Long-term care

The LEOFF-1 Plan offers long-term care services for its members on a case-by-case basis as long as the board has approved the services in advance. To expedite preapproval, contact the member's employer to help you with the preapproval process.

The board will review and consider for approval the placement and payment of charges for LEOFF-1 member care in an adult family home, boarding home or nursing home under the following conditions:

• A physician or advanced registered nurse practitioner prescribes placement;
• The facility has a current license for adult family care, boarding home care or nursing home care in the state of Washington;
• If the facility is located outside Washington state, the facility is licensed in the state or country where it’s located and the licensing requirements are similar, equal to or greater than those required by the State of Washington (the LEOFF-1 member is responsible for providing documentary evidence of such licensing);
• If placement exceeds six months, the facility provides the board with a treatment plan, followed by updated progress reports from a treating physician every six months;
• The LEOFF-1 member is eligible for Medicare and has either applied for or begun receiving both Part A and Part B Medicare coverage, whether paid for by the employer or the member (the board must authorize reimbursements from Part B); and
• The provider or member submits claims for payment directly to the member's insurance, third-party payor or employer, and the member shows the board proof of submission.