PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Adult Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 02-04-096.
Title of Rule: Amending and moving subject matter from the following rules into chapter 388-71 WAC: WAC 388-15-194 Home and community services, 388-15-202 Long-term care services, 388-15-203 Long-term care services -- Assessment of task self-performance and determination of required assistance, and 388-15-205 Long-term care services -- Service plan development. Amending to clarify that a reassessment is required as a condition for continued HCS program eligibility: WAC 388-71-0430 Am I eligible for one of the HCP programs? and 388-71-450 How do I remain eligible for services? Updating cross-references within: WAC 388-71-0410, 388-71-0435, 388-71-0440, 388-71-0445, 388-71-0500, 388-71-0515, 388-71-0600, 388-76-540, and 388-110-020. Repealing obsolete or redundant rules: WAC 388-15-194, 388-15-202, 388-15-203, 388-15-204, 388-15-205, 388-110-210, 388-110-230, and 388-110-250.
Purpose: To (1) amend and move remaining home and community services rules in chapter 388-15 WAC into chapter 388-71 WAC; (2) clarify that the requirement of an in-home assessment applies to all recipients of services through the COPES (community options program entry system), MPC (Medicaid personal care), and chore programs; (3) update WAC and RCW cross-references in other HCS rules; and (4) repeal rules in chapters 388-15 and 388-110 WAC that are now obsolete or redundant.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.520, and 74.39A.090.
Statute Being Implemented: RCW 74.39A.090.
Summary: See Purpose above and Explanation of Rule below.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kristi Olson, AASA, 640 Woodland Square Loop, P.O. Box 45600, Olympia, WA 98505-5600 [98504-5600], (360) 725-2537.
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: The proposed rules will clarify that the requirement of an in-home assessment applies to all recipients of services through the COPES, MPC, and chore programs. Adoption of new WAC 388-71-194, 388-71-202, 388-71-203, and 388-71-205 will place all home and community services (HCS) program rules into one chapter of Title 388 WAC.
Proposal Changes the Following Existing Rules: The following HCS rules have been revised to clarify language and are being proposed as new rules in chapter 388-71 WAC: WAC 388-15-194 (proposed as new WAC 388-71-194), 388-15-202 (proposed as new WAC 388-71-202), 388-15-203 (proposed as new WAC 388-71-203), 388-15-205 (proposed as new WAC 388-71-205).
These proposed rules clarify that a reassessment is required to remain eligible for HCS services: WAC 388-71-0430 Am I eligible for one of the HCP programs? and 388-71-450 How do I remain eligible for services?
These proposed rules update cross-references within: WAC 388-71-0410, 388-71-0435, 388-71-0440, 388-71-0445, 388-71-0500, 388-71-0515, 388-71-0600, 388-76-540 and 388-110-020, to clarify cross-references to other WAC.
The department also proposes to repeal: WAC 388-15-194, 388-15-202, 388-15-203, 388-15-204, 388-15-205, 388-110-210, 388-110-230, and 388-110-250. The subject matter in these rules will be redundant or obsolete.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rules will clarify that the requirement of an in-home assessment applies to all recipients of services through the COPES, MPC, and chore programs, and therefore affect only department clients who may be eligible for these services. The proposed rules will not impact small businesses.
RCW 34.05.328 applies to this rule adoption. Rules do meet the definition of "significant legislative rule," but the department is exempt from preparing a cost benefit analysis 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..." The proposed rules clarify that a reassessment is required to remain eligible for COPES, MPC and chore services.
Hearing Location: Blake Office Park (behind Goodyear Courtesy Tire), 4500 10th Avenue S.E., Rose Room, Lacey, WA 98503, on September 24, 2002, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by September 20, 2002, 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, P.O. Box 45850, Olympia, WA 98504-5850, fax (360) 664-6185, e-mail fernaax@dshs.wa.gov, by 5:00 p.m., September 24, 2002.
Date of Intended Adoption: Not earlier than September 25, 2002.
July 30, 2002
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
3145.2((SOCIAL SERVICES FOR ADULTS)) HOME AND COMMUNITY SERVICES AND
PROGRAMS
(2) Upon department or designee referral, a registered nurse will consult about or visit a community options program entry system client or a Medicaid personal care client to perform a nursing service which may include the following activities:
(a) Nursing assessment/reassessment;
(b) Instruction to care providers and clients;
(c) Care coordination;
(d) Evaluation.
(3) The frequency and scope of the nursing service will be based on individual client need and will be provided as outlined in a nursing service design developed in coordination with each area agency on aging. Each design will include critical indicators of the need for the nursing service and must be approved by the following divisions as appropriate: aging and adult services administration, developmental disabilities, children's administration and mental health.
(4) This nursing service will not be provided if activities duplicate services that the client is receiving from some other resource. Coordination and/or referrals to appropriate health care providers will occur as necessary.
(5) The registered nurse providing this service will not perform skilled treatment except in the event of an emergency. The need for any skilled medical or nursing treatments will be referred to a health care provider, a home health agency or a contracted delegating nurse.
(6) The registered nurse must document the result of the nursing service provided on a department-approved form. The registered nurse provides a copy to the staff who has case management responsibility.
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"Aged person" means a person sixty-five years of age or older.
"Agency provider" means a licensed home care agency or a licensed home health agency having a contract to provide long-term care personal care services to a client in the client's own home.
"Application" means a written request for medical assistance or long-term care services submitted to the department by the applicant, the applicant's authorized representative, or, if the applicant is incompetent or incapacitated, someone acting responsibly for the applicant. The applicant shall submit the request on a form prescribed by the department.
"Assessment" or "reassessment" means an inventory and evaluation of abilities and needs based on an in-person interview in the client's home.
"Attendant care" means the chore personal care service provided to a grandfathered client needing full-time care due to the client's need for:
(1) Assistance with personal care; or
(2) Protective supervision due to confusion, forgetfulness, or lack of judgment. Protective supervision does not include responsibilities a legal guardian should assume such as management of property and financial affairs.
