PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 02-11-064.
Title of Rule: Medically needy residential waiver program, amending rules in chapter 388-71 WAC and WAC 388-515-1540.
Purpose: To adopt rules within chapters 388-71 and 388-515 WAC to establish the medically needy residential waiver (MNRW) program. Amending, clarifying, and reorganizing COPES (community options program entry system) rules to:
• Comply with the Governor's Executive Order 97-02 and the Secretary's Order on Regulatory Improvement;
• Reflect changes in program requirements and/or options.
Enrolled HB 1341 (chapter 269, Laws of 2001) authorized DSHS to develop a new waiver program for individuals in need of long-term care services in the community. The legislation specifically requires the department to adopt rules to establish eligibility criteria, applicable income standards, and specific waiver services to be provided. This change is also necessary to reflect amendments to the COPES waiver.
This amendment is necessary to implement two-year old legislation and will result in budget savings, will afford clients choice in their long-term care, and will result in more efficient care and increased service delivery. These WACs have already been filed as an emergency rule, WSR 03-05-098, effective March 17, 2003. This current process is to implement permanent adoption.
Statutory Authority for Adoption: SHB 1341 (chapter 269, Laws of 2001), RCW 74.09.700, chapter 74.39 RCW, RCW 74.08.090, 74.04.050, and 74.09.575.
Statute Being Implemented: SHB 1341 (chapter 269, Laws of 2001), RCW 74.09.700, chapter 74.39 RCW, RCW 74.08.090, 74.04.050, and 74.09.575.
Summary: See Purpose above.
Reasons Supporting Proposal: See Purpose above.
Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Kristi Knudsen, P.O. Box 45600, Olympia, WA 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: This amendment is necessary to implement two-year old legislation and will result in budget savings, will afford clients choice in their long-term care, and will result in more efficient care and increased service delivery. This new program will allow individuals who cannot afford community residential care and who do not wish to go into a nursing facility, access to long-term care that they could otherwise not afford.
Proposal Changes the Following Existing Rules: Proposed amendments establish eligibility criteria, applicable income standards, and specific medically needy residential waiver services to be provided. This change is also necessary to reflect amendments to the COPES waiver.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The department has determined that no small businesses will be affected by this change.
RCW 34.05.328 does not apply to this rule adoption. Under RCW 34.05.328 (5)(b)(vii) these amendments are exempt from this requirement. The rules relate only to DSHS 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 May 27, 2003, at 10:00 a.m.
Assistance for Persons with Disabilities: Contact Andy Fernando, DSHS Rules Coordinator, by May 23, 2003, 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., May 27, 2003.
Date of Intended Adoption: Not earlier than May 28, 2003.
April 7, 2003
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
3196.8(1) To be eligible for MNRW, a client must meet the following conditions:
(a) Does not meet financial eligibility for Medicaid Personal Care or the COPES program;
(b) Is eighteen years of age or older;
(c) Meets the SSI related criteria described in WAC 388-511-1105(1);
(d) Requires the level of care provided in a nursing facility as described in WAC 388-71-0700;
(e) In the absence of waiver services described in WAC 388-71-0410 and 388-71-0415, would continue to reside in a medical facility as defined in WAC 388-513-1301, or will likely be placed in one within the next thirty days;
(f) Has attained institutional status as described in WAC 388-513-1320;
(g) Has been determined to be in need of waiver services as described in WAC 388-71-0442;
(h) Lives in one of the following department-contracted residential facilities:
(i) Licensed adult family home (AFH);
(ii) Assisted living (AL) facility; or
(iii) Enhanced Adult Residential Care (EARC) facility.
(i) Is not subject to a penalty period of ineligibility for the transfer of an asset as described in WAC 388-513-1364, 388-513-1365 and 388-513-1366; and
(j) Meets the resource and income requirements described in subsections (2) through (6).
(2) The department determines a client's nonexcluded resources under MNRW as described in WAC 388-513-1350 (1) through (4)(a) and WAC 388-513-1360;
(3) Nonexcluded resources, after disregarding excess resources described in (4), must be at or below the resource standard described in WAC 388-513-1350 (1) and (2).
