WAC 110-50-1060. Reimbursement limitations for the caregiver reimbursement program

(1) The department will: (a) Follow these reimbursement limitations when determining reimbursement amounts for the caregiver reimbursement program claims: (i) The total amount the department will pay as the result of one occurrence must not exceed: (A) $10,000 for all property damages and losses; (B) $3,000 for claims related to the ownership and operation of a motor vehicle; (C) $1,000 for emergency medical expenses; and (D) $500 for emergency veterinary expenses; (ii) For damage caused over a period of time, the date of the occurrence is the last date the damages occurred; (iii) The total reimbursement cost is assessed for each occurrence separately and includes the costs for each item in the occurrence; (iv) The limitations for each occurrence must apply regardless of whether there are multiple claims from the same occurrence; (v) The total reimbursement cost for property damages or loss and emergency medical expenses are limited to the costs: (A) Not covered in any insurance policies, up to the maximum occurrence costs in (a)(i) of this subsection; (B) Of the insurance policy deductible and any out-of-pocket expenses, up to the maximum occurrence costs in (a)(i) of this subsection; and (vi) Dental or vision appliances are limited to comparable replacements up to the maximum occurrence costs in (a)(i) of this subsection; and (b) Consider damages from the same occurrence claimed by one or more caregivers in the same household as a single occurrence; (c) Pay comparable replacement costs only if the: (i) Item cannot be cleaned or repaired; or (ii) The comparable replacement cost of the item is less than the cleaning or repair cost; (d) Reimburse for labor expenses for the amount payable to a licensed business; (e) Reimburse caregivers or household members that complete repairs for materials only; (f) Not require caregivers to use their insurance policy but will only consider reimbursement for the insurance deductible, coinsurance amounts, and any out-of-pocket expenses up to the limit of the occurrence in (a)(i) of this subsection; (g) Limit veterinary expenses to animal emergency medical expenses; and (h) Pay the replacement value for animal loss, not to exceed the substantiated value of the animal or maximum per occurrence, whichever is less. (2) Caregivers must: (a) Notify the department if their property damages or losses were paid, will be paid, or are covered by a homeowners', motor vehicles, or other public, personal, or business insurance policy; and (b) Provide detailed medical bills and insurance statements or explanation of benefits showing the amount covered for emergency medical expenses.