WASHINGTON STATE REGISTER

WSR 05-03-096

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed January 18, 2005, 12:48 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 04-19-100.

Title of Rule and Other Identifying Information: New chapter 388-106 WAC, Long-term care services; chapter 388-71 WAC, Home and community services and programs; chapter 388-72A WAC, Comprehensive assessment reporting and evaluation (CARE) tool; and WAC 388-515-1540 through 388-515-1550, Medically needy residential waiver and medically needy in-home waiver. See below for a conversion chart of current long-term care rules and where same subject matter is located in the proposed rules.

This chart indicates the proposed WAC number which will replace those WACs currently adopted in chapters 388-71 and 388-72A WAC.

CURRENT WAC SECTIONS IN CHAPTER 388-71 WAC PROPOSED WAC NUMBER

HOME AND COMMUNITY PROGRAMS

388-71-0194 Home and community services -- Nursing services. 388-106-0200, 388-106-0300, 388-106-0305, 388-106-0400, 388-106-0500

388-71-0202 Long-term care services -- Definitions. 388-71-0215

388-71-0203 Long-term care services -- Assessment of task self-performance and determination of required assistance. 388-71-0230

388-71-0205 Long-term care services -- Service plan. 388-71-0235

388-71-0400 What is the intent of the department's home and community programs? Repeal

388-71-0405 What are the home and community programs? 388-106-0015

388-71-0410 What services may I receive under HCP? 388-106-0300, 388-106-0305, 388-106-0400, 388-106-0500, and 388-106-0600

388-71-0415 What other services may I receive under the COPES program? 388-106-0300, 388-106-0305

388-71-0420 What services are not covered under HCP? 388-106-0020

388-71-0425 Who can provide HCP services? 388-106-0040

388-71-0430 Am I eligible for one of the HCP programs? 388-106-0210, 388-106-0310, 388-106-0410, 388-106-0510, and 388-106-0610

388-71-0435 Am I eligible for COPES-funded services? 388-106-0310

388-71-0440 Am I eligible for MPC-funded services? 388-106-0210

388-71-0442 Am I eligible for Medically Needy Residential waiver services? 388-106-0410

388-71-0445 Am I eligible for Chore-funded services? 388-106-0610

388-71-0450 How do I remain eligible for services? 388-106-0220, 388-106-0320, 388-106-0420, 388-106-0520, and 388-106-0620

388-71-0455 Can my services be terminated if eligibility requirements for HCP change? 388-106-0220, 388-106-0320, 388-106-0420, 388-106-0520, and 388-106-0620

388-71-0460 Are there limitations to HCP services I can receive? 388-106-0130

388-71-0465 Are there waiting lists for HCP services? 388-106-0235, 388-106-0335, 388-106-0435, and 388-106-0535

388-71-0470 Who pays for HCP services? 388-106-0225, 388-106-0325, 388-106-0425, 388-106-0525, and 388-106-0625

388-71-0480 If I am employed, can I still receive HCP services? 388-106-0230, 388-106-0330, 388-106-0430, 388-106-0530, and 388-106-0630

INDIVIDUAL PROVIDER AND HOME CARE AGENCY PROVIDER QUALIFICATIONS Kept in chapter 388-71 WAC

RESIDENTIAL CARE SERVICES

388-71-0600 What are residential services? 388-106-0010

388-71-0605 Am I eligible for residential services? 388-106-0905

388-71-0610 Who pays for residential care? 388-106-0225, 388-106-0325, 388-106-0425, and 388-106-0525

388-71-0613 For what days will the department pay the residential care facility? 388-106-0225, 388-106-0325, 388-106-0425, and 388-106-0525

388-71-0615 If I leave a hospital, residential facility, or nursing facility, are there resources available to help me find a place to live? 388-106-0950

388-71-0620 Am I eligible for a residential discharge allowance? 388-106-0955

NURSING FACILITY CARE AND PAYMENT

388-71-0700 What are the requirements for nursing facility eligibility, assessment, and payment? 388-106-0350, 388-106-0355, and 388-106-0360

ADULT DAY SERVICES (IN CHAPTER 388-71 WAC EXCEPT FOR THE FOLLOWING)

388-71-0704 Adult day care -- Services. 388-106-0800

388-71-0706 Adult day health -- Services. 388-106-0805

388-71-0708 Adult day care -- Eligibility. 388-106-0810

388-71-0710 Adult day health -- Eligibility. 388-106-0815

PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)

388-71-0800 What is PACE? 388-106-0015

388-71-0805 What services does PACE cover? 388-106-0700

388-71-0810 Who provides these services? Repeal

388-71-0815 Where are these services provided? Repeal

388-71-0820 How do I qualify for Medicaid-funded PACE services? 388-106-0705

388-71-0825 What are my appeal rights? 388-106-1305

388-71-0830 Who pays the PACE provider? 388-106-0710

388-71-0835 How do I enroll into the PACE program? 388-106-0705

388-71-0840 How do I disenroll from the PACE program? 388-106-0715

388-71-0845 What are my rights as a PACE client? 388-106-1300

PRIVATE DUTY NURSING

388-71-0900 What is the intent of WAC 388-71-0900 through 388-71-0960? 388-106-1000

388-71-0905 What is private duty nursing (PDN) for adults? 388-106-1005

388-71-0910 Am I financially eligible for Medicaid-funded private duty nursing services? 388-106-1010

388-71-0915 Am I medically eligible to receive private duty nursing services? 388-106-1010

388-71-0920 How is my eligibility determined? 388-106-1015

388-71-0925 Am I required to pay participation toward PDN services? 388-106-1020

388-71-0930 Are PDN costs subject to estate recovery? 388-106-1020

388-71-0935 Who can provide my PDN services? 388-106-1025

388-71-0940 Are there limitations or other requirements for PDN? 388-106-1030

388-71-0945 What requirements must a home health agency meet in order to provide and get paid for my PDN? 388-106-1035

388-71-0950 What requirements must a private RN or LPN meet in order to provide and get paid for my PDN services? 388-106-1040

388-71-0955 Can I receive PDN in a licensed adult family home (AFH)? 388-106-1045

388-71-0960 Can I receive services in addition to PDN? 388-106-1050

388-71-0965 Can I choose to self-direct my care if I receive PDN? 388-106-1055

SENIOR CITIZEN'S SERVICES

388-71-1000 What is the Senior Citizens Services Act? 388-106-0015

388-71-1005 Who administers the Senior Citizens Services Act funds? Repeal

388-71-1010 What services does the SCSA fund? 388-106-1100

388-71-1015 How do I apply for SCSA-funded services? 388-106-1105

388-71-1020 Am I eligible for SCSA-funded services at no cost? 388-106-1110

388-71-1025 What income and resources are exempt when determining eligibility? 388-106-1115

388-71-1030 What if I am not eligible to receive SCSA-funded services at no cost? 388-106-1120

388-71-1035 What are my rights under SCSA? 388-106-1300

RESPITE CARE SERVICES

388-71-1065 What is the purpose of the respite care program? 388-106-0015, 388-106-1205

388-71-1070 What definitions apply to respite care services? 388-106-1200

388-71-1075 Who is eligible to receive respite care services? 388-106-1210

388-71-1080 Who may provide respite care services? 388-106-1215

388-71-1085 How are respite care providers reimbursed for their services? 388-106-1220

388-71-1090 Are participants required to pay for the cost of their services? 388-106-1225

388-71-1095 Are respite care services always available? 388-106-1230

VOLUNTEER CHORE

388-71-1100 What is volunteer chore services (VCS)? 388-106-0015, 388-106-0650

388-71-1105 Am I eligible to receive volunteer chore services? 388-106-0655

388-71-1110 How do I receive information on applying for volunteer chore services? Repeal

CURRENT WAC SECTIONS IN CHAPTER 388-72A WAC PROPOSED WAC NUMBER

APPLICATION

388-72A-0005 When do the rules in chapter 388-72A WAC apply to me? Repeal

388-72A-0010 Does chapter 388-71 WAC apply to me? Repeal

388-72A-0015 If the department did not use the CARE tool for my last assessment, may I have my assessments done on the assessment form used for my last assessment? Repeal

ASSESSMENT AND SERVICE PLANNING

388-72A-0020 What is an assessment? 388-106-005

388-72A-0025 What is the process for conducting an assessment? 388-106-0065

388-72A-0030 What is the purpose of an assessment? 388-106-0055

388-72A-0035 What are personal care services? 388-106-0015

388-72A-0036 How are my needs for personal care services determined? 388-106-0075

388-72A-0037 How are self-performance and support provided for the activities of daily living (ADLs) scored? 388-106-0075

388-72A-0038 How are the ADLs bathing, body care, and medication management scored? 388-106-0075

388-72A-0039 How are self-performance and difficulty for the instrumental activities of daily living (IADLs) scored? 388-106-0075

388-72A-0042 How are ADLs and IADLs scored for children? 388-106-0213

388-72A-0043 How are other elements in CARE scored for children age seventeen and younger and foster care clients? 388-106-0213

388-72A-0045 How will the department plan to meet my care needs? Repeal

388-72A-0050 What if I disagree with the result of the assessment or the decisions about what services I may receive? 388-106-1305

CARE ELIGIBILITY

388-72A-0053 Am I eligible for one of the HCP programs? 388-106-0210, 388-106-0310, 388-106-0410, 388-106-0510, and 388-106-0610

388-72A-0055 Am I eligible for COPES-funded services? 388-106-0310

388-72A-0057 Am I eligible for medically needy residential waiver (MNRW)-funded services? 388-106-0410

388-72A-0058 Am I eligible for medically needy in-home wavier (MNIW)-funded services? 388-106-0510

388-72A-0060 Am I eligible for MPC-funded services? 388-106-0210

388-72A-0065 Am I eligible for Chore-funded services? 388-106-0610

388-72A-0069 How does CARE use the information the assessor gathers? 388-106-0055

CLASSIFICATION FOR IN-HOME AND RESIDENTIAL CARE

388-72A-0070 What are the in-home hours and residential rate based on? 388-106-0080

388-72A-0080 What are the elements that the CARE tool evaluates for each of the criteria in WAC 388-72A-0075? 388-106-0085

388-72A-0081 How is cognitive performance measured in the CARE tool? 388-106-0090

388-72A-0082 How is clinical complexity measured within the CARE tool? 388-106-0095

388-72A-0083 How are mood and behaviors measured within the CARE tool? 388-106-0100

388-72A-0084 How are ADL scores measured within the CARE tool? 388-106-0105

388-72A-0085 How does the CARE tool evaluate for the two exceptional care classifications of in-home care? 388-106-0110

388-72A-0086 How is the information in WAC 388-72A-0081 through 388-72A-0084 used to determine the client's classification payment group for residential settings? 388-106-0115

388-72A-0087 How is the information in WAC 388-72A-0081 through 388-72A-0085 used to determine the classification payment group for in-home clients? 388-106-0125

PAYMENT METHODOLOGY FOR IN-HOME SERVICES

388-72A-0090 What are the maximum hours that I can receive for in-home services? 388-106-0135

388-72A-0092 How are my in-home hours determined? 388-106-0130

388-72A-0095 What additional criteria are considered to determine the number of hours I will receive for in-home services? 388-106-0130

388-72A-0100 Are there other in-home services I may be eligible to receive in addition to those described in WAC 388-72A-0095(3)? 388-106-0300

388-72A-0105 What would cause a change in the maximum hours authorized? 388-106-0140

HOME AND COMMUNITY PAYMENT RATES

388-72A-0110 How much will the department pay for my care? 388-106-0120

388-72A-0115 When the department adjusts an algorithm, when does the adjustment become effective? Repeal

388-72A-0120 When a client requests a fair hearing to have the client's CARE tool assessment results reviewed and there is (are) a more recent CARE assessment(s), which CARE tool assessment does the administrative law judge review in the fair hearing? 388-106-1310

Hearing Location(s): Blake Office Park East (behind Goodyear Courtesy Tire), Rose Room, 4500 10th Avenue S.E., Lacey, WA, on March 22, 2005, at 10:00 a.m.

Date of Intended Adoption: Not early than March 23, 2005.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA, e-mail fernaax@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m., March 22, 2005.

Assistance for Persons with Disabilities: Contact Fred Swenson, DSHS Rules Consultant, by March 18, 2005, TTY (360) 664-6178 or (360) 664-6097.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: New WAC chapters and rules are required to phase out rules that no longer apply, due to the implementation of the comprehensive assessment reporting and evaluation (CARE) tool. In addition, ADSA is reorganizing, amending and streamlining rules to ensure that all rules are current and clear.

This rule making includes the following significant changes:

• Clarifies requirements for how to conduct an assessment when other who are present impede the process.

• Adds a client rights section.

• Includes the right to contest "Other decisions by the department" in the fair hearing section.

• Includes a new program, community transition services, under the COPES, MNIW, and MNRW waiver.

• Incorporates changes to the eligibility and number of hours you may receive under private duty nursing.

• Included CARE deductions (e.g., one meal is thirty minutes).

• Changes to how residential care discharge allowance can be authorized.

• Sets a minimum standards for determining eligibility under respite.

Reasons Supporting Proposal: See above.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

Statute Being Implemented: RCW 74.08.090, 74.09.520.

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

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

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Brooke Buckingham, P.O. Box 45600, Olympia, WA 98504-5600, (425) 670-6458.

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

A cost-benefit analysis is not required under RCW 34.05.328. The proposed new rules are exempt by RCW 34.05.328 (5)(b)(vii), rules relating to client medical eligibility. Amended rules are exempted by RCW 34.05.328 (5)(b)(iv), making address and name changes, and clarifying a rule without changing its effect.

January 12, 2005

Andy Fernando, Manager

Rules and Policies Assistance Unit

3501.6 Chapter 388-106 WAC

Long-Term Care Services

SCOPE AND DEFINITIONS
NEW SECTION
WAC 388-106-0005 What is the purpose and scope of this chapter? This chapter applies to applicants and recipients of long-term care services.

[]

NEW SECTION
WAC 388-106-0010 What definitions apply to this chapter? "Ability to make self understood" means how you make yourself understood to those closest to you; express or communicate requests, needs, opinions, urgent problems and social conversations, whether in speech, writing, sign language, symbols, or a combination of these including use of a communication board or keyboard:

(a) Understood: You express ideas clearly;

(b) Usually understood: You have difficulty finding the right words or finishing thoughts, resulting in delayed responses; or requires some prompting to make self understood;

(d) Rarely/never understood.

"Activities of daily living (ADL)" means the following:

(a) Bathing: How you take a full-body bath/shower, sponge bath, and transfer in/out of tub/shower.

(b) Bed mobility: How you move to and from a lying position, turn side to side, and position your body while in bed.

(c) Body care: How you perform with passive range of motion, applications of dressings and ointments or lotions to the body and pedicure to trim toenails and apply lotion to feet. In adult family homes, contracted assisted living, enhanced adult residential care, and enhanced adult residential care-specialized dementia care facilities, dressing changes using clean technique and topical ointments must be performed by a licensed nurse or through nurse delegation in accordance with chapter 246-840 WAC. Body care excludes:

(i) Foot care if you are diabetic or have poor circulation; or

(ii) Changing bandages or dressings when sterile procedures are required.

(d) Dressing: How you put on, fasten, and take off all items of clothing, including donning/removing prosthesis.