"Authorization" means an official approval of a departmental action, for example, a determination of client eligibility for service or payment for a client's long-term care services.
"Available resources" is a term to describe a chore personal care client's assets accessible for use and conversion into money or its equivalent without significant depreciation in the property value.
"Blind person" means a person determined blind as described under WAC 388-511-1105 by the division of disability determination services of the medical assistance administration.
"Categorically needy" means the financial status of a person as defined under WAC 388-503-0310.
"Client" means an applicant for service or a person currently receiving services.
"Community residence" means:
(1) The client's "own home" as defined in this section;
(2) Licensed adult family home under department contract;
(3) Licensed boarding home under department contract;
(4) Licensed children's foster home;
(5) Licensed group care facility, as described in chapter 388-148 WAC; or
(6) Shared living arrangement as defined in this section.
"Community spouse" means a person as described under WAC 388-513-1365 (1)(b).
"Companionship" means the activity of a person in a client's own home to prevent the client's loneliness or to accompany the client outside the home for other than personal care services.
"Contracted program" means services provided by a licensed and contracted home care agency or home health agency.
"COPES" means community options program entry system.
"Department" means the state department of social and health services.
"Direct personal care services" means verbal or physical assistance with tasks involving direct client care which are directly related to the client's handicapping condition. Such assistance is limited to allowable help with the tasks of ambulation, bathing, body care, dressing, eating, personal hygiene, positioning, self-medication, toileting, transfer, as defined in "personal care services" below.
"Disabled" means a person determined disabled as described under WAC 388-511-1105 by the division of disability determination services of the medical assistance administration.
"Disabling condition" means a condition which prevents a person from self-performance of personal care tasks without assistance.
"Estate recovery" means the department's activity in recouping funds after the client's death which were expended for long-term care services provided to the client during the client's lifetime per WAC 388-527-2742.
"Grandfathered client" means a chore personal care services client approved for either:
(1) Attendant care services provided under the chore personal care program when these services began before April 1, 1988; and
(2) Family care services provided under the chore personal care program when these services began before December 14, 1987; and
(3) The client was receiving the same services as of June 30, 1989.
"Home health agency" means a licensed:
(1) Agency or organization certified under Medicare to provide comprehensive health care on a part-time or intermittent basis to a patient in the patient's place of residence and reimbursed through the use of the client's medical identification card; or
(2) Home health agency, certified or not certified under Medicare, contracted and authorized to provide:
(a) Private duty nursing; or
(b) Skilled nursing services under an approved Medicaid waiver program.
"Household assistance" means assistance with incidental household tasks provided as an integral, but subordinate part of the personal care furnished directly to a client by and through the long-term care programs as described in this chapter. Household assistance is considered an integral part of personal care when such assistance is directly related to the client's medical or mental health condition, is reflected in the client's service plan, and is provided only when a client is assessed as needing personal care assistance with one or more direct personal care tasks. Household assistance tasks include travel to medical services, essential shopping, meal preparation, laundry, housework, and wood supply.
"Income" means "income" as defined under WAC 388-500-0005.
"Individual provider" means a person employed by a community options program entry system (COPES) or Medicaid personal care client when the person:
(1) Meets or exceeds the qualifications as defined under WAC 388-71-0500 through 388-71-0580;
(2) Has signed an agreement to provide personal care services to a client; and
(3) Has been authorized payment for the services provided in accordance with the client's service plan.
"Individual provider program (IPP)" means a method of chore personal care service delivery where the client employs and supervises the chore personal care service provider.
"Institution" means an establishment which furnishes food, shelter, medically-related services, and medical care to four or more persons unrelated to the proprietor. "Institution" includes medical facilities, nursing facilities, and institutions for the mentally retarded, but does not include correctional institutions.
"Institutional eligible client" means a person whose eligibility is determined under WAC 388-513-1315. "Institutionalized client" means the same as defined in WAC 388-513-1365(f).
"Institutional spouse" means a person described under WAC 388-513-1365 (1)(e).
"Medicaid" means the federal aid Title XIX program under which medical care is provided to:
(1) Categorically needy as defined under WAC 388-503-0310; and
(2) Medically needy as defined under WAC 388-503-0320.
"Medical assistance" means the federal aid Title XIX program under which medical care is provided to the categorically needy as defined under WAC 388-503-0310 and 388-503-1105.
"Medical institution" means an institution defined under WAC 388-500-0005.
"Medically necessary" and "medical necessity" mean the same as defined under WAC 388-500-0005.
"Medically oriented tasks" means direct personal care services and household assistance provided as an integral but subordinate part of the personal care and supervision furnished directly to a client.
"Mental health professional" means a person defined under WAC 388-865-0150.
"Own home" means the client's present or intended place of residence:
(1) In a building the client rents and the rental is not contingent upon the purchase of personal care services as defined in this section; or
(2) In a building the client owns; or
(3) In a relative's established residence; or
(4) In the home of another where rent is not charged and residence is not contingent upon the purchase of personal care services as defined in this section.
"Personal care aide" means a person meeting the department's qualification and training requirements and providing direct Medicaid personal care services to a client. The personal care aide may be an employee of a contracted agency provider or may be an individual provider employed by the Medicaid personal care client.
"Personal care services" means both physical assistance and/or prompting and supervising the performance of direct personal care tasks and household tasks, as listed in (1) through (17) of this subsection. Such services may be provided for clients who are functionally unable to perform all or part of such tasks or who are incapable of performing the tasks without specific instructions. Personal care services do not include assistance with tasks performed by a licensed health professional.
(1) "Ambulation" means assisting the client to move around. Ambulation includes supervising the client when walking alone or with the help of a mechanical device such as a walker if guided, assisting with difficult parts of walking such as climbing stairs, supervising the client if client is able to propel a wheelchair if guided, pushing of the wheelchair, and providing constant or standby physical assistance to the client if totally unable to walk alone or with a mechanical device.
