will
be considered eligible between the date of transfer and
reapplication.



WAC 246-130-060 Fiscal information. An individual seeking
coverage shall provide fiscal information upon request of the
department including:

(1)  Sources and amounts of resources to verify financial
eligibility,

(2)  Evidence all other available resources were used before
requests for reimbursement from the state program are submitted
to the department, and

(3)  Other information when required by the department.



WAC 246-130-070  Patient participation. The patient shall be
responsible for paying part of the cost of the treatment received
in any month in which his or her income exceeds two hundred
percent of the NPIG. The amount of the patient's share shall be
one-sixth of the amount by which his or her income for the month
exceeds two hundred percent of the NPIG.



Chapter 246-132 WAC

CLASS IV HIV HEALTH INSURANCE ELIGIBILITY

WAC

246-132-020    Class IV human immunodeficiency virus (HIV)
insurance program.

246-132-030    Eligibility.



WAC 246-132-020  Class IV human immunodeficiency virus (HIV)
insurance program. Definitions of program covered by the
department of health.

(1)  "Class IV HIV insurance program" means the program
authorized by chapter 70.24 RCW and financed by state funds to
assure health insurance coverage for an individual with Class IV
HIV infection as defined by the state board of health meeting
eligibility requirements established by the department.

(2)  "Class IV HIV infection" means an illness characterized by
the diseases and conditions defined and described by the state
board of health in WAC 246-100-011(1) and 246-l00-076.



WAC 246-132-030  Eligibility. (1) The department shall pay, to
the extent a person is liable for group health insurance
premiums, such premiums for a person who has a diagnosis of Class
IV human immunodeficiency virus (HIV) infection and:

(a)  Is terminated from employment for reasons other than gross
misconduct;

(b)Has experienced a reduction in employment hours to the extent
the applicant is liable for part or all of the health insurance
premium;

(c)  Is entitled to benefits under Title XVIII of the Social
Security Act;

(d)  Ceases to be a dependent child under the requirements of the
health insurance plan; or

(e)  Is divorced or legally separated from the covered employee
and has continuation coverage rights.

(2)  An applicant's eligibility under the program shall cease
when the individual:

(a)  Dies;

(b)  Loses insurance eligibility for a reason other than the
reasons noted under subsection (1) of this section; or

(c)  Moves out of state.



Chapter 284.90 WAC

RULES PERTAINING TO AIDS



WAC

284-90-010     Purpose.

284-90-020     Insuring Procedures relating to AIDS.

284-90-030     Policy Reserves - Annual Financial Statements.



WAC 284-90-010 Purpose. (1) The purpose of this chapter is to
assure nondiscriminatory treatment of insureds and prospective
insureds by establishing minimum standards insurers must meet
with respect to acquired immune deficiency syndrome (AIDS) and
its related conditions. Such related conditions include a
positive testing for the Human T-Cell Lymphotropic Virus Type III
(HTLV-III) antibodies and a diagnosis of AIDS related complex.

(2)  The insurance code prohibits unfair discrimination between
insureds having like risk and exposure factors. The practical
effect of the law is to require grouping of insureds into classes
of like risk and exposure and charging a premium commensurate
with the risk and exposure. This assures the equitable treatment
of each class of insureds in the sense that the premium charge is
reasonably related to the risk assumed by the insurer and that no
class of insureds supports (or is supported by) another class of
insureds. For example: Insureds with a heart condition should not
subsidize (or be subsidized by) insureds with AIDS or diabetes;
policies issued on a standard basis should not be surcharged to
support those issued to insureds suffering from an ailment. To
properly classify such prospective insureds, insurers must ask
appropriate questions on application forms and may require
reasonable testing of prospective insureds.



WAC 284-90-020  Insuring procedures relating to AIDS. (1) AIDS
and its related conditions are diseases and must be considered as
such under the insurance laws of this state. Underwriting
considerations must be consistent with the underwriting
considerations applied to other diseases. Prospective insureds
must be accepted or rejected or rated standard or substandard on
the basis of bona fide and substantiated statistical differences
in risk or exposure.

(2)  Questions about AIDS and related health conditions on
applications for insurance must be in clear and understandable
language and must lend themselves to the placement of applicants
in the proper class of insureds. Questions which are ambiguous or
misleading are prohibited.

