WASHINGTON STATE REGISTER

WSR 00-06-028

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)

[ Filed February 24, 2000, 2:05 p.m. ]

Date of Adoption: February 24, 2000.

Purpose: The rules were revised to: Comply with the Governor's Executive Order 97-02 for clarifying, updating, and simplifying where possible; to consider stakeholder input where appropriate; to apply clear rule-writing techniques; to update with statutory changes since the last revision; and to reorganize the chapter to make it easier for users to find the information needed.

Citation of Existing Rules Affected by this Order: Repealing WAC 388-97-010 License application, 388-97-015 License qualification, 388-97-020 Nursing home fees, 388-97-025 License capacity, 388-97-030 Change of ownership, 388-97-035 Change in administrator or director of nursing services, 388-97-040 Name of nursing home, 388-97-045 License relinquishment upon closure, 388-97-050 License denial, modification, nonrenewal, revocation, 388-97-070 Resident rights, 388-97-080 Quality of life, 388-97-095 Dementia care unit, 388-97-100 Discharge planning, 388-97-105 Relocation due to decertification, license revocation closure, evacuation, 388-97-145 Early identification of persons with active tuberculosis, 388-97-150 Surveillance and management of tuberculosis, 388-97-200 Criminal history disclosure and background inquiries, 388-97-210 Respite services, 388-97-215 Adult day or night care, 388-97-225 Nursing facility care, 388-97-230 Discrimination prohibited, 388-97-235 Medical eligibility for nursing facility care, 388-97-240 Nursing facility admission, 388-97-245 Pre-admission screening, 388-97-250 Identification screening for current residents, 388-97-255 Pre-admission screening and annual resident review (PASARR), 388-97-265 Utilization review, 388-97-270 Individual transfer and discharge rights, procedures, appeals, 388-97-275 Resident assessment instrument, 388-97-280 Discharge or leave of a nursing facility resident, 388-97-300 Fire standards and approval, 388-97-305 Other standards, 388-97-320 Space and equipment, 388-97-380 Maintenance and repair, 388-97-390 General, 388-97-395 Design requirements, 388-97-435 Resident care unit, 388-97-440 Resident rooms, 388-97-445 Resident room equipment, 388-97-450 Resident toilet and bathing facilities and 388-97-475 Electrical; and amending WAC 388-97-005 Definitions, 388-97-055 Resident representative and decision making, 388-97-060 Informed consent, 388-97-065 Advance directives, 388-97-075 Nursing home practices -- Resident restraint and prevention of abuse, 388-97-085 Resident assessment, 388-97-090 Comprehensive care planning, 388-97-110 Quality of care, 388-97-115 Nursing services, 388-97-120 Dietary services, 388-97-125 Physician services, 388-97-130 Specialized habilitative and rehabilitative services, 388-97-135 Pharmacy services, 388-97-140 Infection control, 388-97-155 Care of residents with active tuberculosis, 388-97-160 General administration, 388-97-165 Staff and equipment, 388-97-170 Staff development, 388-97-175 Medical director, 388-97-180 Clinical records, 388-97-185 Disaster and emergency preparedness, 388-97-190 Quality assessment and assurance, 388-97-195 Policies and procedures, 388-97-205 Laundry services, 388-97-220 Dialysis services, 388-97-260 PASARR determination and appeal rights, 388-97-295 General, 388-97-310 IMR exceptions to physical plant requirements, 388-97-315 Emergency power, 388-97-325 Resident care unit, 388-97-330 Resident rooms, 388-97-335 Resident room equipment, 388-97-340 Resident toilet and bathing facilities or rooms, 388-97-345 Dining, day rooms, and resident activity areas, 388-97-350 Dementia care unit, 388-97-355 Food service areas, 388-97-360 Lighting, 388-97-365 Safety, 388-97-370 Water supply, 388-97-375 Pest control, 388-97-385 Sewage and liquid waste disposal, 388-97-400 General new construction documents, 388-97-405 Exemptions to new construction requirements, 388-97-410 State building code in new construction, 388-97-415 Electrical codes and standards in new construction, 388-97-420 Elevator codes in new construction, 388-97-425 Local codes and ordinances in new construction, 388-97-430 Entrances and exits in new construction, 388-97-455 Visiting and private spaces in new construction, 388-97-460 Pools in new construction, 388-97-465 Elevators in new construction, 388-97-470 Heating systems in new construction, and 388-97-480 Handwashing sinks in new construction.