(e) Eating: How you eat and drink, regardless of skill. Eating includes any method of receiving nutrition, e.g., by mouth, tube or through a vein.

(f) Locomotion in room and immediate living environment: How you move between locations in your room and immediate living environment. If you are in a wheelchair, locomotion includes how self-sufficient you are once in your wheelchair.

(g) Locomotion outside of immediate living environment including outdoors: How you move to and return from more distant areas. If you are living in a boarding home or nursing facility (NF), this includes areas set aside for dining, activities, etc. If you are living in your own home or in an adult family home, locomotion outside immediate living environment including outdoors, includes how you move to and return from a patio or porch, backyard, to the mailbox, to see the next-door neighbor, etc.

(h) Walk in room, hallway and rest of immediate living environment: How you walk between locations in your room and immediate living environment.

(i) Medication management: Describes the amount of assistance, if any, required to receive medications, over the counter preparations or herbal supplements.

(j) Toilet use: How you use the toilet room, commode, bedpan, or urinal, transfer on/off toilet, cleanse, change pad, manage ostomy or catheter, and adjust clothes.

(k) Transfer: How you move between surfaces, i.e., to/from bed, chair, wheelchair, standing position. Transfer does not include how you move to/from the bath, toilet, or vehicle.

(l) Personal hygiene: How you maintain personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face, hands (including nail care), and perineum (menses care). Personal hygiene does not include hygiene in baths and showers.

"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 you in your 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 must submit the request on a form prescribed by the department.

"Assessment Details" means a summary of information that the department entered into the CARE Assessment describing your needs.

"Assessment or reassessment" means an inventory and evaluation of abilities and needs based on an in-person interview in your own home or your place of residence, using CARE.

"Assistance available" means the amount of informal support available if the need is partially met. The department determines the amount of the assistance available using one of four categories:

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

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

(d) Over three-fourths of the time.

"Assistance with body care" means you need assistance with:

(a) Application of ointment or lotions;

(b) Trimming of toenails;

(d) Passive range of motion treatment.

"Assistance with medication management" means you need assistance managing your medications. You are scored as:

(a) Independent if you remember to take medications as prescribed and manage your medications without assistance.

(b) Assistance required if you need assistance from a non-licensed provider to facilitate your self-administration of a prescribed, over the counter, or herbal medication. Assistance required includes reminding or coaching you, handing you the medication container, opening the container, using an enabler to assist you in getting the medication into your mouth, and placing the medication in your hand. This does not include assistance with intravenous or injectable medications. You must be aware that you are taking medications.

(c) Self-directed medication assistance/administration if you are a person with a functional disability who is capable of and who chooses to self-direct your medication assistance/administration. In licensed boarding homes, this may include situations in which you cannot physically self-administer medications but can accurately direct others, per WAC 388-78A-0300.

(d) Must be administered if you must have medications placed in your mouth or applied or instilled to your skin or mucus membrane. Administration must either be performed by a licensed professional or delegated by a registered nurse to a qualified caregiver (per chapter 246-840 WAC). Intravenous or injectable medications may never be delegated. Administration may also be performed by a family member or unpaid caregiver if facility licensing regulations allow.

"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.

"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 status of a person who is eligible for medical care under Title XIX of the Social Security Act.

"Client" means an applicant for service or a person currently receiving services from the department.

"Current" means a behavior occurred within seven days of the CARE assessment date, including the day of the assessment. Behaviors that the department designates as current must include information about:

(a) Whether the behavior is easily altered or not easily altered; and

(b) The frequency of the behavior.

"Decision-making" means your ability and actual performance in making everyday decisions about tasks or activities of daily living. The department determines whether you are:

(a) Independent: Decisions about your daily routine are consistent and organized; reflecting your lifestyle, choices, culture, and values.

(b) Modified Independence/difficulty in new situations: You have an organized daily routine, are able to make decisions in familiar situations, but experience some difficulty in decision-making when faced with new tasks or situations.

(c) Moderately impaired/poor decisions; unaware of consequences: Your decisions are poor and you require reminders, cues and supervision in planning, organizing and correcting daily routines. You attempt to make decisions, although poorly.

(d) Severely impaired/no or few decisions or preferences regarding ADLs: Decision-making is severely impaired; you never/rarely make decisions.

"Department" means the state department of social and health services, aging and disability services administration or its designee.

"Designee" means Area Agency on Aging.

"Difficulty" means how difficult it is or would be for you to perform an Instrumental Activity of Daily Living (IADL). This is assessed as:

(a) No difficulty in performing the activity;

(b) Some difficulty in performing the activity (e.g., you need some help, are very slow, or fatigue easily); or

"Disabling condition" means you have a medical condition which prevents you from self performance of personal care tasks without assistance.

"Estate recovery" means after the client's death, the department's activity in recouping funds that were expended for long-term care services provided to the client during the client's lifetime, per WAC 388-527-2742.

"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.

"Income" means income as defined under WAC 388-500-0005.

"Individual provider" means a person employed by you to provide personal care services in your own home. See WAC 388-71-0500 through 388-71-05909.

"Disability" is described under WAC 388-511-1105.

"Informal support" means a person or resource that is available to provide assistance without home and community program funding.

"Institution" means medical facilities, nursing facilities, and institutions for the mentally retarded. It does not include correctional institutions.

"Instrumental activities of daily living (IADL)" means routine activities performed around the home or in the community and includes the following:

(a) Meal preparation: How meals are prepared (e.g., planning meals, cooking, assembling ingredients, setting out food, utensils, and cleaning up after meals). NOTE: The department will not authorize this IADL to plan meals or clean up after meals. You must need assistance with actual meal preparation.

(b) Ordinary housework: How ordinary work around the house is performed (e.g., doing dishes, dusting, making bed, tidying up, laundry).

(c) Essential shopping: How shopping is completed to meet your health and nutritional needs (e.g., selecting items). Shopping is limited to brief, occasional trips in the local area to shop for food, medical necessities and household items required specifically for your health, maintenance or well-being. This includes shopping with or for you.

(d) Wood supply: How wood is supplied (e.g., splitting, stacking, or carrying wood) when you use wood as the sole source of fuel for heating and/or cooking.

(e) Travel to medical services: How you travel by vehicle to a physician's office or clinic in the local area to obtain medical diagnosis or treatment-includes driving vehicle yourself, traveling as a passenger in a car, bus, or taxi.

(f) Managing finances: How bills are paid, checkbook is balanced, household expenses are managed. The department cannot pay for any assistance with managing finances.

(g) Telephone use: How telephone calls are made or received (with assistive devices such as large numbers on telephone, amplification as needed).

"Long-term care services" means the services administered directly or through contract by the aging and disability services administration and identified in WAC 388-106-0015.

"Medicaid" is defined under WAC 388-500-0005.

"Medically necessary" is defined under WAC 388-500-0005.

"Medically needy (MN)" means the status of a person who is eligible for a federally matched medical program under Title XIX of the Social Security Act, who, but for income above the categorically needy level, would be eligible as categorically needy. Effective January 1, 1996, an AFDC-related adult is not eligible for MN.

"Own home" means your present or intended place of residence:

(1) In a building that you rent and the rental is not contingent upon the purchase of personal care services as defined in this section;

(2) In a building that you own;

(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.

"Past" means the behavior occurred from eight days to five years of the assessment date. For behaviors indicated as past, the department determines whether the behavior is addressed with current interventions or whether no interventions are in place.

"Personal aide" is defined in RCW 74.39.007.

"Personal care services" means physical or verbal assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) due to your functional limitations. Assistance is evaluated with the use of assistive devices.

"Physician" is defined under WAC 388-500-0005.

"Plan of care" means Assessment Details and Service Summary generated by CARE.

"Provider or provider of service" means an institution, agency, or person:

(a) Having a signed department contract to provide long-term care client services; and

(b) Qualified and eligible to receive department payment.

"Residential facility" means a licensed adult family home under department contract or licensed boarding home under department contract to provide assisted living, adult residential care or enhanced adult residential care.

"Self performance for ADLs" means what you actually did in the last seven days before the assessment, not what you might be capable of doing. Coding is based on the level of performance that occurred three or more times in the seven-day period. Your self performance is scored as:

(a) Independent if you received no help or oversight, or if you needed help or oversight only once or twice;

(b) Supervision if you received oversight (monitoring or standby), encouragement, or cueing three or more times;

(c) Limited assistance if you were highly involved in the activity and given physical help in guided maneuvering of limbs or other non-weight bearing assistance on three or more occasions. For bathing, limited assistance means physical help is limited to transfer only;

(d) Extensive assistance if you performed part of the activity, but on three or more occasions, you needed weight bearing support or you received full performance of the activity during part, but not all, of the activity. For bathing, extensive assistance means you needed physical help with part of the activity (other than transfer);

(e) Total dependence if you received full caregiver performance of the activity and all subtasks during the entire seven-day period from others. Total dependence means complete nonparticipation by you in all aspects of the ADL; or

(f) Activity did not occur if you or others did not perform an ADL over the last seven days before your assessment. The activity may not have occurred because:

(i) You were not able (e.g., walking, if paralyzed);

(ii) No provider was available to assist; or

(iii) You declined assistance with the task.

"Self performance for IADLs" means what you actually did in the last seven days before the assessment, not what you might be capable of doing. Coding is based on the level of performance that occurred three or more times in the seven-day period. Your self performance is scored as:

(a) Independent if you received no help, set-up help, or supervision;

(b) Supervision if you received set-up help or arrangements only;

(d) Extensive assistance if you were involved in performing the activity, but required cueing/supervision or partial assistance at all times;

(e) Total dependence if you needed the activity fully performed by others; or

(f) Activity did not occur if you or others did not perform the activity in the last seven days before the assessment.

"Service Summary" is CARE information which includes: contacts (e.g. emergency contact), services the client is eligible for, number of hours or residential rates, personal care needs, formal and informal providers, provider schedule, and referral needs.

"SSI-related" is defined under WAC 388-500-0005.

"Status" means the amount of informal support available. The department determines whether the ADL or IADL is:

(a) Met, which means the ADL or IADL will be fully provided by an informal support;

(b) Unmet, which means an informal support will not be available to provide assistance with the identified ADL or IADL;

(c) Partially met, which means an informal support will be available to provide some assistance, but not all, with the identified ADL or IADL; or

(d) Client declines, which means you do not want assistance with the task.

"Supplemental Security Income (SSI)" means the federal program as described under WAC 388-500-0005.

"Support provided" means the highest level of support provided (to you) by others in the last seven days before the assessment, even if that level of support occurred only once.

(a) No set-up or physical help provided by others;

(b) Set-up help only provided, which is the type of help characterized by providing you with articles, devices, or preparation necessary for greater self performance of the activity (such as giving or holding out an item that you take from others);

(d) Two- or more person physical assist provided; or

(e) Activity did not occur during entire seven-day period.

"You/Your" means the client.

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APPLYING FOR SERVICES
NEW SECTION
WAC 388-106-0015 What long-term care services does the department provide? The department provides long-term care services under the following programs:

(1) Medical Personal Care (MPC) is a Medicaid state plan program authorized under RCW 74.09.520. Clients eligible for this program may receive personal care in their own home or in a residential facility.

(2) Community Options Program Entry System (COPES) is a Medicaid waiver program authorized under RCW 74.39A.030. Clients eligible for this program may receive personal care in their own home or in a residential facility.

(3) Medically Needy Residential Waiver (MNRW) is a Medicaid waiver program authorized under RCW 74.39.041. Clients eligible for this program may receive personal care in a residential facility.

(4) Medically Needy In-Home Waiver (MNIW) is a Medicaid waiver program authorized under RCW 74.09.700. Clients eligible for this program may receive personal care in their own home or in a residential facility.

(5) Chore is a state-only funded program authorized under RCW 74.39A.110. Grandfathered clients may receive assistance with personal care in their own home.

(6) Volunteer Chore is a state-funded program that provides volunteer assistance with household tasks to eligible clients.

(7) Program of All-Inclusive Care for the Elderly (PACE) is a Medicaid/Medicare managed care program authorized under 42 CFR 460.2. Clients eligible for this program may receive personal care and medical services in their own home, in residential facilities, and in adult day health centers.

(8) Adult Day Health is a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services outlined in WAC 388-106-0800.

(9) Adult day care is a supervised daytime program providing core services, as defined under WAC 388-106-0800.

(10) GAU-funded residential care is a state-funded program authorized under WAC 388-400-0025. Clients eligible for this program may receive personal care services in an adult family home or an adult residential care facility.

(11) Residential Care Discharge Allowance is a service that helps eligible clients to establish or resume living in their own home.

(12) Private Duty Nursing is a Medicaid service that provides an alternative to institutionalization in a hospital or nursing facility setting. Clients eligible for this program may receive at least four continuous hours of skilled nursing care on a day to day basis in their own home.

(13) Senior Citizens Services Act (SCSA) is a program authorized under chapter 74.38 RCW. Clients eligible for this program may receive community-based services as defined in RCW 74.38.040.

(14) Respite Program is a program authorized under RCW 74.41.040 and WAC 388-106-1200. This program provides relief care for unpaid family or other caregivers of adults with a functional disability.

(15) Programs for persons with developmental disabilities are discussed in chapter 388-820 through 388-853 WAC.

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NEW SECTION
WAC 388-106-0020 Under the MPC, COPES, MNRW, MNIW, and Chore programs, what services are not covered? The following types of services are not covered under MPC, COPES, MNRW, MNIW, and Chore:

(1) Child Care.

(2) Individual providers and agency providers must not provide sterile procedures, administration of medications, or other tasks requiring a licensed health professional unless these tasks are provided through nursing delegation, self-directed care or provided by a family member.

(3) Services provided over the telephone.

(4) Services to assist other household members not eligible for services.

(5) Development of social, behavioral, recreational, communication, or other types of community living skills.

(6) Nursing care.

(7) Pet care.

(8) Assistance with managing finances.

(9) Respite.

(10) Yard care.

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NEW SECTION
WAC 388-106-0025 How do I apply for long-term care services? To apply for long-term care services, you must request an assessment from the department and submit a Medicaid application.

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NEW SECTION
WAC 388-106-0030 Where can I receive services? You may receive services:

(1) In your own home.

(2) In a residential facility, which includes licensed:

(a) Adult family homes, as defined in RCW 70.128.010.

(b) Boarding homes. Types of licensed and contracted boarding homes include:

(i) Assisted living facilities, as defined in WAC 388-110-020;

(ii) Enhanced adult residential care facilities, as defined in WAC 388-110-020;

(iii) Enhanced adult residential care facilities-Specialized Dementia Care, as defined in WAC 388-110-020; and

(iv) Adult residential care facilities, as defined in WAC 388-110-020.

(3) In a nursing home, as defined in WAC 388-97-005.

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NEW SECTION
WAC 388-106-0035 May I receive personal care services through any of the long-term care programs when I am out of the state of Washington? (1) You may receive personal care assistance through any long-term care programs in WAC 388-106-0015 subsections (1) through (5) when temporarily traveling out of state for less than thirty days, as long as your:

(a) Individual provider is contracted with the state of Washington;

(b) Travel plans are coordinated with the department prior to departure;

(d) Services are strictly for your personal care.

(2) You may not receive personal care services outside of the United States.