(3)  When used, the blood testing of insurance applicants must be
administered on a nondiscriminatory basis. If a prospective
insured is to be declined or rated substandard because of HTLV-
III antibodies in the blood, such action must be based on a
Western Blot Test or another test of equal or greater accuracy.
Testing procedures of lesser accuracy may be used on a
nondiscriminatory basis for underwriting purposes, but a
prospective insured may not be declined or rated substandard
solely on the basis of results from such test(s).

(4)  There are several aspects of the disease AIDS which may
create unforeseen claim settlement problems under life insurance,
loss of time, and medical coverages. The likelihood of the
claimant incurring medical expenses from several different
symptoms of AIDS or one of its related conditions may make it
difficult to determine when the disease first manifested itself.
The long incubation period along with the concurrent and
aggravating ailments may create problems with the application of
the preexisting conditions clause and the incontestable
provision, as well as the rules which determine a new spell of
illness. The benefit provision, including any extended benefit
provision, will determine the extent of claim payments if the
disease manifested itself while the policy was in force but
continued after expiration of coverage or termination of the
contract. Such matters, and others unique to the disease of AIDS
and its related conditions, must be resolved in a manner consis
tent with the settlement of claims resulting from other diseases.



WAC 284-90-030 Policy reserve-Annual financial statements. The
instructions for the annual statement of life and disability
insurers, health care service contractors, and health maintenance
organizations which must be filed with the insurance commissioner
require an actuarial statement setting forth the actuary's
opinion relating to policy reserves and other actuarial items.
Effective with statements submitted after December 31, 1986, such
statements shall take into account the effect on the adequacy of
the insurer's reserves of AIDS and its related conditions and any
other disease that does or may potentially constitute an
epidemic.



Chapter 392-198 WAC

TRAINING-SCHOOL EMPLOYEES-HIV/AIDS



WAC

392-198-005    Authority.

392-198-010    Purposes.

392-198-015    Course content requirements for HIV/AIDS inservice
training-Mandatory.

392-198-020    Course content requirements for HIV/AIDS inservice
training-Supplemental.

392-198-025    Continuing inservice.

392-I 98-030   New employee training.



WAC 392-198-005  Authority. The authority for this chapter is RCW
70.24.290 which authorizes the superintendent of public
instruction to adopt rules that require appropriate education and
training of public school employees about the transmission,
prevention, and treatment of HIV/ AIDS. The superintendent of
public instruction is further required to develop the course
content in consultation with the department of health under RCW
70.24.250.



WAC 392-198-010  Purposes. The purpose of this chapter is to
provide public school districts with the mandatory and
supplemental course content requirements for training school
district employees regarding the transmission, prevention, and
treatment of HIV/AIDS.



WAC 392-198-015  Course content requirements for HIV/AIDS
inservice training-Mandatory. Pursuant to RCW 70.24,250 and
70.24.290 the HIV/AIDS training provided by public school
districts shall include:

(1)  History and epidemiology of HIV/AIDS;

(2)  Methods of transmission of  HIV;

(3)  Methods of prevention of HIV including universal precautions
for handling of body fluids;

(4)  Current treatment for symptoms of HIV and prognosis of
disease progression;

(5)  State and federal laws governing discrimination of persons
with HIV/AIDS;

(6)  State and federal laws regulating confidentiality of a
person's HIV antibody status.



WAC 392-198-020  Course content requirements for HIV/AIDS
inservice training-Supplemental Pursuant to RCW 70.24.250 and
70.24.290 the HIV/AIDS training may include:

(1)  Federal, state, and local resources for HIV/AIDS;

(2)  Impact of HIV/AIDS on infected individuals and their
families;

(3)  Global impact of HIV/AIDS;

(4)  .Anonymous and confidential testing for HIV antibodies.



WAC 392-198-025  Continuing inservice. Pursuant to RCW 70.24.250,
all local school districts shall ensure that significant new
discoveries or changes in accepted knowledge of transmission,
prevention, and treatment for HIV/ AIDS are provided to all
public school employees within one calendar year of the date of
notification by the superintendent of public instruction as
advised by the office on HIV/ AIDS, department of health, unless
the department of health notifies the districts that the
information is of such an emergent nature that a prompter
response is required.



WAC 392-198-030  New employee training. Each school district
shall ensure that newly hired school district employees shall
receive the HIV/AIDS training prescribed in WAC 392-198-015
within six months from the first day of employment in the
district.