Statutory Authority for Adoption: RCW 18.51.070 and 74.42.620.

Adopted under notice filed as WSR 99-24-045 on November 24, 1999.

Changes Other than Editing from Proposed to Adopted Version: The suggested addition was made for clarification.

WAC 388-97-005 Definitions.

• Neglect: It was suggested that the federal definition of "neglect" be added to the state definition to clarify for skilled nursing facilities and nursing facilities that the federal definition of neglect must also be considered.

The suggested addition was made for clarification.

WAC 388-97-027 Nursing facility admission and payment requirements.

• Concern was expressed about the lack of clarity of the timelines related to medical and financial eligibility and how this might effect the Medicaid payment to the nursing facility.

Home and Community Services Division (HCS) is in the process of changing their system for Medicaid applicants or recipients being discharged from the hospital to the nursing home. This process was not finalized in time to incorporate it into the proposed rule. As a result this section will be reopened after the chapter is final and we will work with HCS staff and providers to develop a clear rule outlining admission and payment issues. Some language clarification regarding payment for current nursing home residents converting to Medicaid in nursing homes was included.

WAC 388-97-042 Individual transfer and discharge rights for residents in Medicaid certified facilities.

• There was a comment that the terms "nursing facility" and "nursing home," related to different notice requirements, were not distinct enough and needed clarification.

Subsection (1) was clarified by identifying the specific state laws the nursing home must follow, and the federal and state laws that the skilled nursing facility and nursing facility must follow. The definition section already includes definitions for nursing home, skilled nursing facility and nursing facility.

WAC 388-97-043 Transfer and discharge appeal rights for residents in Medicare or Medicaid certified facilities.

• Title: It was suggested that "...Medicare or..." be added to the title in order to comply with federal regulations.

The suggested change was made.

• (1): It was suggested that the word "payment" be changed to "payor."

The suggested change was made.

• (3): There was a suggestion to add the term "skilled nursing facility" to this section.

The suggested change was made.

WAC 388-97-060 Informed consent.

• (4) A stakeholder commented that the phrase "The nursing home must take into account..." was too vague and asked that it be changed to make it more specific.

The information in subsection (4) was deleted and placed under subsection (1)(b). We believe that this will clarify the issue.

WAC 388-97-075 Chemical and physical restraints.

• Specific language was suggested to replace the entire section.

Much of the requested language was already in the section but some would be considered a substantive change that cannot be done at this stage of the rule-making process. However some clarifying language was added and the subsections reordered for clarity. Some of the specific areas addressed follow:

WAC 388-97-076 Prevention of abuse.

• Some concern was expressed related to a possible conflict between federal and state law regarding abuse in this section.

The issue was reviewed and some clarifying changes made.

WAC 388-97-29510 New construction compliance.

• It was suggested that "...and give approval..." be inserted between "...is contacted..." and "...for all new construction..."

This language was clarified to include the approval and applicable determination pieces that were implicit in the subsection.

WAC 388-97-315 Emergency power.

• (2): It was suggested that the subsection would be clearer if the term "generator" were moved to the beginning of the subsection and unnecessary words deleted in (a) - (c) of this subsection. In addition there was a suggestion that we add clarifying new construction language to that subsection.

The suggested clarification to subsection (2) was done. The clarifying new construction language was added to subsection (5).

WAC 388-97-32510 Required service areas on resident care units.

• (2): It was suggested that this was a new construction requirement and should have the words "in new construction" inserted in the beginning of the sentence.

The current 1994 WAC 388-97-325 (2)(b) had this requirement under existing facilities language, not under new construction. However we asked the Department of Health's construction review program for clarification and they agreed that this was an area applying to new construction only. The change has been made.

