WSR 04-11-086

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed May 18, 2004, 4:53 p.m. ]

Supplemental Notice to WSR 04-10-097

Preproposal statement of inquiry was filed as WSR 04-01-087.

Title of Rule: Chapter 388-72A WAC, Comprehensive assessment reporting evaluation (CARE) tool.

Purpose: Incorporating CARE assessment criteria for children receiving state plan Medicaid personal care (MPC) services and amending other sections as needed to update program rules.

This CR-102 replaces the notice filed as WSR 04-10-097, which has been withdrawn.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520, and 74.39A.095.

Statute Being Implemented: RCW 74.08.090, 74.09.520, 74.39A.090, 74.39A.095.

Summary: See Purpose above.

Reasons Supporting Proposal: See Purpose above.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Marrianne Backous or Sue Poltl, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2535 or 902-8474.

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

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

Explanation of Rule, its Purpose, and Anticipated Effects: Amending and adding new sections to chapter 388-72A WAC, Comprehensive assessment reporting evaluation (CARE) tool, to incorporate CARE assessment criteria for children receiving state plan Medicaid personal care (MPC) services.

Proposal Changes the Following Existing Rules: Amendments are made to existing rules to incorporate CARE assessment criteria for children receiving state plan MPC services.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has analyzed the proposed rules and determined that no new costs will be imposed on businesses.

RCW 34.05.328 does not apply to this rule adoption. The proposed rules describe eligibility criteria for medical in-home care services and are exempt under RCW 34.05.328 (5)(b)(vii), "Rules of the department of social and health services relating only to client medical or financial eligibility..."

Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on June 22, 2004, at 10:00 a.m.

Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by June 18, 2004, phone (360) 664-6094, TTY (360) 664-6178, e-mail fernaax@dshs.wa.gov.

Submit Written Comments to: Identify WAC Numbers, DSHS Rules Coordinator, Rules and Policies Assistance Unit, mail to P.O. Box 45850, Olympia, WA 98504-5850, deliver to 4500 10th Avenue S.E., Lacey, WA, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., June 22, 2004.

Date of Intended Adoption: Not earlier than June 23, 2004.

May 14, 2004

Brian H. Lindgren, Manager

Rules and Policies Assistance Unit

3399.4
AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0010   Does chapter 388-71 WAC and WAC 388-845-1300 apply to me?   Yes. Chapter 388-71 WAC ((applies)) and WAC 388-845-1300 apply with the exception of the following: WAC 388-71-0202 (Direct personal care services, household assistance, medically oriented tasks, personal care services, plan of care, supervision, and unscheduled tasks), 388-71-0203, 388-71-0205, 388-71-0430, 388-71-0435, 388-71-0440, 388-71-0442, and 388-71-0445.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, 388-72A-0010, filed 2/19/03, effective 3/22/03.]


NEW SECTION
WAC 388-72A-0036   How are my needs for personal care services determined?   The assessor gathers information from you, your caregivers, family members, and other sources to determine how much assistance you need with personal care services. For children age seventeen and younger, age expectations and the role of legally responsible natural/step/adoptive parents are considered and documented. Assistance is measured by your:

(1) Self-performance, what you actually did within the last seven days, not what you might be capable of doing. Coding is based on the level of performance that occurred three or more times in the seven-day period.

(2) Support provided, which means the highest level of support provided by others over the last seven days, even if that level of support occurred only once.

(3) Status, which identifies whether a need is met, unmet, partially met, or declined.

(4) Assistance available.

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NEW SECTION
WAC 388-72A-0041   How are status and assistance available scored for ADLs and IADLs?   (1) For each Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL), the assessor determines whether there is an informal support available. An informal support is a person or resource that is available to provide assistance without home and community program funding.

(a) Met: The ADL or IADL will be fully provided by an informal support.

(b) Unmet: An informal support will not be available to provide assistance with the identified ADL or IADL.

(c) Partially Met: An informal support will be available to provide some assistance, but not all, with the identified ADL or IADL.

(d) Client declines: Client does not want assistance with the task.

(2) If partially met is selected then the amount of the assistance available is determined using one of four categories. Table 1 below is used to determine these percentages.

(a) Less than one-fourth of the time,

(b) One-fourth to one-half of the time,

(c) Over one-half of the time to three-fourths of the time,

(d) Over three-fourths of the time.

NOTE: For children seventeen years and younger living with their legally responsible natural/step/adoptive parents, the status and assistance available will be met or partially met over three fourths of the time.