(2) "Bathing" means assisting a client to wash. Bathing includes supervising the client able to bathe when guided, assisting the client with difficult tasks such as getting in or out of the tub or washing back, and completely bathing the client if totally unable to wash self.
(3) "Body care" means assisting the client with exercises, skin care including the application of nonprescribed ointments or lotions, changing dry bandages or dressings when professional judgment is not required and pedicure to trim toenails and apply lotion to feet. In adult family homes or in licensed boarding homes contracting with DSHS to provide assisted living services, dressing changes using clean technique and topical ointments must be delegated by a registered nurse in accordance with chapter 246-840 WAC. "Body care" excludes:
(a) Foot care for clients who are diabetic or have poor circulation; or
(b) Changing bandages or dressings when sterile procedures are required.
(4) "Dressing" means assistance with dressing and undressing. Dressing includes supervising and guiding client when client is dressing and undressing, assisting with difficult tasks such as tying shoes and buttoning, and completely dressing or undressing client when unable to participate in dressing or undressing self.
(5) "Eating" means assistance with eating. Eating includes supervising client when able to feed self if guided, assisting with difficult tasks such as cutting food or buttering bread, and feeding the client when unable to feed self.
(6) "Essential shopping" means assistance with shopping to meet the client's health care or nutritional needs. Limited to brief, occasional trips in the local area to shop for food, medical necessities, and household items required specifically for the health, maintenance, and well-being of the client. Essential shopping includes assisting when the client can participate in shopping and doing the shopping when the client is unable to participate.
(7) "Housework" means performing or helping the client perform those periodic tasks required to maintain the client in a safe and healthy environment. Activities performed include such things as cleaning the kitchen and bathroom, sweeping, vacuuming, mopping, cleaning the oven, and defrosting the freezer, shoveling snow. Washing inside windows and walls is allowed, but is limited to twice a year. Assistance with housework is limited to those areas of the home which are actually used by the client. This task is not a maid service and does not include yard care.
(8) "Laundry" means washing, drying, ironing, and mending clothes and linens used by the client or helping the client perform these tasks.
(9) "Meal preparation" means assistance with preparing meals. Meal preparation includes planning meals including special diets, assisting clients able to participate in meal preparation, preparing meals for clients unable to participate, and cleaning up after meals. This task may not be authorized to just plan meals or clean up after meals. The client must need assistance with actual meal preparation.
(10) "Personal hygiene" means assistance with care of hair, teeth, dentures, shaving, filing of nails, and other basic personal hygiene and grooming needs. Personal hygiene includes supervising the client when performing the tasks, assisting the client to care for the client's own appearance, and performing grooming tasks for the client when the client is unable to care for own appearance.
(11) "Positioning" means assisting the client to assume a desired position, assistance in turning and positioning to prevent secondary disabilities, such as contractures and balance deficits or exercises to maintain the highest level of functioning which has already been attained and/or to prevent the decline in physical functional level. (Range of motion ordered as part of a physical therapy treatment is not included.)
(12) "Self-medication" means assisting the client to self-administer medications prescribed by attending physician. Self-medication includes reminding the client of when it is time to take prescribed medication, handing the medication container to the client, and opening a container.
(13) "Supervision" means being available to:
(a) Help the client with personal care tasks that cannot be scheduled, such as toileting, ambulation, transfer, positioning, some medication assistance; and
(b) Provide protective supervision to a client who cannot be left alone because of impaired judgment.
(14) "Toileting" means assistance with bladder or bowel functions. Toileting includes guidance when the client is able to care for own toileting needs, helping client to and from the bathroom, assisting with bedpan routines, using incontinent briefs on client, and lifting client on and off the toilet. Toileting may include performing routine perineal care, colostomy care, or catheter care for the client when client is able to supervise the activities. In adult family homes or in licensed boarding homes contracting with DSHS to provide assisted living services colostomy care and catheterization using clean technique must be delegated by a registered nurse in accordance with chapter 246-840 WAC.
(15) "Transfer" means assistance with getting in and out of a bed or wheelchair or on and off the toilet or in and out of the bathtub. Transfer includes supervising the client when able to transfer if guided, providing steadying, and helping the client when client assists in own transfer. Lifting the client when client is unable to assist in their own transfer requires specialized training.
(16) "Travel to medical services" means accompanying or transporting the client to a physician's office or clinic in the local area to obtain medical diagnosis or treatment.
(17) "Wood supply" means splitting, stacking, or carrying wood for the client when the client uses wood as the sole source of fuel for heating and/or cooking. This task is limited to splitting, stacking, or carrying wood the client has at own home. The department shall not allow payment for a provider to use a chain saw or to fell trees.
"Physician" means a doctor of medicine, osteopathy, or podiatry, as defined under WAC 388-500-0005.
"Plan of care" means a "service plan" as described under WAC 388-71-205.
"Property owned" means any real and personal property and other assets over which the client has any legal title or interest.
"Provider" or "provider of service" means an institution, agency, or person:
(1) Having a signed department agreement to furnish long-term care client services; and
(2) Qualified and eligible to receive department payment.
"Relative" means:
(1) For chore personal care service, a client's spouse, father, mother, son, or daughter;
(2) For Medicaid personal care service:
(a) "Legally responsible relative" means a spouse caring for a spouse or a biological, adoptive, or stepparent caring for a minor child.
(b) "Nonresponsible relative" means a parent caring for an adult child and an adult child caring for a parent.
"Service plan" means a plan for long-term care service delivery as described under WAC 388-71-205.
"Shared living arrangement" for purposes of Medicaid personal care means an arrangement where:
(1) A nonresponsible relative as defined in "relative" above is the personal care provider and resides in the same residence with common facilities, such as living, cooking, and eating areas; or
(2) A minor child age seventeen or younger lives in the home of a legally responsible relative as defined in "relative" above.