WAC 388-97-32550 Utility service rooms on resident care units.

• (1)(b): There was a suggestion to "chunk" out the items listed and to add language to clarify that the clean and soiled utility rooms must be separate.

The "chunking" changes suggested for subsection (1) were done. Even though the intent of subsection (2) was to show that in new construction the clean utility room and the soiled utility room must be separate rooms it was not clearly understood. An additional subsection was added to clarify this.

WAC 388-97-32580 Janitor's closets on resident care units.

• It was suggested that a reference to the ventilation requirements for new construction be added.

This suggested clarifying reference was made.

WAC 388-97-340 Resident toilet facilities or rooms.

• (2)(e): Specific language was suggested related to the grab bars.

These clarifying changes were made.

WAC 388-97-345 Dining, dayrooms, and resident activity areas.

• (2): It was suggested that language be added to require that in new construction these rooms be on the same floor as the residents who will use the rooms.

The language in WAC 388-97-325(2) supports this clarifying addition and the language has been included.

WAC 388-97-35030 Indoor areas on a dementia care unit.

• (1): It was suggested that the language regarding the phrase "...maintained free of equipment..." be clarified.

The current language uses the phrase "...providing ambulation areas that meet the needs of residents and are maintained free of equipment..." The word "ambulation" was added to clarify.

WAC 388-97-35050 Physical plant on a dementia care unit.

• (2)(a) and (b): It was suggested that specific language be added to exclude exit doors and doorways from being disguised and to delete the word "exterior" to clarify the Uniform Building Code requirements in this area.

These clarifying changes have been made.

WAC 388-97-35060 Special egress control devices on a dementia care unit.

• It was suggested that the phrase "automatic door locks" be replaced with "special egress control devices" throughout. In addition specific language was suggested for subsection (2) regarding the circumstances under which approval is needed and regarding approval for the devices.

The meaning of the term "special egress control devices" is synonymous with the term "automatic locking devices" and the term used in current practice. We have made this and the other suggested clarifying changes.

WAC 388-97-370 Water supply.

• It was suggested that another WAC reference be added to the section.

This clarifying change was made.

WAC 388-97-401 Final new construction documents.

• (2): It was suggested that this subsection specify that the architect or engineer be licensed by the state of Washington.

It has been the practice of the Department of Health's construction review approval process that both professions be licensed by the state thus this clarifying change was made.

WAC 388-97-46550 Carpets in new construction.

• (1)(a): It was suggested that some outdated language be deleted and that the formula for carpet density be written out for clarification.

The deletion was done and the clarifying change to the carpet density formula made.

WAC 388-97-48020 Mixing valves in new construction.

• It was suggested that the term "mixing valves" to "water supply" be changed throughout. Additional language was also suggested.

Because both mixing valves and mixing faucets can be used to ensure acceptable water temperatures the term mixing faucet was added as an alternative choice for new construction. The water supply section is found at WAC 388-97-370.

Number of Sections Adopted in Order to Comply with Federal Statute: New 32, Amended 5, Repealed 32; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 3, Amended 1, Repealed 3.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 141, Amended 53, Repealed 41.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 141, Amended 53, Repealed 41.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 141, Amended 53, Repealed 41. Effective Date of Rule: Thirty-one days after filing.

February 24, 2000

Marie Myerchin-Redifer, Manager

Rules and Policies Assistance Unit

Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 00-08 issue of the Register.

•	Neglect: It was suggested that the federal definition of "neglect" be added to the state definition to clarify for skilled nursing facilities and nursing facilities that the federal definition of neglect must also be considered.
	The suggested addition was made for clarification.

•	There was a comment that the terms "nursing facility" and "nursing home," related to different notice requirements, were not distinct enough and needed clarification.
	Subsection (1) was clarified by identifying the specific state laws the nursing home must follow, and the federal and state laws that the skilled nursing facility and nursing facility must follow. The definition section already includes definitions for nursing home, skilled nursing facility and nursing facility.

•	Title: It was suggested that "...Medicare or..." be added to the title in order to comply with federal regulations.
	The suggested change was made.

