Preproposal statement of inquiry was filed as WSR 98-07-051.

Title of Rule: WAC 388-15-194 Home and community services--Nurse oversight.

Purpose: Implement RCW 74.09.520 (3)(b) which requires that the plan of care for Medicaid personal care (MPC) clients be reviewed by a nurse.

Other Identifying Information: The title of the rule is being changed from Home and community services--Nurse oversight, and other related sections to Home and community services--Nursing service.

Statutory Authority for Adoption: RCW 74.09.520, 74.08.090.

Statute Being Implemented: RCW 74.09.520(3).

Summary: The proposed rules describe when an RN will consult with or visit Medicaid personal care (MPC) and community options program entry system (COPES) clients. The proposed rule describes the activities that an RN will perform when visiting or consulting on behalf of an MPC or COPES client.

Reasons Supporting Proposal: State legislation RCW 74.09.520 (3)(b).

Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Lorrie Mahar, Aging and Adult Services Administration, Lacey, Washington 98504-5600, (360) 493-2537.

Name of Proponent: Department of Social and Health Services, Aging and Adult Services Administration, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The proposed amendments would enable the area agencies on aging and DSHS regional offices to use the nurses skill set more effectively in managing the increased caseload in home and community based settings. Nursing service would be provided when needed and as appropriate, not on a mandated basis. This would provide targeted nursing services within current funding limits.

Proposal Changes the Following Existing Rules: The change enhances the services that nurses are to provide based on the specific needs of an individual MPC or COPES client.

No small business economic impact statement has been prepared under chapter 19.85 RCW. These rules do not impose a fee or cost on providers, nor do these rules impose a requirement on businesses.

RCW 34.05.328 does not apply to this rule adoption. These rules are related only to internal governmental operations and are not subject to violation by a nongovernmental party (RCW 34.05.328 (5)(b)(ii)).

Hearing Location: Lacey Government Center (behind Tokyo Bento Restaurant), 1009 College Street S.E., Room 104-B, Lacey, WA 98503, on September 8, 1998, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Paige Wall by August 28, 1998, phone (360) 902-7540, TTY (360) 902-8324, e-mail pwall@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, Paige Wall, Rules Coordinator, Rules and Policies Assistance Unit, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 902-8292, by September 8, 1998.

Date of Intended Adoption: September 15, 1998.

August 4, 1998

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

AMENDATORY SECTION (Amending Order 3904, filed 9/28/95, effective 10/29/95)

WAC 388-15-194  Home and community services--((Nurse oversight))Nursing service. (1) A registered nurse will review the plan of care for all Medicaid personal care clients.

(2) Upon department or designee referral a registered nurse ((shall visit)) will consult regarding or visit a community options program entry system client ((and)) or a Medicaid personal care client one time per year or more often ((to)). The registered nurse may perform a comprehensive nursing service, which includes but is not limited to the following activities:

(a) ((Review the personal care task delivery portion of the client's service plan;)) Nursing assessment/reassessment which may include:

(i) Review of history;

(ii) Review of physical systems;

(iii) Physical examination as pertinent to potential problems (may include vital signs, skin assessment, heart/lung sound, bowel sounds, etc.);

(iv) Functional assessment;

(v) Psycho-social/emotional/cognitive assessment;

(vi) Pharmacological assessment;

(vii) Identification of client problems and caregiver teaching needs not currently addressed by service plan (including need for nurse delegation of skilled tasks).

(b) ((Evaluate the effectiveness of the personal care task delivery portion of the client's service plan)) Instruction to care providers and clients which may include:

(i) Specific instruction for personal care services;

(ii) Disease process(es) or symptoms and how to effectively manage (i.e., diabetic management, incontinence, pain control);

(iii) Purpose of medications and potential side effects/complications;

(iv) Behavioral interventions/alternatives to psychoactive medications and physical restraints;

(v) Safety/universal precaution needs;

(vi) Health promotion (including preventive measures).

(c) Care coordination which may include:

(i) Consult/coordinate with all pertinent members of client's care team (i.e., physician, home health, pharmacy, social worker, delegating nurse, therapist family, etc.) And facilitate referrals when needed;

(ii) Educate regarding available community resource/programs pertinent to client's needs;

(iii) Resource for phone consultation or client reassessment (in coordination with case manager) when client condition changes;

(iv) Record keeping/documentation of activities provided;

(v) Facilitate equipment/transportation needs.

(d) Evaluation which may include:

(i) Observation, monitoring and reassessment of client (which may include but is not limited to re-evaluation of skin condition, nutrition/hydration status, disease process, client's response/tolerance of medication regimen);

(ii) Evaluate caregivers capacity and ability to perform necessary activities to meet client's needs;

(iv) Revise care plan based on reassessment information.

(((2) The department or its designee may authorize a registered nurse's oversight visit more frequently than once a year when the client appears to:

(a) Be at high risk; or

(b) Have an unstable condition; or

(c) Have a provider who requires training))

(3) The frequency and scope of the nursing services will be based on individual client need.

(((3))) (4) The registered nurse ((shall)) must documents the result of the ((nurse's oversight visit on the department-prescribed form)) nursing service provided on a department-approved form. The registered nurse provides a copy to the staff who has case management responsibility.

[Statutory Authority: RCW 74.08.090, 74.09.520 and 1995 1st sp.s. c 18. 95-20-041 (Order 3904), § 388-15-194, filed 9/28/95, effective 10/29/95.]

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.