(4) In determining a client's resource eligibility, the department disregards excess resources above the standard described in subsection (3) of this section:
(a) In an amount equal to incurred medical expenses such as:
(i) Premiums, deductibles, and co-insurance/co-payment charges for health insurance and Medicare premiums;
(ii) Necessary medical care recognized under state law, but not covered under the state's Medicaid plan; or
(iii) Necessary medical care covered under the state's Medicaid plan.
(b) As long as the incurred medical expenses:
(i) Are not subject to third-party payment or reimbursement;
(ii) Have not been used to satisfy a previous spend down liability;
(iii) Have not previously been used to reduce excess resources;
(iv) Have not been used to reduce client responsibility toward cost of care; and
(v) Are amounts for which the client remains liable.
(5) The department determines a client's countable income under MNRW in the following way:
(a) Considers income available described in WAC 388-513-1325 and 388-513-1330 (1), (2), and (3);
(b) Excludes income described in WAC 388-513-1340;
(c) Disregards income described in WAC 388-513-1345;
(d) Deducts monthly health insurance premiums, except Medicare premiums.
(6) If the client's countable income is:
(a) less than the residential facility's department-contracted rate, based on an average of 30.42 days in a month the client may qualify for MNRW subject to availability per WAC 388-71-0465;
(b) more than the residential facility's department-contracted rate, based on an average of 30.42 days in a month the client may qualify for MNRW when they meet the requirements described in subsections (7) through (9), subject to availability per WAC 388-71-0465.
(7) The portion of a client's countable income over the department-contracted rate is called "excess income."
(8) A client who meets the requirements for MNRW chooses a three or six month base period. The months must be consecutive calendar months.
(9) A client who has or will have "excess income" is not eligible for MNRW until the client has medical expenses which are equal in amount to that excess income. This is the process of meeting "spenddown." The excess income from each of the months in the base period is added together to determine the total "spenddown" amount.
(10) Medical expenses described in subsection (4) of this WAC may be used to meet spenddown if not already used in subsection (4) of this WAC to disregard excess resources or to reduce countable income as described in subsection (5)(d).
(11) In cases where spenddown has been met, medical coverage begins the day services are authorized.
(12) The client's income that remains after determining available income in WAC 388-513-1325 and 388-513-1330 (1), (2), (3) and excluded income in WAC 388-513-1340 is paid towards the cost of care after deducting the following amounts in the order listed:
(a) An earned income deduction of the first sixty-five dollars plus one-half of the remaining earned income;
(b) Personal needs allowance (PNA) described in WAC 388-515-1505 (7)(b);
(c) Medicare and health insurance premiums not used to meet spenddown or reduce excess resources;
(d) Incurred medical expenses described in (4) not used to meet spenddown or reduce excess resources.
[]
3205.2(2) Upon department or designee referral, a registered nurse will consult about or visit a Community Options Program Entry System client, Medically Needy Residential waiver 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.
[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0194, filed 10/21/02, effective 11/21/02.]
"Long-term care services" means the services administered directly or through contract by the aging and adult services administration of the department, including but not limited to nursing facility care and home and community services.
"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 own home or other place of residence.
"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)) 388-71-0205.
"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)) 388-71-0205.
"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, Medically Needy Residential waiver 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.
[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0202, filed 10/21/02, effective 11/21/02.]
(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)) 388-71-0202; 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.
[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0203, filed 10/21/02, effective 11/21/02.]
(1) Community options program entry system (COPES),
((codified under subsection 1915(c) of the Social Security Act
and 42 C.F.R. 441.300 and 310)) authorized under RCW 74.39A.030.
(2) Medicaid personal care services (MPC), ((found))
authorized under RCW 74.09.520 ((and in the Medicaid state
plan)).
(3) Chore personal care services, a state-only funded
program authorized under RCW ((74.08.090, 74.09.520, and
74.08.570)) 74.39A.110.
(4) Medically Needy Residential waiver, authorized under RCW 74.09.700 and 74.39A.041.