"SSI-related" means a person who is aged, blind, or disabled.
"Supervision" means a person available to a long-term care client as defined under "personal care services."
"Supplemental Security Income (SSI)" means the federal program as described under WAC 388-500-0005.
"Title XIX" is the portion of the federal Social Security Act which authorizes federal funding for medical assistance programs, e.g., nursing facility care, COPES, and Medicaid personal care home and community-based services.
"Transfer of resources" means the same as defined under WAC 388-513-1365 (1)(g).
"Unscheduled tasks" means ambulation, toileting, transfer, positioning, and unscheduled medication assistance as described in this chapter.
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(a) Identify client strengths to maximize current strengths and promote client independence;
(b) Evaluate physical health, functional and cognitive abilities, social resources and emotional and social functioning for service planning for long-term care;
(c) Identify client values and preferences for effective service planning based on the person's values and lifestyles; and
(d) Determine client's need for informal support, community support and services, and department paid services.
(2) Assessment responsibility.
(a) Department staff or designee while assessing need for case management shall perform the assessment.
(b) Except for adult protective service, the assessors shall perform a separate assessment for each client.
(c) The assessors shall document the assessment on a prescribed form.
(d) The assessors shall perform the assessment based on an in-person interview with the client in the client's home. A case manager may request the assessment be conducted in private.
(e) When performing the assessment, the assessors shall take into account the client's:
(i) Risk of and eligibility for nursing facility placement;
(ii) Health status, psychological/social/cognitive functioning, income and resources, and functional abilities;
(iii) Living situation; and
(iv) Availability of alternative resources providing needed assistance, including family, neighbors, friends, community programs, and volunteers.
(3) The adult client's functional ability to self-perform each personal care task and household task shall be determined using the following definitions of the assistance required:
(a) Ambulation:
(i) Independent. The client is mobile, with or without an assistive device, both inside and outside the household without the assistance of another person.
(ii) Minimal. The client is mobile inside without assistance but needs the assistance of another person outside; or the client needs occasional assistance of another person inside, and usually needs assistance of another person outside.
(iii) Substantial. The client is only mobile with regular assistance of another person both inside and outside.
(iv) Total. The client is not mobile.
(b) Bathing:
(i) Independent. The client can bathe self.
(ii) Minimal. The client requires oversight help or reminding only. The client can bathe without assistance or supervision, but must be reminded some of the time; or the client cannot get into the tub alone and physical help is limited to stand-by assist only.
(iii) Substantial. The client requires physical help in a large part of the bathing activity, for example, to lather, wash, and/or rinse own body or hair.
(iv) Total. The client is dependent on others to provide a complete bath.
(c) Body care:
(i) Independent. The client can apply ointment, lotion, change bandages or dressings, and perform exercises without assistance.
(ii) Minimal. The client requires oversight help or reminding only, or requires occasional assistance.
(iii) Substantial. The client requires limited physical help to apply ointment, lotion, or to perform dry bandage or dressing change.
(iv) Total. The client is dependent on others to perform all required body care.
(d) Dressing:
(i) Independent. The client can dress and undress without assistance or supervision.
(ii) Minimal. The client can dress and undress, but may need to be reminded or supervised to do so on some days; the client can assist dressing and undressing, but frequently or most of the time needs some physical assistance.
(iii) Substantial. The client always needs assistance to do parts of dressing and undressing.
(iv) Total. The client is dependent on others to do all dressing and undressing.
(e) Eating:
(i) Independent. The client can feed self, chew and swallow solid foods without difficulty, or can feed self by stomach tube or catheter.
(ii) Minimal. The client:
(A) Can feed self, chew and swallow foods, but needs reminding to maintain adequate intake;
(B) May need food cut up;
(C) Can feed self only if food is brought to the client.
(iii) Substantial. The client:
(A) Can feed self but needs standby assistance for occasional gagging, choking, or swallowing difficulty; or
(B) Needs reminders/assistance with adaptive feeding equipment; or
(C) Must be fed some or all food by mouth by another person.
(iv) Total. The client must be totally fed by another person and/or frequently gags or chokes due to difficulty in swallowing; or the client must be fed by another person by stomach tube or by venous access.
(f) Essential shopping:
(i) Independent. The client can drive and is licensed or the client is capable of using public transportation.
(ii) Minimal. The client can use available transportation and does not need assistance with shopping, but needs instructions or physical assistance to get to or from transportation vehicle.
(iii) Substantial. The client is dependent on being accompanied or helped by others to access community shops and needs assistance with shopping.
(iv) Total. The client is totally dependent on others to do essential shopping.
(g) Housework:
(i) Independent. The client can perform essential housework.
(ii) Minimal. The client needs assistance or needs cuing or supervision in self-performance of essential housework one or two times per month in client use areas.
(iii) Substantial. The client needs weekly assistance of another with essential housework in client use areas.
(iv) Total. The client is dependent on others to do all housework in client use areas.
(h) Laundry:
(i) Independent. The client is capable of using available laundry facilities.
(ii) Minimal. The client is physically capable of using laundry facilities, but requires cuing and/or supervision.
(iii) Substantial. The client is not able to use laundry facilities without physical assistance.
(iv) Total. The client is dependent upon others to do all laundry.
(i) Meal preparation:
(i) Independent. The client can prepare and cook required meals.
(ii) Minimal. The client requires some instruction or physical assistance to prepare meals.
(iii) Substantial. The client can participate but needs substantial assistance to prepare meals.
(iv) Total. The client cannot prepare or participate in preparation of meals.
(j) Personal hygiene:
(i) Independent. The client can manage personal hygiene and grooming tasks on a regular basis.
(ii) Minimal. The client can manage their personal hygiene and grooming but must be reminded or supervised at least some of the time; the client regularly requires some limited assistance with both personal hygiene and grooming.
(iii) Substantial. The client regularly requires assistance with personal hygiene and grooming and cooperates in the process.