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NEW SECTION
WAC 388-106-0040 Who can provide long-term care services? The following types of providers can provide long-term care services:

(1) Individual providers (IPs), who provide services to clients in their own home. IPs must meet the requirements outlined in WAC 388-71-0500 through WAC 388-71-05909.

(2) Home care agencies, who provide services to clients in their own home. Home care agencies must be licensed under chapter 70.127 RCW and chapter 246-336 WAC and contracted with Area Agency on Aging.

(3) Residential providers, which include licensed adult family homes and boarding homes, who contract with the department to provide assisted living, adult residential care, and enhanced adult residential care services (which may also include specialized dementia care).

(4) Providers who have contracted with the department to perform other services.

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NEW SECTION
WAC 388-106-0045 When will the department authorize my long-term care services? The department will authorize long-term care services when you:

(1) Are assessed using CARE;

(2) Are found financially and functionally eligible for services including, if applicable, the determination of the amount of participation toward the cost of your care and/or the amount of room and board that you must pay;

(3) Have given consent for services and approved your plan of care; and

(4) Have chosen a provider(s), qualified for payment.

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COMPREHENSIVE ASSESSMENT REPORTING EVALUATION (CARE) ASSESSMENT
NEW SECTION
WAC 388-106-0050 What is an assessment? An assessment is an inventory and evaluation of abilities and needs based on an in-person interview in your home or your place of residence.

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NEW SECTION
WAC 388-106-0055 What is the purpose of an assessment? The purpose of an assessment is to:

(1) Determine eligibility for long-term care programs;

(2) Identify your strengths, limitations, and preferences;

(3) Evaluate your living situation and environment;

(4) Evaluate your physical health, functional and cognitive abilities;

(5) Determine availability of informal supports and other non-department paid resources;

(6) Determine need for intervention;

(7) Determine need for case management activities;

(8) Determine your classification group that will set your payment rate for residential care or number of hours of in-home care;

(9) Determine need for referrals; and

(10) Develop a plan of care, as defined in WAC 388-106-0010.

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NEW SECTION
WAC 388-106-0060 Who must perform the assessment? The assessment must be performed by the department.

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NEW SECTION
WAC 388-106-0065 What is the process for conducting an assessment? The department:

(1) Will assess you using a department-prescribed assessment tool, titled the comprehensive assessment reporting evaluation (CARE).

(2) May request the assessment be conducted in private. However, you have the right to request that a third party be present (e.g. a friend, a family member, or a legal representative).

(3) Has the right to end the assessment if behaviors by any party are impeding the assessment process. If an assessment is terminated, the department will reschedule.

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NEW SECTION
WAC 388-106-0070 Will I be assessed in CARE? You will be assessed in CARE if you are applying for or receiving COPES, MNIW, MNRW, MPC, Chore, Respite, Adult Day Health, GAU-funded residential care, PACE, or Private Duty Nursing. You may not be assessed by forms previously used by the department once you have been assessed under CARE.

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NEW SECTION
WAC 388-106-0075 How is my need for personal care services assessed in CARE? To assess your need for personal care services, the department gathers information from you, your caregivers, family members, and other sources. The department will assess your ability to perform:

(1) Activities of Daily Living (ADL) using self performance, support provided, status and assistance available, as defined in WAC 388-106-0010. Also, the department determines your need for "assistance with body care" and "assistance with medication management", as defined in WAC 388-106-0010; and

(2) Instrumental Activities of Daily Living (IADL) using self performance, difficulty, status and assistance available, as defined in WAC 388-106-0010.

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CARE CLASSIFICATION
NEW SECTION
WAC 388-106-0080 How is the amount of long-term care services I can receive in my own home or in a residential facility determined? The amount of long-term care services you can receive in your own home or in a residential facility is determined through a classification system. Twelve classifications apply to clients served in residential and in-home settings. Two additional exceptional care groups apply to clients served in in-home settings. The department has assigned each classification a residential facility rate or a base number of hours you can receive in your own home.

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NEW SECTION
WAC 388-106-0085 What criteria does the CARE tool use to place me in one of the classification groups? The department uses CARE to assess your characteristics. Based on this assessment, the CARE tool uses the following criteria to place you in one of the classification groups:

(1) Cognitive performance.

(2) Clinical complexity.

(3) Mood/behaviors symptoms.

(4) Activities of Daily Living (ADLs).

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NEW SECTION
WAC 388-106-0090 How does the CARE tool measure cognitive performance? (1) The CARE tool uses a tool called the cognitive performance scale (CPS) to evaluate your cognitive impairment. The CPS results in a score that ranges from zero (intact) to six (very severe impairment). Your CPS score is based on:

(a) Whether you are comatose.

(b) Your ability to make decisions, as defined in WAC 388-106-0010 "Decision making."

(d) Whether you have short-term memory problem (e.g. can you remember recent events?) or whether you have delayed recall; and

(e) Whether you score as total dependence for self performance in eating, as defined in WAC 388-106-0010 "Self performance of ADLs."

(2) You will receive a CPS score of:

(a) Zero when you do not have problems with decision-making ability, making yourself understood, or recent memory.

(b) One when you meet one of the following:

(i) Your decision-making ability is scored as Modified Independence or Moderately Impaired;

(ii) Your ability to make yourself understood is usually, sometimes, or rarely/never understood; or

(iii) You have a recent memory problem.

(i) Your decision-making ability is scored as Modified Independence or Moderately Impaired;

(ii) Your ability to make yourself understood is usually, sometimes, or rarely/never understood; and/or

(iii) You have a short-term memory problem or delayed recall.

(d) Three when you meet at least two of the criteria listed in sub-section (2)(b) of this section and one of the following applies:

(i) Your decision-making is Moderately Impaired; or

(ii) Your ability to make yourself understood is sometimes or rarely/never understood.

(e) Four when both of the following criteria applies:

(i) Your decision-making is Moderately Impaired; and

(ii) Your ability to make yourself understood is sometimes or rarely/never understood.

(f) Five when your ability to make decisions is scored as severely impaired.

(g) Six when one of the following applies:

(i) Your ability to make decisions is severely impaired and you require total dependence in eating; or

(ii) You are comatose.

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NEW SECTION
WAC 388-106-0095 How does the CARE tool measure clinical complexity? The CARE tool places you in the Clinically Complex classification group only when you have one or more of the following criteria and corresponding ADL scores:

Condition AND an ADL Score of

ALS (Lou Gehrig's disease) >14

Aphasia (expressive and/or receptive) >=2

Cerebral Palsy >14

Diabetes Mellitus (insulin dependent) >14

Diabetes Mellitus (noninsulin dependent) >14

Emphysema & Shortness of Breath (at rest or exertion) or dizziness/vertigo >10

COPD & Shortness of Breath (at rest or exertion) or dizziness/vertigo >10

Explicit terminal prognosis >14

Hemiplegia >14

Multiple sclerosis >14

Parkinson disease >14

Pathological bone fracture >14

Quadriplegia >14

Rheumatoid Arthritis >14

You have one or more of the following skin problems:
     &sqbul; Pressure ulcers, with areas of persistent skin redness;
     &sqbul; Pressure ulcers with partial loss of skin layers;
     &sqbul; Pressure ulcers, with a full thickness lost;
     &sqbul; Skin desensitized to pain/pressure;
     &sqbul; Open lesions; and/or
     &sqbul; Stasis ulcers.
     AND
You require one of the following types of assistance:
     &sqbul; Ulcer care;
     &sqbul; Pressure relieving device;
     &sqbul; Turning/reposition program;
     &sqbul; Application of dressing; or
     &sqbul; Wound/skin care.
>=2

You have a burn(s) and you need one of the following:
     &sqbul; Application of dressing; or
     &sqbul; Wound/skin care

>=2

You have one or more of the following problems:
     &sqbul; You are frequently incontinent (bladder);
     &sqbul; You are incontinent all or most of the time (bladder);
     &sqbul; You are frequently incontinent (bowel); or
     &sqbul; You are incontinent all or most of the time (bowel).
     AND
One of the following applies:
     &sqbul; The status of your individual management of bowel bladder supplies is "Uses, has leakage, needs assistance";
     &sqbul; The status of your individual management of bowel bladder supplies is "Does not use, has leakage"; or
     &sqbul; You use any scheduled toileting plan.
>10

You have a current swallowing problem, and you are not independent in eating. >10

You have Edema. >14

You have Pain daily. >14

You need and receive a Bowel program. >10

You need Dialysis. >10

You require IV nutritional support or tube feedings; and
Your total calories received per IV or tube was at least 25%; and
Your fluid intake is greater than 2 cups.

>=2

You need Hospice care. >14

You need Injections. >14

You need Intravenous medications. >10

You need management of IV lines. >10

You need Ostomy care. >=2

You need Oxygen therapy. >10

You need Radiation. >10

You need and receive Passive range of motion. >10

You need and receive Walking training. >10

You need Suction treatment. >=2

You need Tracheostomy care. >10

You need a Ventilator/respirator >10

Key:
> means greater than.
>= means greater than or equal to.

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NEW SECTION
WAC 388-106-0100 How does the CARE tool measure mood and behaviors? (1) When you do not meet the criteria for the Clinically Complex classification group, or the criteria for exceptional care, or for in-home only have a cognitive performance scale score of five or six, the mood and behavior criteria listed in subsection (3) below determines your classification group.

(2) For each behavior that the CARE tool has documented, the department will determine a status as "Current" or "Past" as defined in WAC 388-106-0010.

(3) CARE places you in the Mood and Behavior classification group only if you have one or more of the behavior/moods that also meets the listed status, frequency, and alterability as identified in the following chart. No other moods or behaviors documented by CARE will qualify you for the Mood and Behavior classification.

Behavior/Mood AND Status, Frequency & Alterability

Assaultive Current

Combative during personal care Current

Combative during personal care In past and addressed with current interventions

Crying tearfulness Current, frequency 4 or more days per week

Delusions In past, addressed with current interventions

Depression score >=14 N/A

Disrobes in public Current and not easily altered

Easily irritable/agitated Current and not easily altered

Eats nonedible substances Current

Eats nonedible substances In past, addressed with current interventions

Hallucinations Current

Hiding items In past, addressed with current interventions

Hoarding/collecting In past, addressed with current interventions

Mental health therapy/program Need

Repetitive complaints/questions Current, daily

Repetitive complaints/questions In past, addressed with current interventions

Repetitive movement/pacing Current, daily

Resistive to care Current

Resistive to care In past, addressed with current interventions

Sexual acting out Current

Sexual acting out In past, addressed with current interventions

Spitting Current and not easily altered

Spitting In past, addressed with current interventions

Breaks/throws items Current

Unsafe smoking Current and not easily altered

Up at night and requires intervention Current

Wanders exit seeking Current

Wanders exit seeking In past, addressed with current interventions

Wanders not exit seeking Current

Wanders not exit seeking In past, addressed with current interventions

Yelling/screaming

Key:
> means greater than.
>= means greater than or equal to.
Current, frequency 4 or more days per week

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NEW SECTION
WAC 388-106-0105 How does the CARE tool measure Activities of Daily Living (ADLs)? (1) CARE determines an ADL score ranging from zero to twenty-eight for each of the following ADLs.

(a) Personal hygiene;

(b) Bed mobility;

(d) Eating;

(e) Toilet use;

(f) Dressing;

(g) Locomotion in room;

(h) Locomotion outside room; and

(i) Walk in room.

(2) The department through the CARE tool determines the ADL score by using the definitions in WAC 388-106-0010 under "Self-performance for ADLs". The CARE tool assigns the following points to the level of self performance for each of the ADLs listed in subsection (1) of this section. For the locomotion in room, locomotion outside of room and walk in room, the department uses the highest score of the three in determining the total ADL score.

ADL Scoring Chart

If Self Performance is: Score Equals

Independent 0

Supervision 1

Limited assistance 2

Extensive assistance 3

Total dependence 4

Did not occur/no provider 4

Did not occur/client not able 4

Did not occur/client declined 0

(3) Although assessed by CARE, the department does not score bathing and medication management to determine classification groups.

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NEW SECTION
WAC 388-106-0110 How does the CARE tool evaluate me for the exceptional care classification of in-home care? CARE places you in the Exceptional care classifications for the in-home setting when the following criteria are met in either Diagram 1 or 2:

Diagram 1

You have one of the following diagnoses:
&sqbul; Quadriplegia;
&sqbul; Paraplegia;
&sqbul; ALS (Amyotrophic Lateral Sclerosis);
&sqbul; Parkinson's Disease;
&sqbul; Multiple Sclerosis;
&sqbul; Comatose;
&sqbul; Muscular Dystrophy;
&sqbul; Cerebral Palsy;
&sqbul; Post Polio Syndrome; or
&sqbul; TBI (traumatic brain injury).

AND

You have an ADL score of greater than or equal to 22.

AND

You need a Turning/repositioning program.

AND

You require at least one of the following:
&sqbul; External catheter;
&sqbul; Intermittent catheter;
&sqbul; Indwelling catheter care;
&sqbul; Bowel program; or
&sqbul; Ostomy care

AND

You need one of the following services provided by an individual provider, agency provider, a private duty nurse, or through self-directed care:
&sqbul; Active range of motion (AROM); or
&sqbul; Passive range of motion (PROM).

Diagram 2

You have an ADL score of greater than or equal to 22.

AND

You need a Turning/repositioning program.

AND

You need one of the following services provided by an individual provider, agency provider, a private duty nurse, or through self-directed care:
&sqbul; Active Range of Motion (AROM); or
&sqbul; Passive Range of Motion (PROM).

AND

All of the following apply:
&sqbul; You require IV nutrition support or tube feeding;
&sqbul; Your total calories received per IV or tube was greater than 50%; and
&sqbul; Your fluid intake is greater than 2 cups.

AND

You need assistance with one of the following, provided by an individual provider, agency provider, a private duty nurse, or through self-directed care:
&sqbul; Dialysis; or
&sqbul; Ventilator/respirator.

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NEW SECTION
WAC 388-106-0115 How does CARE use the criteria of cognitive performance as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behaviors as determined under WAC 388-106-0100, and ADLs as determined under WAC 388-106-0105 to place me in a classification group for residential facilities? The CARE tool uses the criteria of cognitive performance as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behaviors as determined under WAC 388-106-0100, and ADLs as determined under WAC 388-106-0105 to place you into one of the following twelve residential classification groups:

Classification ADL Score Group

Group D
Cognitive performance score = 4-6
and
Clinically complex = yes
and
Mood/behavior = yes or no
ADL Score 18-28 D High (12)

ADL Score 13-17 D Med (11)

ADL Score 2-12 D Low (10)

Group C
Cognitive performance score = 0-3
and
Clinically complex = yes
and
Mood/behavior = yes or no
ADL Score 18-28 C High (9)

ADL Score 9-17 C Med (8)

ADL Score 2-8 C Low (7)

Group B
Mood & behavior = Yes
and
Clinically complex = no
and
Cognitive performance score = 0-6
ADL Score 15-28 B High (6)

ADL Score 5-14 B Med (5)

ADL Score 0-4 B Low (4)

Group A
Mood & behavior = No
and
Clinically complex = No
and
Cognitive performance score = 0-6
ADL Score 10-28 A High (3)

ADL Score 5-9 A Med (2)

ADL Score 0-4 A Low (1)

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NEW SECTION
WAC 388-106-0120 What is the payment rate that the department will pay the provider if I receive personal care services in a residential facility? The department publishes rates and/or adopts rules to establish how much the department pays toward the cost of your care in a residential facility. The department assigns payment rates to the CARE classification groups. Payment for care in a residential facility corresponds to the payment rate assigned to the classification group in which the CARE tool has placed you.