[Statutory Authority: RCW 74.09.520, 74.08.090, 74.39A.130. 00-04-056, § 388-71-0405, filed 1/28/00, effective 2/28/00.]
(1) For COPES, MPC or chore: Assistance with personal
care tasks and household tasks ((in your own home)), as
defined in WAC ((388-71-202)) 388-71-0202; and
(2) For all HCP programs: 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)).
(3) For COPES, MPC: Personal care assistance when temporarily traveling out of state, as long as:
(a) Your provider is contracted with the state of Washington; and
(b) The travel plans are coordinated with your social service case manager prior to departure; and
(c) Services are authorized on your service plan prior to departure; and
(d) Services are strictly for your personal care, which does not include your provider's travel time, expenses, lodging or subsistence.
[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0410, filed 10/21/02, effective 11/21/02. 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.]
(1) ((Adult day services, in an adult day care or adult
day health center if you:
(a) Are ineligible for Medicaid state plan covered adult day health services;
(b) Are chronically ill or disabled, socially isolated and/or confused or have mild to moderate dementia; and
(c) Meet eligibility requirements for adult day services as required in:
(i) WAC 388-15-652, Eligibility for adult day care; or
(ii) WAC 388-15-653, Eligibility for adult day health)) For COPES in-home clients, adult day care if you meet the eligibility requirements under WAC 388-15-652 or its successor.
(2) Environmental modifications, if the minor physical adaptations to your home:
(a) Are necessary to ensure your health, welfare and safety;
(b) Enable you to function with greater independence in the home;
(c) Directly benefit you medically or remedially;
(d) Meet applicable state or local codes;
(e) Adaptions or improvements to the home, which are of general utility or add to the total square footage of the home are excluded.
(3) Home delivered meals provides nutritional balanced meals, limited to one meal per day, if:
(a) You are homebound and live in your own home;
(b) You are unable to prepare the meal;
(c) You don't have a caregiver (paid or unpaid) available to prepare this meal; and
(d) Receiving this meal is more cost-effective than having a paid caregiver.
(4) Home health aide service tasks in your own home, if the service tasks:
(a) Include assistance with ambulation, exercise, self-administered medications and hands on personal care;
(b) Are beyond the amount, duration or scope of Medicaid
reimbursed home health services (WAC 388-551-2100) and are in
addition to those available services; ((and))
(c) Are health-related. Note: Incidental services such as meal preparation may be performed in conjunction with a health-related task as long as it is not the sole purpose of the aide's visit; and
(d) Do not replace Medicare home health services.
(5) Personal emergency response system (PERS), if the service is necessary to enable you to secure help in the event of an emergency and if you:
(a) Live alone in your own home; or
(b) Are alone, in your own home, for significant parts of the day and have no regular provider for extended periods of time.
(6) Skilled nursing in your own home, if the service is:
(a) Provided by a registered nurse or licensed practical nurse under the supervision of a registered nurse; and
(b) Beyond the amount, duration or scope of Medicaid-reimbursed home health services as provided under WAC 388-551-2100.
(7) Specialized durable and nondurable medical equipment and supplies under WAC 388-543-1000, if the items are:
(a) Medically necessary under WAC 388-500-0005; and
(b) Necessary for life support((;
(b))); or
(c) Necessary to increase your ability to perform activities of daily living; or
(((c))) (d) Necessary for you to perceive, control, or
communicate with the environment in which you live; and
(((d))) (e) Directly medically or remedially beneficial
to you; and
(((e))) (f) In addition to and do not replace any medical
equipment and/or supplies otherwise provided under ((the state
plan)) Medicaid and/or Medicare.
(8) Training needs identified in the comprehensive assessment or in a professional evaluation, if you need to meet a therapeutic goal such as:
(a) Adjusting to a serious impairment;
(b) Managing personal care needs; or
(c) Developing necessary skills to deal with care providers.
(9) Transportation services if you live in your own home, if the service:
(a) Provides ((the client)) you access to community
services and resources provided in accordance with a
therapeutic goal;
(b) Is not merely diversional in nature;
(c) Is in addition to ((Medicaid brokered transportation
to medical services;)) and
(((d))) does not replace the Medicaid-brokered
transportation or transportation services available in the
community.
