PERMANENT RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Purpose: Adding new sections WAC 388-72A-0042 and 388-72A-0043 to incorporate CARE assessment criteria for children receiving state plan Medicaid personal care (MPC) services. When effective, these rules will replace emergency rules filed as WSR 04-18-083.
Statutory Authority for Adoption: RCW 74.08.090 and 74.09.520.
Other Authority: RCW 74.39A.090 and 74.39A.095.
Adopted under notice filed as WSR 04-14-099 (original) on July 6, 2004, and WSR 04-18-071 (supplemental) on August 30, 2004.
Changes Other than Editing from Proposed to Adopted Version: Editorial changes only.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 2, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 2, Amended 0, Repealed 0.
Date Adopted: October 12, 2004.
Brian H. Lindgren, Manager
Rules and Policies Assistance Unit
3464.3Activities of Daily Living (ADLs) | |||||||||||||||||
Ages | |||||||||||||||||
&sqbul;= Code status as Met | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 |
Medication Management | |||||||||||||||||
Independent, supervision, limited, extensive, or Total |
&sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Locomotion in RoomNote | |||||||||||||||||
Independent, supervision, limited or extensive |
&sqbul; | &sqbul; | &sqbul; | ||||||||||||||
Total | &sqbul; | ||||||||||||||||
Locomotion Outside RoomNote |
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Independent or supervision | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||||||||
Limited or extensive | &sqbul; | &sqbul; | &sqbul; | ||||||||||||||
Total | &sqbul; | ||||||||||||||||
Walk in RoomNote | |||||||||||||||||
Independent, supervision, limited or extensive |
&sqbul; | &sqbul; | &sqbul; | ||||||||||||||
Total | &sqbul; | ||||||||||||||||
Bed Mobility | |||||||||||||||||
Independent, supervision, limited or extensive |
&sqbul; | &sqbul; | |||||||||||||||
Total | &sqbul; | ||||||||||||||||
Transfers | |||||||||||||||||
Independent, supervision, limited, extensive or total & under 30 pounds |
&sqbul; | &sqbul; | |||||||||||||||
(Total & over 30 pounds = no age limit) |
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Toilet Use | |||||||||||||||||
Support provided for nighttime wetting only (Independent, supervision, limited, extensive, or total) |
&sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||||||
Independent, supervision, limited, extensive |
&sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||||||||
Total | &sqbul; | &sqbul; | &sqbul; | ||||||||||||||
Eating | |||||||||||||||||
Independent, supervision, limited, extensive, or total |
&sqbul; | &sqbul; | |||||||||||||||
Bathing | |||||||||||||||||
Independent or supervision | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Physical assistance all/part | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||||||
Total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | |||||||||||||
Dressing | |||||||||||||||||
Independent or supervision | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Limited or extensive | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||||||
Total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | |||||||||||||
Personal Hygiene | |||||||||||||||||
Independent or supervision | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Limited or extensive | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||||||
Total | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Instrumental Activities of Daily Living | |||||||||||||||||
Ages | |||||||||||||||||
&sqbul; = Code status as Met | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 |
Telephone | |||||||||||||||||
Independent, supervision, limited, extensive, or Total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Transportation | |||||||||||||||||
Independent, supervision, limited, extensive, or total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Shopping | |||||||||||||||||
Independent, supervision, limited, extensive, or total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Wood Supply | |||||||||||||||||
Independent, supervision, limited, extensive, or total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Housework | |||||||||||||||||
Independent, supervision, limited, extensive, or total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Finances | |||||||||||||||||
Independent, supervision, limited, extensive, or total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Meal Preparation | |||||||||||||||||
Independent, supervision, limited, extensive, or total | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
NOTE: If the activity did not occur, the assessor codes self performance as total and status as met.
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Ages | |||||||||||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | |
Additional guidelines based on age |
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Any foot care needs | |||||||||||||||||
Status Need met | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Any skin care (other than feet) |
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Status Need met | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
Speech/Hearing | |||||||||||||||||
Score comprehension as understood |
&sqbul; | &sqbul; | |||||||||||||||
Memory | |||||||||||||||||
Short term memory ok | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Long term memory ok | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Depression | |||||||||||||||||
Select interview = unable to obtain |
&sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Decision making | |||||||||||||||||
Rate how client makes decisions = independent |
&sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Bladder/Bowel | |||||||||||||||||
Support provided for nighttime wetting only - |
&sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; | ||||||
Individual management = Does not need/use |
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Individual management = Does not need/use |
&sqbul; | &sqbul; | &sqbul; | &sqbul; | &sqbul; |
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