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NEW SECTION
WAC 388-106-0125 How does CARE use the criteria of congnitive performance as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behaviors as determined under WAC 388-106-0100, ADLs as determined under WAC 388-106-0105, and exceptional care as determined under WAC 388-106-0110, to place me in a classification group for in-home care? CARE uses the criteria of cognitive performance as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behavior as determined under WAC 388-106-0105, and exceptional care as determined under WAC 388-106-0110 to place you into one of the following fourteen in-home groups.

Classification ADL Score Group Base Hours of Group

Group E
Exceptional care = yes
and
Mood and behavior = yes or no
and
Cognitive performance score = 0-6
ADL Score 26-28 E High (14) 420

ADL Score 22-25 E Med (13) 350

Group D
Cognitive performance score = 4-6
and
Clinically complex = yes
and
Mood and behavior = yes or no
OR
Cognitive performance score = 5-6
and
Clinically complex = no
and
Mood and behavior = yes or no
ADL Score 18-28 D High (12) 240

ADL Score 13-17 D Med (11) 190

ADL Score 2-12 D Low (10) 145

Group C
Cognitive performance score = 0-3
and
Clinically complex = yes
and
Mood and behavior = yes or no
ADL Score 18-28 C High (9) 180

ADL Score 9-17 C Med (8) 140

ADL Score 2-8 C Low (7) 83

Group B
Mood and behavior = yes
and
Clinically complex = no
and
Cognitive performance score = 0-4
ADL Score 15-28 B High (6) 155

ADL Score 5-14 B Med (5) 90

ADL Score 0-4 B Low (4) 52

Group A
Mood and behavior = no
and
Clinically complex = no
and
Cognitive performance score = 0-4
ADL Score 10-28 A High (3) 78

ADL Score 5-9 A Med (2) 62

ADL Score 0-4 A Low (1) 29

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Reviser's note: The spelling error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-106-0130 How does the department determine the number of hours I may receive for in-home care? (1) The department assigns a base number of hours to each classification group as described in WAC 388-106-0125.

(2) The department will deduct from the base hours to account for your informal supports, as defined in WAC 388-106-0010, as follows:

(a) The CARE tool determines the adjustment for informal supports by determining the amount of assistance available to meet your needs, assigns it a numeric percentage, and reduces the base hours assigned to the classification group by the numeric percentage. The department has assigned the following numeric values for the amount of assistance available for each ADL and IADL:

Meds Self Performance Status Assistance Available Value
Percentage

Self administration of medications Rules for all codes apply except independent is not counted Unmet N/A 1

Met N/A 0

Decline N/A 0

Partially met <1/4 time .9

1/4 to 1/2 time .7

1/2 to 3/4 time .5

>3/4 time .3

Unscheduled ADLs Self Performance Status Assistance Available Value
Percentage

Bed mobility, transfer, walk in room, eating, toilet use Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider = 1;
Did not occur/client declined and independent are not counted.
Unmet N/A 1

Met N/A 0

Decline N/A 0

Partially met <1/4 time .9

1/4 to 1/2 time .7

1/2 to 3/4 time .5

>3/4 time .3

Scheduled ADLs Self Performance Status Assistance Available Value
Percentage

Dressing,
personal hygiene,
bathing
Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider = 1;
Did not occur/client declined and independent are not counted.
Unmet N/A 1

Met N/A 0

Decline N/A 0

Partially met <1/4 time .75

1/4 to 1/2 time .55

1/2 to 3/4 time .35

>3/4 time .15

IADLs Self Performance Status Assistance Available Value
Percentage

Meal preparation,
Ordinary housework,
Essential shopping
Rules for all codes apply except independent is not counted. Unmet N/A 1

Met N/A 0

Decline N/A 0

Partially met <1/4 time .3

1/4 to 1/2 time .2

1/2 to 3/4 time .1

>3/4 time .05

IADLs Self Performance Status Assistance Available Value
Percentage

Travel to medical Rules for all codes apply except independent is not counted. Unmet N/A 1

Met N/A 0

Decline N/A 0

Partially met <1/4 time .9

1/4 to 1/2 time .7

1/2 to 3/4 time .5

>3/4 time .3

Key:
> means greater than
< means less than

(b) To determine the amount of reduction for informal support, the value percentage is divided by the number of qualifying ADLs and IADLs needs. The result is value A. Value A is then subtracted from one. This is value B. Value B is divided by three. This is value C. Value A and Value C are summed. This is value D. Value D is multiplied by the "base hours" assigned to your classification group and the result is base in-home care hours reduced for informal supports.

(3) Also, the department will adjust in-home base hours for the following shared living circumstances:

(a) If there is more than one client living in the same household, the status under subsection (2)(a) of this section must be met or partially met for the following IADLs:

(i) Meal preparation,

(ii) Housekeeping,

(iii) Shopping, and

(iv) Wood supply.

(b) If you and your paid provider live in the same household, the status under subsection (2)(a) of this section must be met for the following IADLs:

(i) Meal preparation,

(ii) Housekeeping,

(iii) Shopping, and

(iv) Wood supply.

(c) When there is more than one client living in the same household and your paid provider lives in your household, the status under subsection (2)(a) of this section must be met for the following IADLs:

(i) Meal preparation,

(ii) Housekeeping,

(iii) Shopping, and

(iv) Wood supply.

(4) After deductions are made to your base hours, as described in subsections (2) and (3), the department may add on hours based on your living environment:

Condition Status Assistance Available Add On Hours

Offsite laundry facilities, which means the client does not have facilities in own home and the caregiver is not available to perform any other personal or household tasks while laundry is done. Unmet N/A 8

Client is >45 minutes from essential services (which means he/she lives more than 45 minutes one-way from a full-service market). Unmet N/A 5

Met N/A 0

Partially met <1/4 time 5

between 1/4 to 1/2 time 4

between 1/2 to 3/4 time 2

>3/4 time 2

Wood supply used as sole source of heat. Unmet N/A 8

Met N/A 0

Declines N/A 0

Partially met <1/4 time 8

between 1/4 to 1/2 time 6

between 1/2 to 3/4 time 4

>3/4 time 2

(5) The result of actions under subsections (2), (3), and (4) is the maximum number of hours that can be used to develop your plan of care. The department must take into account cost effectiveness, client health and safety, and program limits in determining how hours can be used to meet your identified needs.

(6) You and your case manager will work to determine what services you choose to receive if you are eligible. The hours may be used to authorize:

(a) Personal care services from a home care agency provider and/or an individual provider.

(b) Home delivered meals (i.e. a half hour from the available hours for each meal authorized).

(d) A home health aide.

[]

NEW SECTION
WAC 388-106-0135 What are the maximum hours that I can receive for in-home services? The maximum hours that you may receive is the base hours assigned to your classification group and adjusted per WAC 388-106-0130. For Chore program clients, the maximum personal care hours per month the department will pay is one hundred sixteen.

[]

NEW SECTION
WAC 388-106-0140 What will change the maximum hours I can receive? When you have a change in any of the criteria listed in WAC 388-106-0125 and/or WAC 388-106-0130, the maximum hours you can receive will change.

[]

MEDICAID PERSONAL CARE (MPC)
NEW SECTION
WAC 388-106-0200 What services may I receive under Medicaid Personal Care (MPC)? You may be eligible to receive only the following services under Medicaid Personal Care (MPC):

(1) Personal care services, as defined in WAC 388-106-0010, in your own home and, as applicable, assistance with personal care tasks while you are out of the home accessing community resources or working.

(2) Personal care services in one of the following residential care facilities:

(a) Adult family homes; or

(b) A licensed boarding home that has contracted with the department to provide adult residential care services.

(3) Nursing services, if you are not already receiving this type of service from another resource. A registered nurse may visit you and perform any of the following activities:

(a) Nursing assessment/reassessment;

(b) Instruction to you and your providers;

(d) Skilled treatment, only in the event of an emergency. A skilled treatment is care that would require authorization, prescription, and supervision by an authorized practitioner prior to its provision by a nurse, for example, medication administration or wound care such as debridement. In non-emergency situations, the nurse will refer the need for any skilled medical or nursing treatments to a health care provider, a home health agency or other appropriate resource;

(e) File review; and/or

(f) Evaluation of health-related care needs affecting service planning and delivery.

[]

NEW SECTION
WAC 388-106-0210 Am I eligible for MPC-funded services? You are eligible for MPC-funded services when the department assesses your needs and determines that you meet all of the following criteria:

(1) You are certified as noninstitutional categorically needy, as defined in WAC 388-500-0005. Categorically needy medical institutional programs described in chapter 388-513 WAC do not meet this criteria.

(2) You are functionally eligible which means one of the following applies:

(a) You have an unmet or partially met need with at least three of the following Activities of Daily Living, as defined in WAC 388-106-0010:

For each Activity of Daily Living, the minimum level of assistance required in:

Self Performance is: Support Provided is:

Eating N/A Setup

Toileting Supervision N/A

Bathing Supervision N/A

Dressing Supervision N/A

Transfer Supervision Setup

Bed Mobility Supervision Setup

Walk in Room
OR
Locomotion in Room
OR
Locomotion Outside Immediate Living Environment
Supervision Setup

Medication Management Assistance Required N/A

Personal Hygiene Supervision N/A

Body care which includes:
Application of ointment or lotions;
Toenails trimmed;
Dry bandage changes; or
Passive range of motion treatment.
Need N/A

Your need for assistance in any of the activities listed in subsection (a) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose of determining your functional eligibility.

or:

(b) You have an unmet or partially met need or the activity did not occur (because you were unable or no provider was available) with at least one or more of the following:

For each Activity of Daily Living, the minimum level of assistance required in

Self Performance is: Support Provided is:

Eating Supervision One person physical assist

Toileting Extensive Assistance One person physical assist

Bathing Limited Assistance One person physical assist

Dressing Extensive Assistance One person physical assist

Transfer Extensive Assistance One person physical assist

Bed Mobility
and
Turning and repositioning
Limited Assistance
and
Need
One person physical assist

Walk in Room
OR
Locomotion in Room
OR
Locomotion Outside Immediate Living Environment
Extensive Assistance One person physical assist

Medication Management Assistance Required Daily N/A

Personal Hygiene Extensive Assistance One person physical assist

Body care which includes:
Application of ointment or lotions;
Toenails trimmed;
Dry bandage changes; or
Passive range of motion treatment.
Need N/A

Your need for assistance in any of the activities listed in subsection (b) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose determining your functional eligibility.

[]

NEW SECTION
WAC 388-106-0213 How are my needs assessed if I am a child applying for MPC services? If you are a child applying for MPC services, the department will complete a CARE assessment and:

(1) Consider and document the role of your legally responsible natural/step/adoptive parent(s).

(2) Code your needs as met based on the guidelines outlined in the following table:

Activities of Daily Living (ADLs)

Ages

&sqbul; = Code status as Met 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 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 Room^Note

Independent, supervision,
limited or extensive
&sqbul; &sqbul; &sqbul;

Total &sqbul;

Locomotion Outside
Room^Note

Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;

Limited or extensive &sqbul; &sqbul; &sqbul;

Total &sqbul;

Walk in Room^Note

Independent, supervision,
limited or extensive
&sqbul; &sqbul; &sqbul;

Total &sqbul;

Bed Mobility

Independent, supervision,
limited or extensive
&sqbul; &sqbul;

Total &sqbul;

Transfers

Independent, supervision,
limited, extensive or total
& under 30 pounds
&sqbul; &sqbul;

(Total & over 30
pounds = no age limit)

Toilet 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 department codes self performance as total and status as met.

Ages

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Additional guidelines based
on age

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)

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 -
Individual management =
Does not need/use
&sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;

Support provided for daytime
wetting - Individual
Management = Does not
need/use
&sqbul; &sqbul; &sqbul; &sqbul; &sqbul;

(3) In addition, determine that the status and assistance available are met or partially met over three-fourths of the time, when you are living with your legally-responsible natural/step/adoptive parent(s).

(4) Will not code mental health therapy, behaviors, or depression if you are in foster care.

[]

NEW SECTION
WAC 388-106-0220 How do I remain eligible for MPC? (1) In order to remain eligible for MPC, you must be in need of services in accordance with WAC 388-106-0210 as determined through a CARE assessment. The assessment in CARE must be at least annually or more often when there are significant changes in your functional or financial circumstances.

(2) When eligibility statutes, regulations, and/or rules for MPC change, irrespective of whether your functional or financial circumstances have changed, if you do not meet the changed eligibility requirements, the department will terminate your MPC services.

[]

NEW SECTION
WAC 388-106-0225 How do I pay for MPC? (1) If you live in your own home, you do not participate toward the cost of your personal care services.

(2) If you live in a residential facility and 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 under 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. You will receive a personal allowance of fifty-eight dollars and eighty-four cents; or

(d) A GA-X client in a residential care facility, you are allowed to keep a personal allowance of only thirty-eight dollars and eighty-four cents per month. The remainder of your grant must be paid to the facility.

(3) The department pays the residential care facility from the first day of service through the:

(a) Last day of service when the Medicaid resident dies in the facility; or

(b) Day of service before the day the Medicaid resident is discharged.

[]

NEW SECTION
WAC 388-106-0230 Can I be employed and receive MPC? You can be employed and receive MPC services if you remain medicaid eligible under the noninstitutional categorically needy program.

[]

NEW SECTION
WAC 388-106-0235 Are there waiting lists for MPC? There are no waiting lists for MPC. Instead of waiting lists, the department may revise rules to reduce caseload size, hours, rates, or payments in order to stay within the legislative appropriation.

[]

COMMUNITY OPTIONS PROGRAM ENTRY SYSTEM (COPES)
NEW SECTION
WAC 388-106-0300 What services may I receive under Community Options Program Entry System (COPES) when I live in my own home? When you live in your own home, you may be eligible to receive only the following services under COPES:

(1) Personal care services as defined in WAC 388-106-0010 in your own home and, as applicable, while you are out of the home accessing community resources or working.

(2) Adult day care if you meet the eligibility requirements under WAC 388-106-0805.

(3) 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;

(d) Meet applicable state or local codes; and

(e) Are not adaptations or improvements, which are of general utility or add to the total square footage.

(4) Home delivered meals, providing 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;

(d) Receiving this meal is more cost-effective than having a paid caregiver.

(5) 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 as described in WAC 388-551-2120 and are in addition to those available services;

(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.

(6) 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.

(7) Skilled nursing, 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.

(8) Specialized durable and non-durable medical equipment and supplies under WAC 388-543-1000, if the items are:

(a) Medically necessary under WAC 388-500-0005;

(b) Necessary for: life support; to increase your ability to perform activities of daily living; or to perceive, control, or communicate with the environment in which you live;

(d) In addition to and do not replace any medical equipment and/or supplies otherwise provided under Medicaid and/or Medicare.

(9) Training needs identified in CARE or in a professional evaluation, which meet a therapeutic goal such as:

(a) Adjusting to a serious impairment;

(b) Managing personal care needs; or

(10) Transportation services, if the service:

(a) Provides you access to community services and resources to meet your therapeutic goal;

(b) Is not diversional in nature; and

(c) Is in addition to and does not replace the Medicaid-brokered transportation or transportation services available in the community.