(10) For COPES or Medically Needy Residential waiver clients, skilled nursing in a residential setting, if the service is:
(a) Provided by a registered nurse or licensed practical nurse under the supervision of a registered nurse; and
(b) Beyond the amount, duration or scope of Medicaid-reimbursed home health services as provided under WAC 388-551-2100; and
(c) In addition to and does not replace the services required by DSHS contract in residential settings.
(11) Specialized durable and nondurable medical equipment and supplies under WAC 388-543-1000, if the items are:
(a) Medically necessary under WAC 388-500-0005; and
(b) Necessary for life support; or
(c) Necessary to increase your ability to perform activities of daily living; or
(d) Necessary for you to perceive, control, or communicate with the environment in which you live; and
(e) Directly medically or remedially beneficial to you; and
(f) In addition to and do not replace any medical equipment and/or supplies otherwise provided under Medicaid and/or Medicare; and
(g) In addition to and do not replace the services required by DSHS contract in residential settings.
(12) Training needs identified in the comprehensive assessment or in a professional evaluation, if you need to meet a therapeutic goal such as:
(a) Adjusting to a serious impairment;
(b) Managing personal care needs; or
(c) Developing necessary skills to deal with care providers; and
(d) The service is in addition to and does not replace the services required by DSHS contract in residential settings.
(13) Transportation services if you live in a residential setting, if the service:
(a) Provides you access to community services and resources provided in accordance with a therapeutic goal;
(b) Is not merely diversional in nature;
(c) Is in addition to and does not replace the Medicaid-brokered transportation or transportation services available in the community; and
(d) Does not replace the services required by DSHS contract in residential settings.
Note: Clients who reside in enhanced residential care, assisted living or adult family homes are not eligible for waiver funded adult day care.
[Statutory Authority: RCW 74.08.090, 74.39.020. 00-04-056, § 388-71-0415, filed 1/28/00, effective 2/28/00.]
(1) For chore personal care and MPC:
(a) Teaching, including teaching how to perform personal care tasks;
(b) Development of social, behavioral, recreational, communication, or other types of community living skills;
(c) Nursing care.
(2) Personal care services provided outside of your
residence, unless ((they)) the services are authorized in your
written service plan.
(3) Child care;
(4) Sterile procedures, administration of medications, or other tasks requiring a licensed health professional, unless authorized as an approved nursing delegation task, client self-directed care task, or provided by a family member;
(5) Services provided over the telephone;
(6) Services provided outside the state of Washington if
((COPES or)) chore personal care;
(7) Services to assist other household members not eligible for services;
(8) Yard care.
[Statutory Authority: RCW 74.09.520, 74.08.090, 74.39A.130. 00-04-056, § 388-71-0420, filed 1/28/00, effective 2/28/00.]
(1) ((Individual)) For in-home clients, individual
providers, who must meet the requirements outlined in WAC 388-71-0500 through 388-71-0580;
(2) For in-home clients, home care agencies, which must be licensed under chapters 70.127 RCW and 246-336 WAC, or home health agencies, licensed under chapters 70.127 RCW and 246-327 WAC;
(3) For residential clients, licensed adult family home and boarding home providers who are contracted with DSHS (see WAC 388-71-0600); and
(4) As applicable, service providers who have contracted with the AAA to perform other waiver services under COPES or Medically Needy Residential waiver services listed in WAC 388-71-0415.
[Statutory Authority: 1999 c 175, chapters 70.126, 70.127 RCW, RCW 74.08.044. 00-04-056, § 388-71-0425, filed 1/28/00, effective 2/28/00.]
[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0430, filed 10/21/02, effective 11/21/02. 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)))
as defined in WAC 388-515-1505.
(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))
waiver 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
((388-71-202 and 388-71-203)) 388-71-0202 and 388-71-0203:
(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
((388-71-205)) 388-71-0205.