Place illustration here.

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NEW SECTION
WAC 388-72A-0042   How are ADLs and IADLs scored for children?   For children, the following age appropriate guidelines apply. The table indicates which tasks are considered met per age expectations and/or the role of the natural/step or adoptive parent.
Activities of Daily Living (ADLs)
Ages
&sqbul; = Code status as Met 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Medication Management
Independent, supervision, limited, extensive, or Total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Locomotion in RoomNote
Independent, supervision, limited or extensive &sqbul; &sqbul; &sqbul;
Total &sqbul;
Locomotion Outside RoomNote
Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Limited or extensive &sqbul; &sqbul; &sqbul;
Total &sqbul;
Walk in RoomNote
Independent, supervision, limited or extensive &sqbul; &sqbul; &sqbul;
Total &sqbul;
Bed Mobility
Independent, supervision, limited or extensive &sqbul; &sqbul;
Total &sqbul;
Transfers
Independent, supervision, limited, extensive or total & under 30 pounds &sqbul; &sqbul;
(Total & over 30 pounds = no age limit)
Toilet UseNote
Support provided for nighttime wetting only (Independent, supervision, limited, extensive, or total) &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Independent, supervision, limited, extensive &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul;
Eating
Independent, supervision, limited, extensive, or total &sqbul; &sqbul;
Meal Preparation
Independent, supervision, limited, extensive, or total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Bathing
Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Physical assistance all/part &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul; &sqbul;
Dressing
Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Limited or extensive &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul; &sqbul;
Personal Hygiene
Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Limited or extensive &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul; &sqbul;
Instrumental Activities of Daily Living
Ages
&sqbul; = Code status as Met 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Telephone
Independent, supervision, limited, extensive, or Total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Transportation
Independent, supervision, limited, extensive, or total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Shopping
Independent, supervision, limited, extensive, or total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Wood Supply
Independent, supervision, limited, extensive, or total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Housework
Independent, supervision, limited, extensive, or total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Finances
Independent, supervision, limited, extensive, or total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;

NOTE: If the activity did not occur, the assessor codes self performance as total and status as met.

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NEW SECTION
WAC 388-72A-0086   How is the information in WAC 388-72A-0081 through 388-72A-0084 used to determine the client's classification payment group for residential settings?   The information in WAC 388-72A-0081 through 388-72A-0084 is used to place an adult applicant or recipient into one of the twelve residential classification groups, as shown in the table below.


Classification ADL Score Group
Group D

Cognitive performance score = 4-6

and

Clinically complex = yes

and

Mood/behavior = yes or no

ADL Score 18-28 D High (12)
ADL Score 13-17 D Med (11)
ADL Score 2-12 D Low (10)
Group C

Cognitive performance score = 0-3

and

Clinically complex = yes

and

Mood/behavior = yes or no

ADL Score 18-28 C High (9)
ADL Score 9-17 C Med (8)
ADL Score 2-8 C Low (7)
Group B

Mood & behavior = Yes

and

Clinically complex = no

and

Cognitive performance score = 0-6

ADL Score 15-28 B High (6)
ADL Score 5-14 B Med (5)
ADL Score 0-4 B Low (4)
Group A

Mood & behavior = No

and

Clinically complex = No

and

Cognitive performance score = 0-6

ADL Score 10-28 A High (3)
ADL Score 5-9 A Med (2)
ADL Score 0-4 A Low (1)

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AMENDATORY SECTION(Amending WSR 03-05-097, filed 2/19/03, effective 3/22/03)

WAC 388-72A-0095   ((How are)) What additional criteria are considered to determine the number of hours I ((can)) will receive for in-home services ((determined))?   (1) In addition to criteria defined in WAC ((388-72A-0075, 388-72A-0080, and 388-72A-0085)) 388-72A-0081, 388-72A-0082, 388-72A-0083, 388-72A-0084, 388-72A-0087, or 388-71-0460, CARE will take into account ((your:

(a) Assistance available to meet your needs. This is defined as:

(I) Met;

(ii) Unmet;

(iii) Partially met.

NOTE: Home and community programs (HCP) services may not replace other available resources the department identified when completing CARE. The hours will be adjusted to account for tasks that are either fully or partially met by other available resources. These resources may be unpaid or paid for by other state or community sources.

(b) Environment, such as whether you:

(I) Have laundry facilities out of home; and/or

(ii) Use wood as a primary source of heat and/or;

(iii) The time it takes to access essential shopping services.