(11) Nurse delegation services, when:

(a) You are receiving personal care from a registered or certified nursing assistant who has completed nurse delegation core training;

(b) Your medical condition is considered stable and predictable by the delegating nurse; and

(12) Nursing services, when you are not already receiving this type of service from another resource. A registered nurse may visit you and perform any of the following activities:

(a) Nursing assessment/reassessment;

(b) Instruction to you and your providers;

(e) File review; and/or

(f) Evaluation of health-related care needs affecting service plan and delivery.

(13) Community transition services, if you are being discharged from the nursing facility or hospital and if services are necessary for you to set up your own home. Services:

(a) May include: safety deposits, utility set-up fees or deposits, health and safety assurances such as pest eradication, allergen control or one-time cleaning prior to occupancy, moving fees, furniture, essential furnishings, and basic items essential for basic living outside the institution; and

(b) Do not include rent, recreational or diversional items such as TV, cable or VCR's.

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NEW SECTION
WAC 388-106-0305 What services may I receive under COPES if I live in a residential facility? If you live in one of the following residential facilities: a licensed boarding home contracted with the department to provide Assisted Living, Enhanced Adult Residential Care, Enhanced Adult Residential Care-Specialized Dementia Care or an Adult Family Home, you may be eligible to receive only the following services under COPES:

(1) Personal care services as defined under WAC 388-106-0010.

(2) Specialized durable and non-durable medical equipment and supplies under WAC 388-543-1000, when the items are:

(a) Medically necessary under WAC 388-500-0005; and

(b) Necessary: for life support; to increase your ability to perform activities of daily living; or to perceive, control, or communicate with the environment in which you live; and

(d) In addition to and do not replace any medical equipment and/or supplies otherwise provided under Medicaid and/or Medicare; and

(e) In addition to and do not replace the services required by the department's contract with a residential facility.

(3) Training needs identified in CARE or in a professional evaluation, that are in addition to and do not replace the services required by the department's contract with the residential facility and that meet a therapeutic goal such as:

(a) Adjusting to a serious impairment;

(b) Managing personal care needs; or

(4) Transportation services, when the service:

(a) Provides you access to community services and resources to meet a therapeutic goal;

(b) Is not 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 facilities.

(5) Skilled nursing, when the service is:

(a) Provided by a registered nurse or licensed practical nurse under the supervision of a registered nurse;

(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 the department's contract with the residential facility (e.g. intermittent nursing services as defined in WAC 388-78A-2310).

(6) Nursing services, when you are not already receiving this type of service from another resource. A registered nurse may visit you and perform any of the following activities:

(a) Nursing assessment/reassessment;

(b) Instruction to you and your providers;

(e) File review; and/or

(f) Evaluation of health-related care needs affecting service plan and delivery.

(7) Community transition services, if you are being discharged from the nursing facility or hospital and if services are necessary for you to live in a residential facility. Services:

(a) May include: safety deposits, utility set up fees or deposits, health and safety assurances such as pest eradication, allergen control or one time cleaning prior to occupancy, moving fees, furniture, essential furnishings, and basic items essential for basic living outside the institution.

(b) Do not include rent, recreational or diversional items such as TV, cable or VCR's.

[]

NEW SECTION
WAC 388-106-0310 Am I eligible for COPES-funded services? You are eligible for COPES-funded services if you meet all of the following criteria. The department must assess your needs in CARE and determine that:

(1) You are age:

(a) Eighteen or older and blind or have a disability, 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 (MPC); or

(b) Are eligible for MPC services, but the department determines that the amount, duration, or scope of your needs is beyond what MPC can provide.

(4) Your CARE 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 is defined in WAC 388-106-0355(1).

[]

NEW SECTION
WAC 388-106-0315 When do COPES services start? Your eligibility for COPES begins the date the department authorizes services.

[]

NEW SECTION
WAC 388-106-0320 How do I remain eligible for COPES? (1) In order to remain eligible for COPES, you must be in need of services in accordance with WAC 388-106-0310 as determined through a CARE assessment. The assessment in CARE must be at least annually or more often when there are significant changes in your functional or financial circumstances.

(2) When eligibility statutes, regulations, and/or rules for COPES change, irrespective of whether your functional or financial circumstances have changed, if you do not meet the changed eligibility requirements, the department will terminate your COPES services.

[]

NEW SECTION
WAC 388-106-0325 How do I pay for COPES services? Depending on your income and resources, you may be required to pay participation toward the cost of your care, as outlined in WAC 388-515-1505. If you have nonexempt income that exceeds the cost of COPES services, you may retain the difference. If you are receiving services in:

(1) Your own home, you are allowed to keep some of your income for a maintenance allowance.

(2) In a residential facility, you must use your income to pay for your room and board and services. You are allowed to keep some of your income for personal needs allowance (PNA). The department determines the amount of PNA that you may keep. The department pays the facility for the difference between what you pay and the department-set rate for the facility. The department pays the residential care facility from the first day of service through the:

(a) Last day of service when the Medicaid resident dies in the facility; or

(b) Day of service before the day the Medicaid resident is discharged.

[]

NEW SECTION
WAC 388-106-0330 Can I be employed and receive COPES? You can be employed and receive COPES, per WAC 388-515-1505.

[]

NEW SECTION
WAC 388-106-0335 Are there waiting lists for COPES? The department will create a waiting list in accordance with caseload limits determined by legislative funding. Wait listed clients will gain access in the following manner:

(1) Nursing home residents wanting COPES waiver services will be ranked first on the wait list by date of application for services;

(2) Then clients living in the community with a higher level of need, as determined by the CARE assessment, will be ranked higher on the wait list over clients with a lower level of need; and

(3) When two or more clients in the community have equal need levels, the client with the earlier application for services will have priority over later applications for services.

[]

NURSING FACILITY CARE SERVICES
NEW SECTION
WAC 388-106-0350 What are nursing facility care services? You may receive care in a nursing facility, as outlined in chapter 388-97 WAC.

[]

NEW SECTION
WAC 388-106-0355 Am I eligible for nursing facility care services? You are eligible for nursing facility care if the department:

(1) Assesses you in CARE and determines that you meet the functional criteria for nursing facility level of care which means one of the following applies:

(a) You require care provided by or under the supervision of a registered nurse or a licensed practical nurse on a daily basis;

(b) You have an unmet or partially met need with at least three of the following Activities of Daily Living, as defined in WAC 388-106-0010:

For each Activity of Daily Living, the minimum level of assistance required in

Self Performance is: Support Provided is:

Eating N/A Setup

Toileting Supervision N/A

Bathing Supervision N/A

Transfer Supervision Setup

Bed Mobility Supervision Setup

Walk in Room
OR
Locomotion in Room
OR
Locomotion Outside Immediate Living Environment
Supervision Setup

Medication Management Assistance Required N/A

Your need for assistance in any activities listed in subsection (b) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose in determining your functional eligibility.

(c) You have an unmet or partially met need with at least two of the following Activities of Daily Living, as defined in WAC 388-106-0010:

For each Activity of Daily Living, the minimum level of assistance required in

Self Performance is: Support Provided is:

Eating Supervision One person physical assist

Toileting Extensive Assistance One person physical assist

Bathing Limited Assistance One person physical assist

Transfer Extensive Assistance One person physical assist

Bed Mobility
and
Turning and repositioning
Limited Assistance
and
Need
One person physical assist

Walk in Room
OR
Locomotion in Room
OR
Locomotion Outside Immediate Living Environment
Extensive Assistance One person physical assist

Medication Management Assistance Required Daily N/A

Your need for assistance in any of the activities listed in subsection (c) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose of determining your functional eligibility.

or:

(d) You have a cognitive impairment and require supervision due to one or more of the following: Disorientation, memory impairment, impaired decision-making, or wandering and have an unmet or partially met need with at least one or more of the following:

For each Activity of Daily Living, the minimum level of assistance required in

Self Performance is: Support Provided is:

Eating Supervision One person physical assist

Toileting Extensive Assistance One person physical assist

Bathing Limited Assistance One person physical assist

Transfer Extensive Assistance One person physical assist

Bed Mobility
and
Turning and repositioning
Limited Assistance
and
Need
One person physical assist

Walk in Room
OR
Locomotion in Room
OR
Locomotion Outside Immediate Living Environment
Extensive Assistance One person physical assist

Medication Management Assistance Required Daily N/A

Your need for assistance in any of the activities listed in subsection (d) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose of determining your functional eligibility.

(2) Determines that you meet the financial eligibility requirements set through WAC 388-513-1315.

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NEW SECTION
WAC 388-106-0360 How do I pay for nursing facility care services? (1) If you are Medicaid eligible and the nursing facility admits you without a request for assessment from the department, the nursing facility will not:

(a) Be reimbursed by the department; or

(b) Be allowed to collect payment, including a deposit or minimum stay fee, from you or your family/representative for any care provided before the date of request for assessment.

(2) If you are eligible for Medicaid-funding nursing facility care, the department pays for your services beginning on the date:

(a) Of the request for a department assessment; or

(b) Nursing facility care actually begins, whichever is later.

(3) If you become financially eligible for Medicaid after you have been admitted, the department pays for your nursing facility care beginning on the date of:

(a) Request for assessment or financial application, whichever is earlier;

(b) Nursing facility placement; or

(4) Exception: Payment back to the request date is limited to three months prior to the month that the financial application is received.

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MEDICALLY NEEDY RESIDENTIAL WAIVER
NEW SECTION
WAC 388-106-0400 What services may I receive under Medically Needy Residential Waiver (MNRW)? You may be eligible to receive only the following MNRW services in one of the following residential facilities: a licensed boarding home contracted with the department to provide Assisted Living, Enhanced Residential Care, Enhanced Adult Residential Care-Specialized Dementia Care or an Adult Family Home:

(1) Personal care services as defined in WAC 388-106-0010.

(2) Specialized durable and nondurable medical equipment and supplies under WAC 388-543-1000, when the items are:

(a) Medically necessary under WAC 388-500-0005; and

(b) Necessary: for life support; to increase your ability to perform activities of daily living; or to perceive, control, or communicate with the environment in which you live;

(d) In addition to and do not replace any medical equipment and/or supplies otherwise provided under Medicaid and/or Medicare; and

(e) In addition to and do not replace the services required by the department's contract with the residential facility.

(3) Training needs identified in CARE or in a professional evaluation that are in addition to and do not replace services required by the department's contract with the residential facility and that meet a therapeutic goal such as:

(a) Adjusting to a serious impairment;

(b) Managing personal care needs; or

(4) Transportation services, when the service:

(a) Provides you access to community services and resources provided to meet a therapeutic goal;

(b) Is not 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 the department's contract with a residential facility.

(5) Skilled nursing, when the service is:

(a) Provided by a registered nurse or licensed practical nurse under the supervision of a registered nurse;

(b) Beyond the amount, duration or scope of Medicaid-reimbursed home health services as provided under WAC 388-551-2120; and

(c) In addition to and does not replace the services required by the department's contract with the residential facility (e.g. intermittent nursing services as defined in WAC 388-78A-2310).

(6) Nursing services, when you are not already receiving this type of service from another resource. A registered nurse may visit you and perform any of the following activities:

(a) Nursing assessment/reassessment;

(b) Instruction to care providers and clients;

(e) File review; and/or

(f) Evaluation of health-related care needs affecting service plan and delivery.

(7) Community transition services, if you are being discharged from the nursing facility or hospital and if services are necessary for you to live in a residential facility. Services:

(b) Do not include rent, recreational or diversional items such as TV, cable or VCR's.

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NEW SECTION
WAC 388-106-0410 Am I eligible for MNRW-funded services? You are eligible for MNRW-funded services if you choose to receive services in a residential facility and you meet all of the following criteria. The department must assess your needs, using CARE, and determine that:

(1) You are age:

(a) Eighteen or older and blind or have a disability, 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 388-515-1540.

(3) You are not eligible for Medicaid personal care services (MPC) or COPES.

(4) Your CARE 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 MNRW services are provided) which is defined in WAC 388-106-0355(1).

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NEW SECTION
WAC 388-106-0415 When do MNRW services start? Your eligibility for MNRW begins the date the department authorizes services.

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NEW SECTION
WAC 388-106-0420 How do I remain eligible for MNRW? (1) In order to remain eligible for MNRW, you must be in need of services in accordance with WAC 388-106-0410 as determined through a CARE assessment. The assessment in CARE must be at least annually or more often when there are significant changes in your functional or financial circumstances.

(2) When eligibility statutes, regulations, and/or rules for MNRW change, irrespective of whether your functional or financial circumstances have changed, if you do not meet the changed eligibility requirements, the department will terminate your MNRW services.

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NEW SECTION
WAC 388-106-0425 How do I pay for MNRW services? (1) You must use your income to pay for your room and board and services. The amount you pay is determined in WAC 388-515-1540. You are allowed to keep some of your income for personal needs allowance (PNA). The department pays the facility for the difference between what you pay and the department-set rate for the facility. The department pays the residential care facility from the first day of service through the:

(a) Last day of service when the Medicaid resident dies in the facility; or

(b) Day of service before the day the Medicaid resident is discharged.

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NEW SECTION
WAC 388-106-0430 Can I be employed and receive MNRW? You may be employed and receive MNRW per WAC 388-515-1540.

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NEW SECTION
WAC 388-106-0435 Are there waiting lists for MNRW? The department will create a waiting list in accordance with caseload limits determined by legislative funding. Wait listed clients will gain access in the following manner:

(1) Nursing home residents wanting MN waiver services will be ranked first on the wait list by date of application for services;

(2) Then clients living in the community with a higher level of need, as determined by the department's CARE assessment, will be ranked higher on the wait list over clients with lower level of need; and

(3) When two or more clients in the community have equal need levels, the client with the earlier application for services will have priority over later applications for services.

[]

MEDICALLY NEEDY IN-HOME WAIVER
NEW SECTION
WAC 388-106-0500 What services may I receive under Medically Needy In-Home Waiver (MNIW)? You may be eligible to receive only the following Medically Needy In-Home Waiver (MNIW) services in your own home:

(1) Personal care services as defined in WAC 388-106-0010 in your own home and, as applicable, while you are out of the home accessing community resources or working.

(2) Adult day care if you meet the eligibility requirements under WAC 388-106-0805.

(3) 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;

(d) Meet applicable state or local codes; and

(e) Are not adaptations or improvements, which are of general utility or add to the total square footage.

(4) Home delivered meals, providing 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;

(d) Receiving this meal is more cost-effective than having a paid caregiver.

(5) Home health aide service, 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 388-551-2120) and are in addition to those available services;

(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.

(6) 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.

(7) Skilled nursing, 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 388-551-2120.

(8) 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;

(b) Necessary: for life support; to increase your ability to perform activities of daily living; or to perceive, control, or communicate with the environment in which you live;

(d) In addition to and do not replace any medical equipment and/or supplies otherwise provided under Medicaid and/or Medicare.

(9) Training needs identified in CARE or in a professional evaluation, which meet a therapeutic goal such as:

(a) Adjusting to a serious impairment;

(b) Managing personal care needs; or

(10) Transportation services if you live in your own home, if the service:

(a) Provides you access to community services and resources to meet a therapeutic goal;

(b) Is not diversional in nature;

(c) Is in addition to and does not replace the Medicaid-brokered transportation or transportation services available in the community.

