Long-term services and supports are for persons who need assistance with activities of daily living such as bathing, dressing, ambulation, transfers, toileting, medication assistance or administration, personal hygiene, transportation, and other health-related tasks.  The Department of Social and Health Services (Department) administers Medicaid funded long-term services and supports to eligible persons in Washington.  For a person to receive long-term services and supports, the person must be determined by the Department to be both functionally and financially eligible.  Once a person is determined to be eligible for long-term services and supports, the person has the option to receive services in the home, from a community residential services provider, or in a skilled nursing facility.
 
The Department contracts with 13 area agencies on aging to provide case management and related services to persons receiving long-term services and supports in their homes.  Case management services may include establishing a plan of care for the person and monitoring the plan's implementation, reassessing and reauthorizing services, and assessing the quality of care being provided to persons.  In situations in which an individual provider who provides the services is under contract with the Department, rather than employed by a consumer-directed employer, the area agency on aging has additional responsibilities related to verifying training requirements, conducting background checks, monitoring service provision, and terminating individual provider contracts for cause.  The Department assesses the degree and quality of case management services performed by area agencies on aging.

The Department of Social and Health Services (Department) may contract with a federally recognized Indian tribe (tribe) to determine eligibility for services, authorize and reauthorize services, and perform other case management functions for persons receiving home and community services within its regional authority.  Specifically, if the Department contracts with a tribe, the tribe must perform the same functions as required for area agencies on aging, including:

• developing a plan of care with each client to coordinate health and long-term care services and supports;
• monitoring the implementation of each client's plan of care;
• reassessing and reauthorizing services;
• explaining to consumers that they have the right to waive case management services offered by the federally recognized Indian tribe and documenting any such waiver;
• notifying the consumer-directed employer if an individual provider is not delivering services or is jeopardizing a person's health, safety, or well-being;
• assessing the quality of in-home care services provided to individuals; and
• fulfilling responsibilities related to individual providers under contract with the Department, such as verifying training requirements, conducting background checks, monitoring service provision, and terminating individual provider contracts for cause.

 
The Department must assess the degree and quality of case management services performed by contracted federally recognized Indian tribes to the same extent that it may assess area agencies on aging.