(iv) Total. The client is dependent on others to provide all personal hygiene and grooming.
(k) Positioning:
(i) Independent. The client can move to and from a lying position, position their body in bed, and get into and out of bed and chairs.
(ii) Minimal. The client can move to and from a lying position, turn from side to side, and position their body while in bed and chairs but requires assistance some of the time.
(iii) Substantial. The client needs occasional assistance to move to and from a lying position, turn from side to side, and position body while in bed and chairs.
(iv) Total. The client needs assistance most or all of the time to move to and from a lying position, turn from side to side, and position body while in bed and chairs.
(l) Self-medication:
(i) Independent. The client can take own medications or does not take medication.
(ii) Minimal. The client is physically able to take medications but requires another person to:
(A) Remind, monitor, or observe the taking of medications less than daily; or
(B) Open a container, lay out, or organize medications less than daily.
(iii) Substantial. The client can physically take medications, but requires another person to either remind, monitor, or observe the taking of medications daily; or the client can physically take medications if another person daily opens containers, lays out, organizes medications.
(iv) Total. The client cannot physically take medications and requires another person to assist and administer all medications.
(m) Toileting:
(i) Independent. The client can use the toilet without physical assistance or supervision; or the client can manage own closed drainage system if the system has a catheter or sheath; or the client uses and manages protective aids. The client may need grab bars or raised toilet seat.
(ii) Minimal. The client needs stand-by assistance for safety or encouragement. The client may need minimal physical assistance with parts of the task, such as clothing adjustment, washing hands, wiping, and cleansing. The client may need a protective garment and may or may not be aware of this need.
(iii) Substantial. The client cannot get to the toilet without assistance; or the client needs substantial physical assistance with part of the task; or the client needs someone else to manage care of a closed drainage system if it has a catheter or sheath. The client may or may not be aware of own needs.
(iv) Total. The client is physically unable to use toilet. Requires continual observation and total cleansing. The client may require protective garments or padding or linen changes. The client may or may not be aware of own needs.
(n) Transfer:
(i) Independent. The client can transfer without physical assistance.
(ii) Minimal. The client transfers without assistance most of the time, but needs assistance on occasion.
(iii) Substantial. The client can assist with own transfers, but frequently or most of the time needs assistance.
(iv) Total. The client transfers must be done by someone else.
(o) Travel to medical services:
(i) Independent. The client can drive and is licensed; or is capable of using available public transportation.
(ii) Minimal. The client cannot drive or can drive but should not; or public transportation is not available.
(iii) Substantial. The client requires physical assistance or supervision to both get into and out of a vehicle, but can use the transportation without assistance during the trip.
(iv) Total. The client is totally dependent on being accompanied or helped by others during the trip.
(p) Wood supply:
(i) Independent. The client does not rely on wood as the sole fuel source or is capable of splitting, stacking, or carrying wood for heating or cooking.
(ii) Minimal. The client can carry wood but needs occasional assistance with splitting or stacking wood.
(iii) Substantial. The client is not able to carry, split, or stack wood, but is able to use the wood supply once it is inside the residence.
(iv) Total. The client is dependent on another person to establish and maintain heat for cooking or residential heating.
(4) Scoring of functional abilities and supports.
(a) For each direct personal care service and household assistance task listed on the assessment form, the assessor shall determine:
(i) The client's ability to perform each activity;
(ii) Assistance available to the client through alternative resources, including families, friends, neighbors, community programs, and unpaid caregivers; and
(iii) Assistance needed from department programs after alternative resources have been taken into account.
(b) The assessor shall award points for each task based on
the level of unmet need. The number of points allowable for each
task are listed below under columns identified as 0 = none, M
= minimal, S = substantial, and T = total:
| TASK | 0 | M | S | T | |
| Eating | |||||
| Breakfast | 0 | 4 | 7 | 10 | |
| Light meal | 0 | 4 | 7 | 10 | |
| Main meal | 0 | 5 | 10 | 15 | |
| Toileting | 0 | 5 | 10 | 15 | |
| Ambulation | 0 | 4 | 7 | 10 | |
| Transfer | 0 | 1 | 3 | 5 | |
| Positioning | 0 | 1 | 3 | 5 | |
| Body care | 0 | 5 | 10 | 15 | |
| Personal hygiene | 0 | 1 | 3 | 5 | |
| Dressing | 0 | 4 | 7 | 10 | |
| Bathing | 0 | 4 | 7 | 10 | |
| Self-medication | 0 | 2 | 4 | 6 | |
| Travel to medical services | 0 | 1 | 2 | 3 | |
| Essential shopping With client or |
0 | 5 | 10 | 15 | |
| For client | 0 | 1 | 3 | 5 | |
| Meal preparation Breakfast |
0 | 4 | 7 | 10 | |
| Light meal | 0 | 4 | 7 | 10 | |
| Main meal | 0 | 5 | 10 | 15 | |
| Laundry Facilities in home or |
0 | 1 | 2 | 3 | |
| Facilities out of home | 0 | 3 | 5 | 7 | |
| Housework | 0 | 1 | 2 | 3 | |
| Wood supply | 3 | 5 | 7 | ||
(5) Hour computation. The assessor shall:
(a) Convert the total score into maximum hours per month which may be authorized using the scoring conversion chart.