(11) Nurse delegation services when:

(a) You are receiving personal care from a registered or certified nursing assistant who has completed nurse delegation core training;

(b) Your medical condition is considered stable and predictable by the delegating nurse; and

(12) Nursing services, when you are not already receiving this type of service from another resource. A registered nurse may visit you and perform any of the following activities:

(a) Nursing assessment/reassessment;

(b) Instruction to you and your providers;

(e) File review; and/or

(f) Evaluation of health-related care needs affecting service planning and delivery.

(13) Community transition services, if you are being discharged from the nursing facility or hospital and if services are necessary for you to set up your own home. Services:

(b) Do not include rent, recreational or diversional items such as TV, cable or VCR's.

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NEW SECTION
WAC 388-106-0510 Am I eligible for MNIW-funded services? You are eligible for MNIW-funded services if you choose to receive services in your own home and you meet all of the following criteria. The department must assess your needs in CARE and determine that:

(1) You are age:

(a) Eighteen or older and blind or have a disability, 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;

(3) You are not eligible for Medicaid personal care services (MPC) or COPES;

(4) Your CARE 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 MNIW services are provided) which is defined in WAC 388-106-0355(1).

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NEW SECTION
WAC 388-106-0515 When do MNIW services start? Your eligibility for MNIW begins the date the department authorizes services.

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NEW SECTION
WAC 388-106-0520 How do I remain eligible for MNIW? (1) In order to remain eligible for MNIW, you must be in need of services in accordance with WAC 388-106-0510 as determined through a CARE assessment. The assessment in CARE must be at least annually or more often when there are significant changes in your functional or financial circumstances.

(2) When eligibility statutes, regulations, and/or rules for MNIW change, irrespective of whether your functional or financial circumstances have changed, if you do not meet the changed eligibility requirements, the department will terminate your MNIW services.

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NEW SECTION
WAC 388-106-0525 How do I pay for MNIW? The amount you pay is determined in WAC 388-515-1550.

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NEW SECTION
WAC 388-106-0530 Can I be employed and receive MNIW? You can be employed and receive MNIW, per WAC 388-515-1550.

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NEW SECTION
WAC 388-106-0535 Are there waiting lists for MNIW? The department will create a waiting list in accordance with caseload limits determined by legislative funding. Wait listed clients will gain access in the following manner:

(1) Nursing home residents wanting MN waiver services will be ranked first on the wait list by date of application for services;

(2) Then clients living in the community with a higher level of need as determined by the department's CARE assessment will be ranked higher on the wait list over clients with lower level of need; and

(3) When two or more clients in the community have equal need levels, the client with the earlier application for services will have priority over later applications for services.

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CHORE
NEW SECTION
WAC 388-106-0600 What services may I receive under Chore? You may receive personal care services in your own home and, as applicable, assistance with personal care tasks while you are out of the home accessing community resources or working.

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NEW SECTION
WAC 388-106-0610 Am I eligible for Chore-funded services? To be eligible for Chore-funded services you must meet all of the following criteria:

(1) Be grandfathered on the Chore program before August 1, 2001 and have continued to receive Chore without a break in service.

(2) Not be eligible for MPC or COPES.

(3) Be eighteen years of age or older.

(4) Have an unmet or partially met need with at least one of the following Activities of Daily Living, as defined in WAC 388-106-0010.

For each Activity of Daily Living, the minimum level of assistance required in

Self Performance is: Support Provided is:

Eating N/A Setup

Toileting Supervision N/A

Bathing Supervision N/A

Dressing Supervision N/A

Transfer Supervision Setup

Bed Mobility Supervision Setup

Walk in Room
OR
Locomotion in Room
OR
Locomotion Outside Immediate Living Environment
Supervision Setup

Medication Management Assistance Required N/A

Personal Hygiene Supervision N/A

Body care which includes:
Application of ointment or lotions;
Toenails trimmed;
Dry bandage changes; or
Passive range of motion treatment.
Need N/A

Your need for assistance in any of the activities listed in this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose of determining your functional eligibility.

(5) Have net household income (as described in WAC 388-450-0005 and 388-450-0040) not exceeding:

(a) The sum of the cost of your Chore services; and

(b) One-hundred percent of the Federal Poverty Level (FPL) adjusted for family size.

(6) Have resources, as described in chapter 388-470 WAC, which do 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.); and

(7) Not transfer assets on or after November 1, 1995 for less than fair market value, as described in WAC 388-513-1365.

[]

Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-106-0615 When do Chore services start? Your eligibility for Chore services begins the date the department authorizes services.

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NEW SECTION
WAC 388-106-0620 How do I remain eligible for Chore? (1) In order to remain eligible for Chore, you must be in need of services in accordance with WAC 388-106-0610 as determined through a CARE assessment. The assessment in CARE must be at least annually or more often when there are significant changes in your functional or financial circumstances.

(2) When eligibility statutes, regulations, and/or rules for Chore change, irrespective of whether your functional or financial circumstances have changed, if you do not meet the changed eligibility requirements, the department will terminate your Chore services.

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NEW SECTION
WAC 388-106-0625 How do I pay for Chore? 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:

(1) Income listed in WAC 388-513-1340;

(2) Spousal income allocated and actually paid as participation in the cost of the spouse's Community Options Program Entry System (COPES) services;

(3) Amounts paid for medical expenses not subject to third party payment;

(4) Health insurance premiums, coinsurance or deductible charges; and

(5) If applicable, those work expense deductions listed in WAC 388-106-0630(2).

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NEW SECTION
WAC 388-106-0630 Can I be employed and receive Chore? If you are not Medicaid eligible due to your earned income and resources and are receiving chore personal care services:

(1) You may be required to pay participation, per WAC 388-106-0625, for any earned income above one hundred percent of the federal poverty level.

(2) The department will exempt fifty percent of your earned income after work expense deductions. Work expense deductions are:

(a) Personal work expenses in the form of self-employment taxes (FICA); and income taxes when paid;

(b) Payroll deductions required by law or as a condition of employment in the amounts actually withheld;

(c) The necessary cost of transportation to and from the place of employment by the most economical means, except rental cars;

(d) Expenses necessary for continued employment such as tools, materials, union dues, transportation to service customers not furnished by the employer; and

(e) Uniforms needed on the job and not suitable for wear away from the job.

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VOLUNTEER CHORE
NEW SECTION
WAC 388-106-0650 What services may I receive under volunteer chore? Volunteer Chore is a state-funded program which provides volunteer assistance with household tasks and:

(1) Assists people who need but are not eligible for DSHS services.

(2) Complements DSHS services by using volunteer assistance to perform tasks which do not require specially-skilled personnel.

(3) Provides assistance with housework, laundry, shopping, cooking, moving, minor home repair, yard care, limited personal care, monitoring and transportation.

[]

NEW SECTION
WAC 388-106-0655 Am I eligible to receive volunteer chore services? You may receive volunteer chore services if you are:

(1) Eighteen years of age or older;

(2) Living at home unless you are moving from a residential facility to home and need assistance moving;

(3) Unable to perform certain personal care tasks due to functional or cognitive impairment;

(4) Financially unable to purchase services from a private provider;

(5) Not receiving services under COPES, MNIW, MPC, or Chore because you:

(a) Do not meet the eligibility requirements; or

(b) Decline these services.

(6) In need of assistance from volunteer chore in addition to or in substitution of paid services under COPES, MNIW, MPC, or Chore.

[]

PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
NEW SECTION
WAC 388-106-0700 What services may I receive under PACE? Under their contract with the department, the PACE provider develops an individualized plan of care, as defined in 42 CFR 460.106, that integrates necessary long-term care, medical services, mental health services, and alcohol and substance abuse treatment services.

(1) The care plan includes, but is not limited to any of the following long-term care services:

(a) Care coordination;

(b) Home and community-based services:

(i) Personal (in-home) care;

(ii) Residential care.

(2) The care plan may also include, but is not limited to, the following medical services:

(a) Primary medical care;

(b) Vision care;

(d) Restorative therapies, including speech, occupational, and physical therapy;

(e) Oxygen therapy;

(f) Audiology (including hearing aids);

(g) Transportation;

(h) Podiatry;

(i) Durable medical equipment (e.g., wheelchair);

(j) Dental care;

(k) Pharmaceutical products;

(l) Immunizations and vaccinations;

(m) Emergency room visits and inpatient hospital stays.

(3) The care plan may also include any other services determined necessary by the interdisciplinary team to improve and maintain your overall health status.

[]

NEW SECTION
WAC 388-106-0705 Am I eligible for PACE services? To qualify for Medicaid-funded PACE services, you must apply for an assessment by contacting your local home and community services office. The department will assess and determine whether you:

(1) Are age:

(a) Fifty-five or older, and blind or have a disability, as defined in WAC 388-511-1105, SSI-related eligibility requirements; or

(b) Sixty-five or older.

(2) Need nursing facility level of care as defined in WAC 388-106-0355. Note: If you are already enrolled, but no longer need nursing facility care, you may still be eligible for PACE services if the department reasonably expects you to need nursing facility care within the next six months in the absence of continued PACE coverage;

(3) Live within the designated service area of the PACE provider;

(4) 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;

(5) Not be enrolled in any other medical coverage plan that purchases services on a prepaid basis (e.g., prepaid health plan); and

(6) Agree to receive services exclusively through the PACE provider and the PACE provider's network of contracted providers.

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NEW SECTION
WAC 388-106-0710 How do I pay for PACE services? Depending on your income and resources, you may be required to pay for part of the PACE services. The department's financial worker will determine what amount, if any, you must contribute if you decide to enroll. The department pays the PACE provider the remaining amount.

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NEW SECTION
WAC 388-106-0715 How do I disenroll from the PACE program? (1) You may choose to voluntarily disenroll from the PACE program without cause at any time. To do so, you must give the PACE provider written notice. If you give notice:

(a) Before the fifteenth of the month, disenrollment is effective at the end of the month; or

(b) After the fifteenth, disenrollment is not effective until the end of the following month.

(2) You may also be involuntarily disenrolled from the program by the PACE provider, if you:

(a) Move out of the designated service area or are out of the service area for more than thirty consecutive days, unless the PACE provider agrees to a longer absence due to extenuating circumstances;

(b) Engage in disruptive or threatening behavior such that the behavior jeopardizes your health or safety, or the safety of others;

(d) Fail to pay or make arrangements to pay your part of the costs after the thirty-day grace period;

(e) Become financially ineligible for Medicaid services, unless you choose to pay privately;

(f) Are enrolled with a provider that loses its license and/or contract; or

(g) No longer meet the nursing facility level of care requirement as defined in WAC 388-106-0205 and are not deemed PACE eligible.

(3) For any of the above reasons, the PACE provider must give you written notice, explaining that they are terminating benefits. If the provider gives you notice:

(a) Before the fifteenth of the month, then you may be disenrolled at the end of the month; or

(b) After the fifteenth, then you may be disenrolled at the end of the following month.

(4) Before the PACE provider can involuntarily disenroll you from the PACE program, the department must review and approve all proposed involuntary disenrollments.

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ADULT DAY SERVICES
NEW SECTION
WAC 388-106-0800 What adult day care services may I receive? You may receive the following services in an adult day care:

(1) Core services, which include assistance with:

(a) Locomotion Outside of Room, Locomotion in Room, Walk in Room;

(b) Body care;

(d) Repositioning;

(e) Medication Management that does not require a licensed nurse;

(f) Transfer;

(g) Toileting;

(h) Personal hygiene at a level that ensures your safety and comfort while in attendance at the program; and

(i) Bathing at a level that ensures your safety and comfort while in attendance at the program.

(2) Social services on a consultation basis, which may include:

(a) Referrals to other providers for services not within the scope of Medicaid reimbursed adult day care services;

(b) Caregiver support and education; or

(3) Routine health monitoring with consultation from a registered nurse that a consulting nurse acting within the scope of practice can provide with or without a physician's order. Examples include:

(a) Obtaining baseline and routine monitoring information on your health status, such as vital signs, weight, and dietary needs;

(b) General health education such as providing information about nutrition, illnesses, and preventive care;

(d) Annual and as needed updating of your medical record; or

(e) Assistance as needed with coordination of health services provided outside of the adult day care program.

(4) General therapeutic activities that an unlicensed person can provide or that a licensed person can provide with or without a physician's order. These services are planned for and provided based on your abilities, interests, and goals. Examples include:

(a) Recreational activities;

(b) Diversionary activities;

(d) Cognitive stimulation; or

(e) Group range of motion or conditioning exercises.

(5) General health education that an unlicensed person can provide or that a licensed person can provide with or without a physician's order, including but not limited to topics such as:

(a) Nutrition;

(b) Stress management;

(d) Preventative care.

(6) A nutritional meal and snacks are provided every four hours, including a modified diet if needed and within the scope of the program, as provided under WAC 388-71-0768;

(7) Supervision and/or protection if needed for your safety;

(8) Assistance with arranging transportation to and from the program; and

(9) First aid and provisions for obtaining or providing care in an emergency. NOTE: If you require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of your physician, consider adult day health services.

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NEW SECTION
WAC 388-106-0805 Am I eligible for adult day care? (1) If you receive COPES or MNIW, you may be eligible for adult day care as a waiver service if you are assessed as having an unmet need for one or more of the following core services:

(a) Personal care services;

(b) Routine health monitoring with consultation from a registered nurse;

(d) Supervision and/or protection if required for your safety.

(2) You are not eligible for adult day care if you receive COPES or MNIW and you:

(a) Can independently perform or obtain the services provided at an adult day care center;

(b) Have unmet needs that can be met through the COPES or MNIW program more cost effectively without authorizing day care services;

(i) Exceed the scope of authorized services that the adult day care center is able to provide;

(ii) Can be met in a less structured care setting; or

(iii) Are being met by paid or unpaid caregivers.

(d) Live in a nursing home, boarding home, adult family home, or other licensed institutional or residential facility; or

(e) Are not capable of participating safely in a group care setting.

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NEW SECTION
WAC 388-106-0810 What adult day health services may I receive? You may receive the following adult day health services:

(1) All core services under WAC 388-106-0800;

(2) Skilled nursing services other than routine health monitoring with nurse consultation;

(3) At least one of the following skilled therapy services: physical therapy, occupational therapy, or speech-language pathology or audiology, as defined under chapter 18.74, 18.59, and 18.35 RCW, and

(4) Psychological or counseling services, including assessing for psycho-social therapy need, dementia, abuse or neglect, and alcohol or drug abuse; making appropriate referrals; and providing brief, intermittent supportive counseling.

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NEW SECTION
WAC 388-106-0815 Am I eligible for adult day health? (1) You are eligible for adult day health services if you meet all of the following criteria. You are:

(a) Age eighteen years or older.

(b) Enrolled in one of the following medical assistance programs:

(i) Categorically needy (CNP);

(ii) Categorically needy qualified Medicare beneficiaries (CNP-QMB);

(iii) General assistance--Expedited Medicaid Disability (GA-X); or

(iv) Alcohol and Drug Abuse Treatment and Support Act (ADATSA).

(c) Assessed as having an unmet need for skilled nursing under WAC 388-71-0712 or skilled rehabilitative therapy under WAC 388-71-0714; and

(i) There is a reasonable expectation that these services will improve, restore or maintain your health status, or in the case of a progressive disabling condition, will either restore or slow the decline of your health and functional status or ease related pain or suffering; and

(ii) You are at risk for deteriorating health, deteriorating functional ability, or institutionalization; and

(iii) You have a chronic or acute health condition that you are not able to safely manage due to a cognitive, physical, or other functional impairment.