(c) Living arrangement. The department will adjust payments to a personal care provider who is doing household tasks at the same time (e.g., essential shopping, meal preparation, laundry, and wood supply) if:

(I) There is more than one client living in the same household; or

(ii) You and your paid provider live in the same household.

(2))):

(a) The amount of informal supports available to fully or partially meet your needs as described in WAC 388-72A-0041.

(I) As shown in the following table, CARE determines the adjustment by placing a numeric value on the amount of assistance available to meet your needs and reduces the base hours assigned to the classification group using the values listed below for each ADL and IADL.


Meds Self Performance Status Assistance Available Value Percentage
Self administration of medications Rules for all codes apply except independent is not counted Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .9
1/4 to 1/2 time .7
> 1/2 to 3/4 time .5
> 3/4 time .3
Unscheduled ADLs Self Performance Status Assistance Available Value Percentage
Bed mobility, transfer, walk in room, eating, toilet use Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider= 1;

Did not occur/client declined and independent are not counted.

Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .9
1/4 to 1/2 time .7
>1/2 to 3/4 time .5
>3/4 time .3
Scheduled ADLs Self Performance Status Assistance Available Value Percentage
Dressing

personal hygiene

bathing

Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider= 1;

Did not occur/client declined and independent are not counted .

Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .75
between 1/4 to 1/2 time .55
between 1/2 to 3/4 time .35
> 3/4 time .15
IADLs Self Performance Status Assistance Available Value Percentage
Meal preparation

Ordinary housework

Essential shopping

Rules for all codes apply except independent is not counted. Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met < 1/4 time .3
between 1/4 to 1/2 time .2
between 1/2 to 3/4 time .1
> 3/4 time .05

(ii) The value percentage assigned to each specified ADL/IADL is summed and carried two decimal places. The resulting number is then divided by the number of qualifying ADL and IADL needs. If self-performance is coded as independent or did not occur/client declined then they are not qualifying ADLs and IADLs. The result is value A. Value A is then subtracted from one. This is value B. Value B is divided by three. This is value C. Value A and value C are summed. This is value D. Value D is multiplied by the "base hours" assigned to the client's classification group in WAC 388-72A-0087.

(b) Your environment, as described in the diagrams below.


Condition Assessment Status Assistance Available Ad On Hours
Offsite laundry facilities, which means the client does not have facilities in own home and the caregiver is not available to perform any other personal or household tasks while laundry is done. Yes. N/A N/A 8
Client is > 45 minutes from essential services (which means he/she lives more than 45 minutes one-way from a full-service market.) If yes, then the assistance available for this task is assessed by the response to essential shopping. Unmet N/A 5
Met N/A 0
Partially met <1/4 time 5
between 1/4 to 1/2 time 4
between 1/2 to 3/4 time 2
>3/4 time 2
Wood supply used as only source of heat. Yes Unmet N/A 8
Met N/A 0
Declines N/A 0
Partially met < 1/4 time 8
between 1/4 to 1/2 time 6
between 1/2 to 3/4 time 4
> 3/4 time 2

(c) Your living arrangement.

(I) If there is more than one client living in the same household, the status cannot be unmet for the following IADLs:

(A) Meal preparation,

(B) Housekeeping,

(C) Shopping,

(D) Wood supply.

(ii) If you and your paid provider live in the same household, the status must be met for the following IADLs:

(A) Meal preparation,

(B) Housekeeping,

(C) Shopping,

(D) Wood supply.

(2) The ((CARE tool will provide a)) hours identified in WAC 388-72A-0095 (1)(b) are added to the resulting hours in WAC 388-72A-0095 (1)(a). The result is the maximum number of hours that can be used to develop your care plan. The assessor must take into account cost effectiveness, client health and safety, and program limits in determining how hours can be used to meet identified client needs.

(3) Within the limits of subsection (2) of this section, you and your case manager will work to determine what services you choose to receive if you are eligible. The hours may be used to authorize:

(a) Personal care services (per WAC 388-72A-0055, 388-72A-0060, ((or)) 388-72A-0065, or 388-845-1300);

(b) Home delivered meals (per WAC ((388-72A-0055)) 388-71-0415);

(c) Adult day care (per WAC ((388-72A-055 or 388-15-652)) 388-71-0415);

(d) ((Adult day health (per WAC 388-72A-055 or 388-15-653);

(c))) A home health aide (per WAC ((388-72A-0055)) 388-71-0415).

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.090. 03-05-097, 388-72A-0095, filed 2/19/03, effective 3/22/03.]

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.

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