| Scoring Conversion Chart |
||||||||||||||||||
| MAXIMUM | MAXIMUM | MAXIMUM | ||||||||||||||||
| Score | Hours | Score | Hours | Score | Hours | |||||||||||||
| 1 | - | 4 | 5 | 60 | - | 64 | 44 | 120 | - | 124 | 83 | |||||||
| 5 | - | 9 | 8 | 65 | - | 69 | 47 | 125 | - | 129 | 87 | |||||||
| 10 | - | 14 | 11 | 70 | - | 74 | 51 | 130 | - | 134 | 90 | |||||||
| 15 | - | 19 | 14 | 75 | - | 79 | 54 | 135 | - | 139 | 93 | |||||||
| 20 | - | 24 | 18 | 80 | - | 84 | 57 | 140 | - | 144 | 97 | |||||||
| 25 | - | 29 | 21 | 85 | - | 89 | 60 | 145 | - | 149 | 100 | |||||||
| 30 | - | 34 | 24 | 90 | - | 94 | 64 | 150 | - | 154 | 103 | |||||||
| 35 | - | 39 | 28 | 95 | - | 99 | 67 | 155 | - | 159 | 106 | |||||||
| 40 | - | 44 | 31 | 100 | - | 104 | 70 | 160 | - | 164 | 110 | |||||||
| 45 | - | 49 | 34 | 105 | - | 109 | 74 | 165 | - | 169 | 113 | |||||||
| 50 | - | 54 | 37 | 110 | - | 114 | 77 | 170 | and | |||||||||
| 55 | - | 59 | 41 | 115 | - | 119 | 80 | Above | 116 | |||||||||
(6) The assessor shall determine the client's additional hours of supervision needed:
(a) Due to impaired judgment; and
(b) For standby assistance necessary for unscheduled tasks defined under WAC 388-71-202; and
(c) Recognize supervision hours show client need, and may not reflect department paid hours as determined by program standards.
(7) Department staff or the department's designee shall authorize services to correspond with the client's assessed need according to eligibility criteria for aging and adult services administration programs or the eligibility criteria for the division authorizing the service. The department or the department's designee shall notify the client of the right to contest a denial or reduction of services.
(8) Department staff or the department designee shall be responsible for representing the department at any hearing involving the assessment or decisions made relating to such assessment.
[]
(2) Staff who develop the service plan shall document the:
(a) Client's specific problems and needs;
(b) Plan for meeting each need;
(c) Responsible parties for carrying out each part of the plan;
(d) Anticipated outcomes;
(e) Dates and changes to the plan;
(f) Dates of referral, service initiation, follow-up reviews; and
(g) Agreement to the service plan by the client or the client's representative.
[]
(1) Assistance with personal care tasks and household tasks
in your own home, as defined in ((388-15-202(38))) WAC 388-71-202; and
(2) Assistance with personal care tasks and household tasks in a residential setting, as described in WAC 388-71-0600. Note: Household tasks are included as part of the board and room rate. You may receive, under MPC:
(a) Up to thirty hours of personal care services in an adult residential care facility; or
(b) Up to sixty hours of personal care services in an adult family home.
[Statutory Authority: RCW 74.08.090, 74.39.010, 74.09.520. 00-04-056, § 388-71-0410, filed 1/28/00, effective 2/28/00.]
[Statutory Authority: RCW 74.39A.030. 00-13-077, § 388-71-0430, filed 6/19/00, effective 7/20/00. Statutory Authority: RCW 74.39.010, 74.08.090, 74.39A.110, 74.09.520. 00-04-056, § 388-71-0430, filed 1/28/00, effective 2/28/00.]
(1) You are age:
(a) Eighteen or older and blind or disabled, as defined in WAC 388-511-1105; or
(b) Sixty-five or older.
(2) You meet financial eligibility requirements. This means the department will assess your finances and determine if your income and resources fall within the limits set in WAC 388-515-1505, Community options program entry system (COPES).
(3) You:
(a) Are not eligible for Medicaid personal care services; or
(b) Are eligible for Medicaid personal care services, but the department determines that the amount, duration, or scope of your needs is beyond what Medicaid personal care can provide.
(4) Your comprehensive assessment shows you need the level of care provided in a nursing facility (or will likely need the level of care within thirty days unless COPES services are provided) which means one of the following applies. You:
(a) Require care provided by or under the supervision of a registered nurse or a licensed practical nurse on a daily basis;
(b) Have an unmet need requiring substantial or total
assistance with at least two or more of the following activities
of daily living (ADLS) as defined in WAC ((388-15-202 and
388-15-203)) 388-71-202 and 388-71-203:
(i) Eating,
(ii) Toileting,
(iii) Ambulation,
(iv) Transfer,
(v) Positioning,
(vi) Bathing, and
(vii) Self-medication.
(c) Have an unmet need requiring minimal, substantial or total assistance in three or more of the ADLS listed in subsection (4)(b)(i) through (vii) of this section; or
(d) Have:
(i) A cognitive impairment and require supervision due to one or more of the following: disorientation, memory impairment, impaired judgment, or wandering; and
(ii) An unmet need requiring substantial or total assistance with one or more of the ADLS listed in subsection (4)(b)(i) through (vii) of this section.
(5) You have a completed service plan, per WAC
((388-15-205)) 388-71-205.
[Statutory Authority: RCW 74.39A.030. 00-13-077, § 388-71-0435, filed 6/19/00, effective 7/20/00.]
(1) Be eighteen years of age or older;
(2) Require assistance with at least one of the direct
personal care tasks listed in WAC ((388-15-202(17))) 388-71-202;
(3) Not be eligible for MPC or COPES, Medicare home health or other programs if these programs can meet your needs;
(4) Have net household income (as described in WAC 388-450-0005, 388-450-0020, 388-450-0040, and 388-511-1130) not exceeding:
(a) The sum of the cost of your chore services, and
(b) One-hundred percent of the FPL adjusted for family size.
(5) Have resources, as described in chapter 388-470 WAC, which does not exceed ten thousand dollars for a one-person family or fifteen thousand dollars for a two-person family. (Note: One thousand dollars for each additional family member may be added to these limits.)
(6) Not transfer assets on or after November 1, 1995 for less than fair market value as described in WAC 388-513-1365.