(d) Assessed as having needs for personal care or other core services, whether or not those needs are otherwise met.

(2) You are not eligible for adult day health if you:

(a) Can independently perform or obtain the services provided at an adult day health center;

(b) Have referred care needs that:

(i) Exceed the scope of authorized services that the adult day health center is able to provide;

(ii) Do not need to be provided or supervised by a licensed nurse or therapist;

(iii) Can be met in a less structured care setting; or

(iv) In the case of skilled care needs, are being met by paid or unpaid caregivers.

(d) Are not capable of participating safely in a group care setting.

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GAU-FUNDED RESIDENTIAL CARE
NEW SECTION
WAC 388-106-0900 What services may I receive under GAU-funded residential care? You may receive personal care services in an adult family home or a licensed boarding home contracted with the department to provide adult residential care services. You may also receive nurse delegation services under this program.

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NEW SECTION
WAC 388-106-0905 Am I eligible to receive GAU-funded residential care services? You are eligible to receive GAU-funded residential care services if:

(1) You meet financial eligibility requirements for general assistance unemployable (GAU), described in WAC 388-400-0025;

(2) You are not eligible for services under COPES, MNRW, or MPC; and

(3) You are assessed in CARE and meet the functional criteria outlined in WAC 388-106-0210(2).

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RESIDENTIAL CARE DISCHARGE ALLOWANCE
NEW SECTION
WAC 388-106-0950 What services may I receive under the residential care discharge allowance? The residential care discharge allowance is a one-time payment used to help you establish or resume living in your own home. You may receive up to eight hundred and sixteen dollars to cover necessary equipment, remodeling, rent, and utilities.

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NEW SECTION
WAC 388-106-0955 Am I eligible for Residential Care Discharge Allowance? You are eligible for a residential discharge allowance if you:

(1) Receive long-term care services from Home and Community Services;

(2) Are being discharged from a hospital, nursing facility, a licensed boarding home, or adult family home to your own home;

(3) Do not have other programs, services, or resources to assist you with these costs; and

(4) Have needs beyond what is covered under the Community Transition Service (under COPES, MNRW, and MNIW).

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PRIVATE DUTY NURSING (PDN)
NEW SECTION
WAC 388-106-1000 What is the intent of WAC 388-106-1000 through WAC 388-106-1055? The intent of 388-106-1000 through WAC 388-106-1055 is to:

(1) Describe the eligibility requirements under which you may receive private duty nursing (PDN) services;

(2) Provide a program which supports you in your own home; and

(3) Describe the requirements that you and your family, home health agencies, privately contracted registered nurses (RNs) and licensed practical nurses (LPNs), and adult family homes must meet in order for services to be authorized for PDN.

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NEW SECTION
WAC 388-106-1005 What services may I receive under private duty nursing (PDN)? PDN is an optional program that provides skilled nursing care if you have complex medical needs that cannot be met through other services. An alternative to institutional care, this is a program of last resort. If you are eligible, you may receive at least four continuous hours of skilled nursing care on a day-to-day basis from private duty nursing (PDN).

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NEW SECTION
WAC 388-106-1010 Am I eligible for Medicaid-funded private duty nursing (PDN) services? In order to be eligible for Medicaid-funded PDN, you must:

(1) Be financially eligible, which means you:

(a) Meet Medicaid requirements under the Categorically needy program or the Medically needy program.

(b) Use private insurance as first payer under Medicaid rules. Private insurance benefits, which cover hospitalization and in-home services must be ruled out as the first payment source to PDN.

(2) Be medically eligible, which means the community nurse consultant (CNC) or DDD nursing care consultant must assess you using the CARE assessment every six months and determine that you:

(a) Require care in a hospital or meet nursing facility level of care, as defined in 388-106-0355; and

(b) Are not able or willing to have your care tasks provided through nurse delegation, COPES Skilled Nursing, or self-directed care; and

(c) Have a complex medical need that requires four or more hours of continuous skilled nursing care which can be safely provided outside a hospital or nursing facility; and

(d) Are technology-dependent daily, which means you require at least one of the following:

(i) A mechanical ventilator or complex respiratory support that requires skilled nursing care;

(ii) Tracheostomy that requires sterile suctioning; or

(iii) Intravenous/parenteral administration of multiple medications that are occurring on a continuing or frequent basis such that skilled nursing care is required for a four-hour period or more.

(iv) Intravenous administration of nutritional substances.

(e) Require skilled nursing care that is medically necessary.

(3) Be able to supervise your care (provider) or have a guardian who is authorized to supervise your care; and

(4) Have family or other appropriate support who is responsible for assuming a portion of your care; and

(5) Do not have other resources or means for providing this service.

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NEW SECTION
WAC 388-106-1015 How is my eligibility determined? In order to be eligible for Medicaid-funded PDN services:

(1) A community nurse consultant (CNC) or DDD nursing care consultant must use CARE to assess you in combination with the department-designated PDN Skilled Nursing Task Log and other documentation that is completed and provided by your health care provider(s).

(2) Your primary care physician must:

(a) Document your medical stability and appropriateness for PDN;

(b) Provide orders for medical services; and

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NEW SECTION
WAC 388-106-1020 How do I pay for my PDN services? You are not required to pay any participation toward PDN services, but the cost of services is subject to estate recovery, per chapter 388-527 WAC.

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NEW SECTION
WAC 388-106-1025 Who can provide my PDN services? In addition to a family member(s) or a personal aide providing self-directed care under RCW 74.39.050:

(1) A Washington state licensed and contracted home health provider can provide your PDN services.

(2) A private (non-home health agency) registered nurse (RN) or licensed practical nurse (LPN) under the direction of the physician can provide your PDN services only when:

(a) The geographic location precludes a contracted home health agency from providing services to you; or

(b) No contracted home health agency is willing to provide PDN services to you.

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NEW SECTION
WAC 388-106-1030 Are there limitations or other requirements for PDN? The limits to PDN services are:

(1) Your PDN cannot exceed sixteen hours a day. The hours are based on a combination of skilled nursing tasks identified in CARE, the department-designated PDN Skilled Nursing Task Log, and detailed information provided by a CNC or DDD nursing care consultant that computes the number of skilled nursing tasks into skilled nursing hours that you require. The department designated PDN Skilled Nursing Task Log will be used to document skilled nursing tasks performed for at least fourteen days;

(2) Trained family must provide for any hours above your assessment determination, or you or your family must pay for these additional hours;

(3) In instances where your family is temporarily absent due to vacations, PDN must be:

(a) Paid for by you or your family; or

(b) Provided by other trained family. If this is not possible, you may need placement in a long-term care setting during their absence.

(4) You may use respite care if you and your unpaid family caregiver meet the eligibility criteria defined in WAC 388-106-1210.

(5) You may receive additional hours, up to thirty days only, when:

(a) Your family is being trained in care and procedures;

(b) You have an acute episode that would otherwise require hospitalization;

(d) There is a family emergency.

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NEW SECTION
WAC 388-106-1035 What requirements must a home health agency meet in order to provide and get paid for my PDN? A home health agency must:

(1) Be licensed and contracted by Washington State. A license is obtained through the department of health. A contract is obtained through aging and disability services administration;

(2) Have physician orders;

(3) Have a detailed plan of care, including time sheets, that is reviewed at least every six months by the physician and CNC case manager or DDD nursing care consultant when you are reassessed;

(4) Complete the department-designated PDN Skilled Task Log and provide other documentation, as needed, for the determination of eligibility and the number of PDN hours to be authorized; and

(5) Submit timely and accurate invoices to the social services payment system (SSPS).

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NEW SECTION
WAC 388-106-1040 What requirements must a private RN or LPN under the supervision of an RN meet in order to provide and get paid for my PDN services? In order to be paid by the department, a private RN or LPN under the supervision of an RN must:

(1) Have a license in good standing, per RCW 18.79.030 (1)(3);

(2) Complete a contract;

(3) Provide services according to the plan of care under the supervision/direction of a physician;

(4) Complete a background inquiry application. This will require fingerprinting if the RN or LPN has lived in the state of Washington less than three years;

(5) Have no conviction for a disqualifying crime, as stated in RCW 43.43.830 and 43.43.842;

(6) Have no stipulated finding of fact, conclusion of law, an agreed order, or finding of fact, conclusion of law, or final order issued by a disciplining authority, a court of law, or entered into a state registry with a finding of guilt for abuse, neglect, abandonment or exploitation;

(7) Meet provider requirements established in WAC 388-71-0510, WAC 388-71-0515, WAC 388-71-0540, WAC 388-71-0551, and WAC 388-71-0556;

(8) Complete time sheets monthly;

(9) Document notes regarding your services provided, per the plan of care and the department-designated PDN Skilled Nursing Task Log, and other documentation needed to determine eligibility and the number of PDN hours to be authorized. These notes are reviewed when the CNC or DDD nursing care consultant completes a CARE assessment every six months; and

(10) Submit timely and accurate invoices to SSPS.

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NEW SECTION
WAC 388-106-1045 Can I receive PDN in a licensed adult family home (AFH)? You may be eligible to receive PDN in a licensed adult family home (AFH). In order for you to receive these services, the AFH provider must:

(1) Possess a WA state registered nurse license;

(2) Sign a contract amendment stating they will ensure twenty-four-hour personal care and nursing care services pursuant to the Nurse Practice Act;

(3) Provide your PDN services through an RN or LPN, under the supervision of an RN, based on the CARE assessment, the department-designated PDN Skilled Task Log, and other documentation needed to determine eligibility. The number of PDN hours to be authorized are based on the following chart:

If the number of clients receiving PDN services in an AFH is: Then the department will authorize care provided by an RN or LPN (under the supervision of an RN) for up to:

1 16 hours of care per day

2-3 24 hours of care per day

4-6 48 hours of care per day

(5) Have a nursing service plan prescribed by your primary physician that allows you to reside in an AFH. The physician is responsible for:

(a) Overseeing your plan of care, which must be updated at least every six months;

(b) Monitoring your medical stability; and

(6) Document notes regarding your services provided, per the plan of care and the department-designated PDN Skilled Task Log, and other documentation needed to determine eligibility and the number of PDN hours to be authorized. These notes are reviewed when the CNC or DDD nursing care consultant completes a CARE assessment every six months; and

(7) Keep records, per AFH licensing and contract requirements, for review when the CARE assessment is completed at least every six months.

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Reviser's note: The typographical error in the above section occurred in the copy filed by the agency and appears in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-106-1050 May I receive other long-term care services in addition to PDN? In addition to PDN services, you may be eligible to receive care through COPES, medically needy residential waiver (MNRW), medically needy in-home waiver (MNIW), or Medicaid personal care (MPC), for unmet personal care needs not performed by your family/informal support system. Your PDN hours will deduct hour for hour from any personal care that you require.

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NEW SECTION
WAC 388-106-1055 Can I choose to self-direct my care if I receive PDN? You may choose to self-direct part of your health-related tasks to an individual provider, as outlined in RCW 74.39.050. You may still receive PDN if you meet the PDN eligibility requirements.

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SENIOR CITIZENS' SERVICES
NEW SECTION
WAC 388-106-1100 What services can I receive under the Senior Citizens' Services Act (SCSA) fund? You may receive community-based services, described in RCW 74.38.040.

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NEW SECTION
WAC 388-106-1105 How do I apply for SCSA-funded services? To receive SCSA-funded services, you or your representative must:

(1) Complete and submit a department application form, providing complete and accurate information; and

(2) Promptly submit a written report of any changes in income or resources. For the definition of income and resources, refer to WAC 388-500-0005.

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NEW SECTION
WAC 388-106-1110 Am I eligible for SCSA-funded services at no cost? To be eligible for SCSA-funded services at no cost, you must:

(1) Be age:

(a) Sixty-five or older; or

(b) Sixty or older, and:

(i) Either unemployed, or

(ii) Working twenty hours a week or less;

(2) Have a physical, mental, or other type of impairment, which without services would prevent you from remaining in your home;

(3) Have income at or below forty percent of the state median income (SMI) for a family of four adjusted for family size; and

(4) Have nonexempt resources (including cash, marketable securities, and real or personal property) not exceeding ten thousand dollars for a single person or fifteen thousand for a family of two, increased by one thousand dollars for each additional family member of the household. Household means a person living alone or a group of people living together.

(5) If you have income over forty percent of SMI, you may be eligible for services on a sliding fee basis.

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NEW SECTION
WAC 388-106-1115 What income and resources are exempt when determining eligibility? The following income and resources, regardless of value, are exempt when determining whether you are eligible for SCSA-funded services:

(1) Your home, and the lot it is upon;

(2) Garden produce, livestock, and poultry used for home consumption;

(3) Program benefits which are exempt from consideration in determining eligibility for needs based programs (e.g., uniform relocation assistance, Older Americans Act funds, foster grandparents' stipends or similar monies);

(4) Used and useful household furnishings, personal clothing, and automobiles;

(5) Personal property of great sentimental value;

(6) Personal property used by the individual to earn income or for rehabilitation;

(7) One cemetery plot for each member of the family unit;

(8) Cash surrender value of life insurance;

(9) Real property held in trust for an individual Indian or Indian tribe; and

(10) Any payment received from a foster care agency for children in the home.

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NEW SECTION
WAC 388-106-1120 What if I am not eligible to receive SCSA-funded services at no cost? (1) Even if your income is above the forty percent SMI limit to receive SCSA-funded services at no cost, you may receive SCSA-subsidized services. The department uses a sliding fee schedule to determine what percentage the department pays for the cost of your services. You pay the remaining amount, but not more than the usual rate paid for services, as negotiated by the AAA or the department. The formula for determining the department's share of the cost of the services is:

100% State Median Income (SMI) - Household Income x 100

100% - 40% SMI

(2) Service providers must be responsible for collecting fees owed by eligible persons and reporting to area agencies all fees paid or owed by eligible persons.

(3) Some services are provided at no charge regardless of income or need requirements. These services include, but are not limited to, nutritional services, health screening, services under the long-term care ombudsman program, and access services. Note: Well adult clinic services may be provided in lieu of health screening services if such clinics use the fee schedule established by this section.

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RESPITE CARE SERVICES
NEW SECTION
WAC 388-106-1200 What definitions apply to respite care services? The following definitions apply to respite care services:

"Caregivers" means a spouse, relative, or friend who has primary responsibility for the daily care of an adult with a functional disability without receiving payment for services provided.

"Continuous care or supervision" means daily assistance or oversight of an adult with a functional disability.

"Functionally disability" means a condition requiring substantial assistance in completing activities of daily living and community living skills.

"Participant" means an adult with a functional disability who needs substantial daily continuous care or supervision.

"Service provider" means an individual, agency, or organization under contract to the area agency on aging (AAA) or its subcontractor.

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NEW SECTION
WAC 388-106-1205 What are respite care services? Respite services relieve unpaid caregivers by providing temporary care or supervision to adults with a functional disability.

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NEW SECTION
WAC 388-106-1210 Who is eligible to receive respite care services? (1) To be eligible to receive respite care services, the caregivers must:

(a) Have primary responsibility for the daily continuous care or supervision of an adult with a functional disability;

(b) Provide a minimum of an average of twelve hours per day for care or supervision;

(d) Be assessed as being at risk of placing the participant in a long-term care facility if home and community support services, including respite care, are not available.