[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0435, filed 10/21/02, effective 11/21/02. Statutory Authority: RCW 74.39A.030. 00-13-077, § 388-71-0435, filed 6/19/00, effective 7/20/00.]
(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 the financial eligibility requirements defined in WAC 388-515-1540.
(3) You are not eligible for Medicaid personal care services or COPES.
(4) You meet the functional criteria for nursing facility level of care as defined in WAC 388-71-0435(4).
(5) You have a completed service plan, per WAC 388-71-0205.
(6) Note: Depending on the number of available spaces, you may be placed on a waiting list.
[]
(1) Be eighteen years of age or older;
(2) Require assistance with at least one of the direct
personal care tasks listed in WAC ((388-71-202)) 388-71-0202;
(3) Not be eligible for MPC or COPES, Medically Needy Residential waiver, 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: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0445, filed 10/21/02, effective 11/21/02. Statutory Authority: RCW 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.]
(1) HCP services may not replace other available resources, both paid and unpaid.
(2) AASA published rates and program rules establish your total hours and how much the department pays toward the cost of your services.
(3) 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, housework, travel to medical services, wood supply and supervision due to impaired judgement) for:
(a) More than one client living in the same household; or
(b) A client in a shared living arrangement (MPC).
[Statutory Authority: RCW 74.09.520. 00-04-056, § 388-71-0460, filed 1/28/00, effective 2/28/00.]
(1) COPES services, a waiting list may be created if:
(a) The caseload or expenditures exceed the legislative funding, or
(b) ((HCFA)) The federal Centers for Medicare and
Medicaid Services (CMS) or the legislature imposes caseload
limits.
(2) ((Chore services, a waiting list may be created to
maintain the monthly expenditures within the legislative
appropriation. You receive priority if you:
(a) Have received chore as of June 30, 1995; or
(b) Need chore:
(i) To return to the community from a nursing home,
(ii) To prevent unnecessary nursing home placement, or
(iii) For protection based on referral from an APS investigation.
(3))) MPC, there is no waiting list. Note: Instead of waiting lists, the department may be required to revise HCP rules to reduce caseload size, hours, rates, or payments in order to stay within the legislative appropriation.
(3) For Medically Needy Residential waiver, the department will create a waiting list in accordance with caseload limits determined by legislative funding. Wait listed clients will be ranked in the following manner:
(a) Nursing home residents wanting MN waiver services will be ranked first on the wait list by date of application for services; and
(b) After nursing home residents are ranked, clients living in the community with a higher level of need as determined by the comprehensive assessment will be ranked higher on the wait list over clients with lower level of need; and
(c) As between two or more clients in the community with equal need levels, clients with earlier applications for services will have priority over later applications for services.
[Statutory Authority: RCW 74.39.010, 74.39A.120. 00-04-056, § 388-71-0465, filed 1/28/00, effective 2/28/00.]
(1) COPES in-home or residential,
(a) You participate income per rules in WAC 388-515-1505;
(b) If you have nonexempt income that exceeds the cost of COPES services, you may retain the difference.
(2) MPC in-home services, you do not participate toward the cost of your personal care services.
(3) MPC services in a residential setting and you are:
(a) An SSI beneficiary who receives only SSI income, you only pay for board and room. You are allowed to keep a personal needs allowance of at least thirty-eight dollars and eighty-four cents per month.
(b) An SSI beneficiary who receives SSI and SSA benefits, you only pay for board and room. You are allowed to keep a personal needs allowance of at least fifty-eight dollars and eighty-four cents per month.
(c) An SSI-related person per WAC 388-511-1105, you may
be required to participate towards the cost of your personal
care services in addition to your board and room if your
financial eligibility is based on the facility's state
contracted rate ((plus add-on hours)). You will receive a
personal allowance of fifty-eight dollars and eighty-four
cents.
(d) A GA-X client in a residential care facility, you are allowed to keep a personal allowance of thirty-eight dollars and eighty-four cents only per month. The remainder of your grant must be paid to the facility.
(4) Medically Needy Residential waiver services, the amount you pay is determined in WAC 388-515-1540.