[Statutory Authority: 74.39A.110, 74.39A.150. 01-02-051, § 388-71-0445, filed 12/28/00, effective 1/28/01. Statutory Authority: RCW 74.09.520, 74.09.530, 74.39A.110, [74.39A.]120, [74.39A.]130, and 1998 c 346 § 205 (1)(c), and RCW 74.39A.030. 00-18-099, § 388-71-0445, filed 9/5/00, effective 10/6/00. Statutory Authority: RCW 74.39A.110, 74.39A.150. 00-04-056, § 388-71-0445, filed 1/28/00, effective 2/28/00.]
Reviser's note: The bracketed material preceding the section above was supplied by the code reviser's office.
AMENDATORY SECTION(Amending WSR 00-04-056, filed 1/28/00,
effective 2/28/00)
WAC 388-71-0450
How do I remain eligible for services?
In
order to remain eligible for services, you must have and be found
still in need of HCP services through a ((reassessment)) new
assessment. The reassessment must be ((conducted:
(1) Face-to-face.
(2) In your own home. Note: A case manager may request the interview be conducted in private.
(3))) at least annually or more often if your functional, financial, or other significant circumstances change.
[Statutory Authority: 42 C.F.R. 441.302, RCW 74.09.520. 00-04-056, § 388-71-0450, filed 1/28/00, effective 2/28/00.]
(1) Qualifications of an individual provider, as defined in
WAC ((388-15-202 (25) and (26))) 388-71-202;
(2) Qualifications of a home care agency provider, as
defined in WAC ((388-15-202(2))) 388-71-202 and chapter 246-336 WAC;
(3) Conditions under which the department or the area agency on aging (AAA) will pay for the services of an individual provider or a home care agency provider;
(4) Training requirements for an individual provider and home care agency provider.
[Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0500, filed 4/30/02, effective 5/31/02. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0500, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0500, filed 1/13/00, effective 2/13/00.]
(1) Understand the client's service plan that is signed by the client or legal representative and social worker/case manager, and translated or interpreted, as necessary, for the client and the provider;
(2) Provide the services as outlined on the client's service
plan, within the scope of practice in WAC ((388-15-202(38) and
388-15-203)) 388-71-202 and 388-71-203;
(3) Accommodate client's individual preferences and differences in providing care, within the scope of the service plan;
(4) Contact the client's representative and case manager when there are changes which affect the personal care and other tasks listed on the service plan;
(5) Observe the client for change(s) in health, take appropriate action, and respond to emergencies;
(6) Notify the case manager immediately when the client enters a hospital, or moves to another setting;
(7) Notify the case manager immediately if the client dies;
(8) Notify the department or AAA immediately when unable to staff/serve the client; and
(9) Notify the department/AAA when the individual provider or home care agency will no longer provide services. Notification to the client/legal guardian must:
(a) Give at least two weeks' notice, and
(b) Be in writing.
(10) Complete and keep accurate time sheets that are accessible to the social worker/case manager; and
(11) Comply with all applicable laws and regulations.
[Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830, 74.39.095. 01-11-019, § 388-71-0515, filed 5/4/01, effective 6/4/01. Statutory Authority: RCW 74.08.090, 74.09.520, 43.20A.050, 43.43.842, 74.39A.090, 43.20A.710, 74.39.050, 43.43.830. 00-03-043, § 388-71-0515, filed 1/13/00, effective 2/13/00.]
(1) Adult family homes with a state contract provide services for two to six unrelated adults (chapter 388-76 WAC). Services include room, board and supervision. Residents may also receive limited nursing services, under nurse delegation or if the sponsor or the manager is a nurse.
(2) Assisted living provides services in a licensed boarding home with a state contract (chapter 388-110 WAC, part I and II). Structural requirements include two hundred twenty square foot private room, private bathroom, and a kitchen in each unit. Resident services may include room, board, assistance with ADL and IADL, and limited nursing services. Services are authorized according to the department's comprehensive assessment and service plan.
(3) Enhanced adult residential care provides services in a licensed boarding home with a state contract (chapter 388-110 WAC, part I and III). Services may include a shared room, limited nursing services, assistance with ADL and IADL, limited nursing services, and supervision. Services are authorized according to the department's comprehensive assessment and service plan.
(4) Adult residential care provides services in a licensed boarding home with a state contract (chapter 388-110 WAC, part I and IV). Services may include supervision.
[Statutory Authority: RCW 74.08.44 [74.08.044]. 00-04-056, § 388-71-0600, filed 1/28/00, effective 2/28/00.]
3150.1"Abuse" means a nonaccidental act of physical or mental mistreatment or injury, or sexual mistreatment, which harms a person through action or inaction by another individual.
"Adult family home" means the same as the definition in RCW 70.128.010.
"Applicant" means an individual, partnership, corporation, or other entity seeking a license to operate an adult family home.
"Capacity" means the maximum number of persons in need of personal or special care permitted in an adult family home at a given time. This number shall include related children or adults in the home who receive special care.
"Caregiver" means any person eighteen years of age or older responsible for providing direct personal care to a resident and may include but is not limited to the provider, resident manager, employee, relief caregiver, volunteer, student, entity representative, or household member.
"Case manager" means the department staff person or designee assigned to negotiate, monitor, and facilitate a service plan for residents receiving services fully or partially paid for by the department.
"Chemical restraint" means a psychopharmacologic drug that is used for discipline or convenience and not required to treat the resident's medical symptoms.
"Department" means the Washington state department of social and health services.
"Entity provider" means any corporation, partnership, association, or limited liability company that is licensed under this chapter to operate an adult family home.
"Entity representative" means the individual designated by an entity provider who is responsible for the daily operation of the adult family home.
"Exploitation" means the illegal or improper use of a frail elder or vulnerable adult or that person's income or resources, including trust funds, for another person's profit or advantage.
"Frail elder or vulnerable adult" means the same as the definition in RCW 74.34.020 or RCW 43.43.830.
"Individual provider" means an individual person or a legally married couple who is licensed to operate an adult family home.
"Inspection" means an on-site visit by department personnel to determine the adult family home's compliance with this chapter and chapter 70.128 RCW, Adult family homes.