•	(1): It was suggested that the word "payment" be changed to "payor."
	The suggested change was made.

•	(3): There was a suggestion to add the term "skilled nursing facility" to this section.
	The suggested change was made.

•	(4) A stakeholder commented that the phrase "The nursing home must take into account..." was too vague and asked that it be changed to make it more specific.
	The information in subsection (4) was deleted and placed under subsection (1)(b). We believe that this will clarify the issue.

•	Specific language was suggested to replace the entire section.
	Much of the requested language was already in the section but some would be considered a substantive change that cannot be done at this stage of the rule-making process. However some clarifying language was added and the subsections reordered for clarity. Some of the specific areas addressed follow:

•	Some concern was expressed related to a possible conflict between federal and state law regarding abuse in this section.
	The issue was reviewed and some clarifying changes made.

•	It was suggested that "...and give approval..." be inserted between "...is contacted..." and "...for all new construction..."
	This language was clarified to include the approval and applicable determination pieces that were implicit in the subsection.

•	(2): It was suggested that the subsection would be clearer if the term "generator" were moved to the beginning of the subsection and unnecessary words deleted in (a) - (c) of this subsection. In addition there was a suggestion that we add clarifying new construction language to that subsection.
	The suggested clarification to subsection (2) was done. The clarifying new construction language was added to subsection (5).

•	(2): It was suggested that this was a new construction requirement and should have the words "in new construction" inserted in the beginning of the sentence.
	The current 1994 WAC 388-97-325 (2)(b) had this requirement under existing facilities language, not under new construction. However we asked the Department of Health's construction review program for clarification and they agreed that this was an area applying to new construction only. The change has been made.

•	(1)(b): There was a suggestion to "chunk" out the items listed and to add language to clarify that the clean and soiled utility rooms must be separate.
	The "chunking" changes suggested for subsection (1) were done. Even though the intent of subsection (2) was to show that in new construction the clean utility room and the soiled utility room must be separate rooms it was not clearly understood. An additional subsection was added to clarify this.

•	It was suggested that a reference to the ventilation requirements for new construction be added.
	This suggested clarifying reference was made.

•	(2)(e): Specific language was suggested related to the grab bars.
	These clarifying changes were made.

•	(2): It was suggested that language be added to require that in new construction these rooms be on the same floor as the residents who will use the rooms.
	The language in WAC 388-97-325(2) supports this clarifying addition and the language has been included.

•	(1): It was suggested that the language regarding the phrase "...maintained free of equipment..." be clarified.
	The current language uses the phrase "...providing ambulation areas that meet the needs of residents and are maintained free of equipment..." The word "ambulation" was added to clarify.

•	(2)(a) and (b): It was suggested that specific language be added to exclude exit doors and doorways from being disguised and to delete the word "exterior" to clarify the Uniform Building Code requirements in this area.
	These clarifying changes have been made.

•	It was suggested that the phrase "automatic door locks" be replaced with "special egress control devices" throughout. In addition specific language was suggested for subsection (2) regarding the circumstances under which approval is needed and regarding approval for the devices.
	The meaning of the term "special egress control devices" is synonymous with the term "automatic locking devices" and the term used in current practice. We have made this and the other suggested clarifying changes.

•	It was suggested that another WAC reference be added to the section.
	This clarifying change was made.

•	(2): It was suggested that this subsection specify that the architect or engineer be licensed by the state of Washington.
	It has been the practice of the Department of Health's construction review approval process that both professions be licensed by the state thus this clarifying change was made.

© Washington State Code Reviser's Office

•	(1)(a): It was suggested that some outdated language be deleted and that the formula for carpet density be written out for clarification.
	The deletion was done and the clarifying change to the carpet density formula made.

•	It was suggested that the term "mixing valves" to "water supply" be changed throughout. Additional language was also suggested.
	Because both mixing valves and mixing faucets can be used to ensure acceptable water temperatures the term mixing faucet was added as an alternative choice for new construction. The water supply section is found at WAC 388-97-370.