(5) Chore services, you may retain an amount equal to one hundred percent of the federal poverty level, adjusted for family size, as the home maintenance allowance and pay the difference between the FPL and your nonexempt income. Exempt income includes:
(a) Income listed in WAC 388-513-1340;
(b) Spousal income allocated and actually paid as participation in the cost of the spouse's community options program entry system (COPES) services;
(c) Amounts paid for medical expenses not subject to third party payment;
(d) Health insurance premiums, coinsurance or deductible charges; and
(e) If applicable, those work expense deductions listed as WAC 388-71-480(2).
[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, § 388-71-0470, filed 9/5/00, effective 10/6/00. Statutory Authority: RCW 74.39A.120, 74.39.010, 74.39.020. 00-04-056, § 388-71-0470, filed 1/28/00, effective 2/28/00.]
(1) If you remain Medicaid eligible under the categorically needy program, you are financially eligible for MPC services.
(2) If you are receiving Medically Needy Residential waiver services in a residential setting, you may have earned income allowances per WAC 388-515-1540.
(3) If you are not Medicaid eligible due to your earned
income and resources, ((you may be eligible to receive)) and
are receiving chore personal care services.
(a) You may be required to pay participation per WAC 388-71-0470(4) for any earned income above one hundred percent of the federal poverty level.
(b) The department will exempt fifty percent of your earned income after work expense deductions. Work expense deductions are:
(i) Personal work expenses in the form of self-employment taxes (FICA); and income taxes when paid;
(ii) Payroll deductions required by law or as a condition of employment in the amounts actually withheld;
(iii) The necessary cost of transportation to and from the place of employment by the most economical means, except rental cars;
(iv) Expenses necessary for continued employment such as tools, materials, union dues, transportation to service customers is not furnished by the employer; and
(v) Uniforms needed on the job and not suitable for wear away from the job.
[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, § 388-71-0480, filed 9/5/00, effective 10/6/00. Statutory Authority: RCW 74.39A.140, 74.39A.150. 00-04-056, § 388-71-0480, filed 1/28/00, effective 2/28/00.]
(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. Services are authorized according to the department's comprehensive assessment and service plan.
(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, board, 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). This service is not available under the
COPES or MN waiver program. Services ((may)) include room,
board and supervision. Services are authorized according to
the department's comprehensive assessment and service plan.
[Statutory Authority: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0600, filed 10/21/02, effective 11/21/02. Statutory Authority: RCW 74.08.44 [74.08.044]. 00-04-056, § 388-71-0600, filed 1/28/00, effective 2/28/00.]
(a) Community options program entry system (COPES),
described in WAC 388-71-0435; ((or))
(b) Medicaid personal care funding (MPC), described in WAC 388-71-0440; or
(c) Medically Needy Residential waiver described in WAC 388-71-0442.
(2) If you are not eligible for services under one of the
programs listed above, you may receive state-only funding for
residential services if you meet eligibility requirements for
general assistance unemployable (GAU), described in WAC
((388-235-5000)) 388-400-0025.
(3) If you are on:
(a) MPC, you can receive services in adult family homes and adult residential care facilities.
Note: If you are under eighteen, you may receive MPC services in a children's foster family home or a children's group care facility.
(b) COPES/Medically Needy Residential waiver, you can receive services in adult family homes, enhanced adult residential care facilities, and assisted living facilities.
(c) GAU, you can receive state-funded services in adult family homes and adult residential care facilities.
[Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.200, and 74.08.090. 01-14-055, § 388-71-0605, filed 6/29/01, effective 7/30/01. Statutory Authority: RCW 74.08.44 [74.08.044]. 00-04-056, § 388-71-0605, filed 1/28/00, effective 2/28/00.]
(1) The department pays the facility for the difference between what you pay and the department-set rate for the facility. AASA published rates and program rules establish your total hours and how much the department pays toward the cost of your services.
(2) Washington state collects from your estate the cost of the care that the department provides based on chapter 388-527 WAC.
[Statutory Authority: RCW 74.08.44 [74.08.044]. 00-04-056, § 388-71-0610, filed 1/28/00, effective 2/28/00.]