"Multiple facility provider" means an individual or entity provider who is licensed to operate more than one adult family home.
"Neglect" means a pattern of conduct or inaction resulting in deprivation of care necessary to maintain a resident's physical or mental health.
"Nursing assistant" means the same as the definition in chapter 18.88A RCW.
"Personal care services" means both physical assistance
and/or prompting and supervising the performance of direct
personal care tasks as determined by the resident's needs as
defined in WAC ((388-15-202)) 388-71-202, Long-term care
services--Definitions. Personal care services do not include
assistance with tasks performed by a licensed health
professional.
"Physical restraint" means a manual method, obstacle, or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that restricts freedom of movement or access to his or her body, is used for discipline or convenience, and not required to treat the resident's medical symptoms.
"Provider" means any person or entity that is licensed under this chapter to operate an adult family home.
"Resident" means any adult unrelated to the provider who lives in the adult family home and who is in need of care. "Resident" includes former residents when examining complaints about admissions, readmissions, transfers or discharges. For decision-making purposes, the term "resident" includes the resident's surrogate decision maker in accordance with state law or at the resident's request.
"Resident manager" means a person employed or designated by the provider to manage the adult family home.
"Special care" means care beyond personal care services as defined by "personal care services" in this section.
"Unsupervised" means the same as the definition in RCW 43.43.830(8).
[Statutory Authority: RCW 70.128.040, chapters 70.128 and 70.129 RCW. 98-11-095, § 388-76-540, filed 5/20/98, effective 7/1/98. Statutory Authority: RCW 70.128.040, 70.128.060, 70.128.120, 70.128.130, 43.43.842, 18.88A.210 and 18.88A.230. 96-14-003 (Order 3984), § 388-76-540, filed 6/19/96, effective 7/20/96.]
3147.1 (((2))) "Aging in place" means being in a care environment
that can accommodate a resident's progressive disability or
changing needs without relocating. For aging in place to occur,
needed services are adjusted to meet the changing needs of the
resident.
(((3))) "Applicant" means the individual, partnership,
corporation or other entity which has applied for a contract with
the department to provide assisted living services, enhanced
adult residential care, or adult residential care to state funded
residents in a licensed boarding home.
(((4))) "Assisted living services" is a package of services,
including personal care and limited nursing services, that the
department contracts with a licensed boarding home to provide in
accordance with Parts I and II of this chapter. Assisted living
services include housing for the resident in a private
apartment-like unit.
(((5))) "Boarding home" means the same as the definition
found in RCW 18.20.020(2), or a boarding home located within the
boundaries of a federally recognized Indian reservation and
licensed by the tribe.
(((6))) "Caregiver" means any person responsible for
providing direct personal care services to a resident and may
include but is not limited to the contractor, employee,
volunteer, or student.
(((7))) "Case manager" means the department staff person or
designee assigned to negotiate, monitor, and facilitate a service
plan for residents receiving services fully or partially paid for
by the department.
(((8))) "Contractor" means the individual, partnership,
corporation, or other entity which contracts with the department
to provide assisted living services, enhanced adult residential
care, or adult residential care to state funded residents in a
licensed boarding home.
(((9))) "Department" means the Washington state department
of social and health services (DSHS).
(((10))) "Dignity" means the quality or condition of being
esteemed and respected in such a way as to validate the
self-worth of the resident.
(((11))) "Enhanced adult residential care" is a package of
services, including personal care and limited nursing services,
that the department contracts with a licensed boarding home to
provide in accordance with Parts I and III of this chapter.
(((12))) "Frail elder or vulnerable adult" means the same as
the definition found in RCW 74.34.020 or 43.43.830.
(((13))) "Homelike" means an environment having the
qualities of a home, including privacy, comfortable surroundings,
and the opportunity to modify one's living area to suit one's
individual preferences. A homelike environment provides
residents with an opportunity for self-expression, and encourages
interaction with the community, family and friends.
(((14))) "Independence" means free from the control of
others and being able to assert one's own will, personality and
preferences.
(((15))) "Individuality" means the quality of being unique;
the aggregate of qualities and characteristics that distinguishes
one from others. Individuality is supported by modifying
services to suit the needs or wishes of a specific individual.
(((16))) "Limited nursing services" means the same as the
definition found in WAC 246-316-265.
(((17))) "Personal care services" means both physical
assistance and/or prompting and supervising the performance of
direct personal care tasks as determined by the resident's needs
as defined in WAC ((388-15-202(38))) 388-71-202. Personal care
services do not include assistance with tasks that must be
performed by a licensed health professional.
(((18))) "Resident" means a person residing in a boarding
home for whom services are paid for, in whole or in part, by the
department under a contract for assisted living services,
enhanced adult residential care, or adult residential care. "Resident" includes former residents when examining complaints
about admissions, re-admissions, transfers or discharges. For
decision-making purposes, the term "resident" includes the
resident's surrogate decision maker in accordance with state law
or at the resident's request.
[Statutory Authority: RCW 74.39A.010, 74.39A.020, 74.39A.060, 74.39A.080, 74.39A.170, 18.88A.210-[18.88A.]240 and 70.129.040. 96-11-045 (Order 3979), § 388-110-020, filed 5/8/96, effective 6/8/96.]
The following sections of the Washington Administrative Code are repealed:
| WAC 388-110-210 | Client service eligibility. |
| WAC 388-110-230 | Client eligibility. |
| WAC 388-110-250 | Client service eligibility. |
The following sections of the Washington Administrative Code are repealed:
| WAC 388-15-194 | Home and community services--Nursing services. |
| WAC 388-15-202 | Long-term care services -- Definitions. |
| WAC 388-15-203 | Long-term care services--Assessment of task self-performance and determination of required assistance. |
| WAC 388-15-204 | Home and community services--Reassessment. |
| WAC 388-15-205 | Long-term care services--Service plan development. |