(2) An eligible participant is an adult who:

(a) Has a functional disability;

(b) Needs daily substantial continuous care or supervision; and

(c) Is assessed as requiring placement in a long-term care facility if home and community support services, including respite care, are not available.

(3) The Area Agency on Aging (AAA) determines how many hours of continuous care or supervision a day an unpaid caregiver must provide to a participant to become eligible for respite care services.

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NEW SECTION
WAC 388-106-1215 Who may provide respite care services? Respite care providers include, but are not limited to the following:

(1) Nursing homes (chapter 388-97 WAC).

(2) Adult day services, which includes adult day care and adult day health.

(3) Home health/care agencies.

(4) Hospitals.

(5) Licensed residential care facilities such as boarding homes, adult family homes, and assisted living facilities.

(6) Providers such as volunteer chore workers, senior companions, and individual providers.

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NEW SECTION
WAC 388-106-1220 How are respite care providers reimbursed for their services? The department reimburses:

(1) Respite care providers for the number of hours or days of services authorized and used. The rate that is established for the services is negotiated between the respite care program of the local area agency on aging and the respite care service provider.

(2) Medicaid-certified nursing homes and DDD-certified group homes providing respite services the Medicaid rate approved for that facility. Contracted nursing homes must not charge more than the Medicaid rate for any services covered from the date of eligibility, unless authorized by the department (see RCW 18.51.070). Participants must pay for services not included in the Medicaid rate.

(3) Private nursing homes at their published daily rate.

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NEW SECTION
WAC 388-106-1225 Are participants required to pay for the cost of their services? (1) There is no charge to the participant whose income is at or below forty percent of the state median income, based on a family of four.

(2) If the participant's gross income is above forty percent of the state median income, he or she is required to pay for part or all of the cost of the respite care services. The department will determine what amount the participant must contribute based on the state median income and family size.

(3) If the participant's gross income is one hundred percent or more of the state median income, the participant must pay the full cost of services.

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NEW SECTION
WAC 388-106-1230 Are there waiting lists for respite services? (1) The department must first consider requests for emergency respite care. An example of an emergency is when the caregiver becomes ill or injured to the extent that the caregiver's ability to care for the participant is impaired.

(2) In non-emergency situations, respite care is allocated based upon available respite funds at the local level. Respite care must be provided on a first-come, first-served basis. If sufficient funds are not available when respite care is requested, services are made available using waiting lists and department-approved priority categories, developed by the AAA, including caregiver vulnerability and health condition, availability of other support systems, and whether other family members need care.

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CLIENT RIGHTS
NEW SECTION
WAC 388-106-1300 What rights do I have as a client of the department? As a client of the department, you have a right to:

(1) Be treated with dignity, respect and without discrimination;

(2) Not be abused, neglected, financially exploited, abandoned;

(3) Have your property treated with respect;

(4) Not answer questions, turn down services, and not accept case management services you do not want to receive. However, it may not be possible for the department to offer some services if you do not give enough information;

(5) Be told about all services you can receive and make choices about services you want or don't want;

(6) Have information about you kept private within the limits of the laws and DSHS regulations;

(7) Be told in writing of agency decisions and receive a copy of your care plan;

(8) Make a complaint without fear of harm;

(9) Not be forced to answer questions or do something you don't want to;

(10) Talk with your social service worker's supervisor if you and your social service worker do not agree;

(11) Request a fair hearing;

(12) Have interpreter services provided to you free of charge if you cannot speak or understand English well;

(13) Take part in and have your wishes included in planning your care;

(14) Choose, fire, or change a qualified provider you want; and

(15) Receive results of the background check for any individual provider you choose.

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NEW SECTION
WAC 388-106-1305 What if I disagree with the result of the CARE assessment and/or other decisions made by the department? You have a right to contest the result of your CARE assessment and/or other decisions made by the department. The department will notify you in writing of the right to contest a decision and provide you with information on how to request a hearing.

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NEW SECTION
WAC 388-106-1310 When I request a fair hearing on my CARE assessment and another CARE assessment(s) is done between my fair hearing request and the fair hearing, which CARE assessment must the administrative law judge review? When you request a fair hearing on your CARE assessment and another CARE assessment(s) is done between your fair hearing request and the fair hearing, the administrative law judge must review the most recent CARE assessment.

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3508.1
REPEALER

The following sections of the Washington Administrative Code are repealed:

WAC 388-72A-0005 When do the rules in chapter 388-72A WAC apply to me?

WAC 388-72A-0010 Do chapter 388-71 WAC and WAC 388-845-1300 apply to me?

WAC 388-72A-0015 If the department did not use the CARE tool for my last assessment, may I have my assessments done on the assessment form used for my last assessment?

WAC 388-72A-0020 What is an assessment?

WAC 388-72A-0025 What is the process for conducting an assessment?

WAC 388-72A-0030 What is the purpose of an assessment?

WAC 388-72A-0035 What are personal care services?

WAC 388-72A-0036 How are my needs for personal care services determined?

WAC 388-72A-0037 How are self-performance and support provided for the activities of daily living (ADLs) scored?

WAC 388-72A-0038 How are the ADLs bathing, body care, and medication management scored?

WAC 388-72A-0039 How are self-performance and difficulty for the instrumental activities of daily living (IADLs) scored?

WAC 388-72A-0041 How are status and assistance available scored for ADLs and IADLs?

WAC 388-72A-0042 How are ADLs and IADLs scored for children?

WAC 388-72A-0043 How are other elements in CARE scored for children age seventeen and younger and foster care clients?

WAC 388-72A-0045 How will the department plan to meet my care needs?

WAC 388-72A-0050 What if I disagree with the result of the assessment or the decisions about what services I may receive?

WAC 388-72A-0053 Am I eligible for one of the HCP programs?

WAC 388-72A-0055 Am I eligible for COPES-funded services?

WAC 388-72A-0057 Am I eligible for medically needy residential waiver (MNRW)-funded services?

WAC 388-72A-0058 Am I eligible for medically needy in-home wavier (MNIW)-funded services?

WAC 388-72A-0060 Am I eligible for MPC-funded services?

WAC 388-72A-0065 Am I eligible for Chore-funded services?

WAC 388-72A-0069 How does CARE use the information the assessor gathers?

WAC 388-72A-0070 What are the in-home hours and residential rate based on?

WAC 388-72A-0080 What criteria does the CARE tool use to place a client in one of the classification groups?

WAC 388-72A-0081 How is cognitive performance measured in the CARE tool?

WAC 388-72A-0082 How is clinical complexity measured within the CARE tool?

WAC 388-72A-0083 How are mood and behaviors measured within the CARE tool?

WAC 388-72A-0084 How are ADL scores measured within the CARE tool?

WAC 388-72A-0085 How does the CARE tool evaluate for the two exceptional care classifications of in-home care?

WAC 388-72A-0086 How is the information in WAC 388-72A-0081 through 388-72A-0084 used to determine the client's classification payment group for residential settings?

WAC 388-72A-0087 How is the information in WAC 388-72A-0081 through 388-72A-0085 used to determine the classification payment group for in-home clients?

WAC 388-72A-0090 What are the maximum hours that I can receive for in-home services?

WAC 388-72A-0092 How are my in-home hours determined?

WAC 388-72A-0095 What additional criteria are considered to determine the number of hours I will receive for in-home services?

WAC 388-72A-0100 Are there other in-home services I may be eligible to receive in addition to those described in WAC 388-72A-0095(3)?

WAC 388-72A-0105 What would cause a change in the maximum hours authorized?

WAC 388-72A-0110 How much will the department pay for my care?

WAC 388-72A-0115 When the department adjusts an algorithm, when does the adjustment become effective?

WAC 388-72A-0120 When a client requests a fair hearing to have the client's CARE tool assessment results reviewed and there is (are) a more recent CARE assessment(s), which CARE tool assessment does the administrative law judge review in the fair hearing?

3500.3COMPREHENSIVE ASSESSMENT (CA)
NEW SECTION
WAC 388-71-0210 What is the purpose of WAC 388-71-0210 through 388-71-0260? The purpose of this section is to describe comprehensive assessment and service plan procedures and eligibility criteria for children age seventeen and younger, receiving Medicaid Personal Care (MPC). This section does not apply to you if you are assessed in the comprehensive assessment reporting evaluation (CARE).

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NEW SECTION
WAC 388-71-0215 What definitions apply to WAC 388-71-0210 through 0260? The following definitions apply to this chapter:

"Ambulation" means assisting the child to move around as a result of a disability. Ambulation includes age appropriate supervision of the child 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 child if able to propel a wheelchair if guided, pushing of the wheelchair, and providing constant or standby physical assistance to the child if totally unable to walk alone or with a mechanical device.

"Assessment" means an inventory and evaluation of a child's abilities and needs based on an in-person interview in the child's own home.

"Bathing" means assisting the child to wash. Bathing includes age appropriate supervision of the child who is able to bathe when guided, assisting the child with difficult tasks such as getting in or out of the tub or washing back, and completely bathing the child if totally unable to wash self.

"Body care" means age appropriate assistance to the child, as a result of a disability, with exercises, skin care including the application of non-prescribed ointments or lotions, changing dry bandages or dressings when professional judgment is not required, and pedicure to trim toenails and apply lotion to feet. Body care excludes:

• Foot care for child who is diabetic or has poor circulation; or

• Changing bandages or dressings when sterile procedures are required.

"Child/Children" means a child age seventeen and younger.

"Department" means the state department of social and health services, aging and disability services administration.

"Dressing" means age appropriate assistance with dressing and undressing as a result of the child's disability. Dressing includes supervising and guiding the child when dressing and undressing, assisting with difficult tasks such as tying shoes and buttoning, and completely dressing or undressing when unable to participate in dressing or undressing self.

"Eating" means age appropriate assistance with eating as a result of the child's disability. Eating includes supervising children when able to feed self if guided, assisting with difficult tasks such as cutting food or buttering bread, and feeding the child when unable to feed self.

"Household assistance" means assistance with incidental household tasks provided as an integral, but subordinate part of personal care. Household assistance is considered an integral part of personal care when such assistance is directly related to the children's medical or mental health condition, is reflected in the children's service plan, and is provided only when children are assessed as needing personal care assistance with one or more direct personal care tasks. Household assistance tasks include a second adult to assist with travel to medical services, meal preparation, laundry, housework.

"Housework" means, as a result of the child's disability, extraordinary housekeeping measures are required. The following are examples: daily extensive cleaning due to a child's severe allergies or substantial cleanup is required due to destructive behaviors which are a result of the child's disability.

"Laundry" means extraordinary laundry needs are required due to excessive soiling related to the child's medical condition.

"Meal preparation" means unusual time or tasks are required such as ground food or special diet preparations due to the child's disability.

"Own Home" means any of the following places where the child resides:

• In the home of the natural, step, or adoptive parent;

• In a relative's established residence;

• In the home of any legally responsible adult; or

• In a Children's Administration licensed and paid child foster home.

"Personal care services" mean both physical assistance and/or prompting and supervising the performance of direct personal care tasks and household tasks. Such services may be provided for children 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 that are age appropriate for children or performed by a licensed health professional.

"Personal hygiene" means age appropriate assistance required as a result of the child's disability with care of hair, teeth, shaving, menses care, filing of nails, and other basic personal hygiene and grooming needs. Personal hygiene includes supervising the child when performing the tasks, assisting the child to care for own appearance, and performing grooming tasks when the child is unable to care for own appearance.

"Positioning" means age appropriate assistance required as a result of the child's disability 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.)

"Supervision" means being available to:

• Help the child with age appropriate personal care tasks that cannot be scheduled, such as toileting, ambulation, transfer, positioning, as a result of a disability; and

• Provide age appropriate protective supervision to a child age twelve or older who cannot be left alone due to the disability.

"Toileting" means age appropriate assistance with bladder or bowel functions as a result of the child's disability. Toileting includes guidance when the child is able to care for own toileting needs, helping to and from the bathroom, assisting with bedpan routines, using incontinent briefs on the child, and lifting the child on and off the toilet. Toileting may include performing routine perineal care, colostomy care, or catheter care for the child when he/she is able to supervise the activities.

"Transfer" means age appropriate assistance required, as a result of the child's disability, 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 child when able to transfer if guided, providing steadying, and helping the child when he/she can assist in own transfer.

"Travel to medical services" means transporting the child to a physician's office or clinic in the local area to obtain medical diagnosis or treatment when a child, as a result of a disability, requires a second adult to accompany the parent or guardian.

"You" means a child.

[]

NEW SECTION
WAC 388-71-0220 What is an assessment? An assessment is an inventory and evaluation of abilities and needs based on an in-person interview in your own home or place of residence, using the department-prescribed form, comprehensive assessment (child).

[]

NEW SECTION
WAC 388-71-0225 What is the purpose of a Comprehensive Assessment? The purpose of the Comprehensive Assessment is to:

(1) Identify strengths to maximize current strengths and promote your independence;

(2) Evaluate physical health, functional and cognitive abilities, social resources and emotional and social functioning for service planning for long-term care;

(3) Identify your values and preferences for effective service planning; and

(4) Determine your need for informal support, community support and services, and department paid services.

(5) Account for your:

(a) Health status, psychological/social/cognitive functioning, income and resources, and functional abilities;

(b) Living situation; and

(c) Availability of alternative resources providing needed assistance, including family, neighbors, friends, community programs, and volunteers.

[]

NEW SECTION
WAC 388-71-0230 How are my needs for MPC services assessed? (1) Using the comprehensive assessment, the department will determine your ability to self-perform each personal care task and household task using the following definitions of the assistance required:

(a) Ambulation:

(i) Independent. No special assistance is needed.

(ii) Minimal. You are age four or older and you need your hand held on stairs or uneven surfaces or use adaptive devices with minimal assistance.

(iii) Substantial. You are age four or older and mobile inside but need assistance of another person outside.

(iv) Total.

(A) You are age two or three and always require total physical assistance (e.g. you need to be carried or your caregiver must push your manual wheelchair).

(B) You are age four or older and only mobile with physical assistance of another person or need ongoing assistance with adaptive devices.

(b) Bathing:

(i) Independent. You can bathe self.

(ii) Minimal.

(A) You are age eight or older and require minor physical or verbal assistance such as adjusting water temperature; or

(B) You are age five or older and require the presence of an adult in the room due to your health condition.

(iii) Substantial. You are age five or older and require physical help in a large part of the bathing activity (i.e. to lather, wash and/or rinse own body or hair).

(iv) Total. You are age five or older and dependent on others to provide a complete bath.

(i) Independent. No specialized body care is needed.

(ii) Minimal. You are age ten or older and need reminding or occasional physical assistance to: Apply non-prescription ointments or lotion; perform non-sterile bandage or dressing change; or perform exercises.

(iii) Substantial. You are age ten or older and require limited physical help to: Apply ointment/lotion; perform non-sterile bandage or dressing change; or perform exercises on a daily basis.

(iv) Total. You are age ten or older and dependent on others to perform all required body care.

(d) Dressing:

(i) Independent. You can dress and undress without assistance or supervision.

(ii) Minimal. You are age eight or older and need some physical assistance, reminders, or supervision several times per week.

(iii) Substantial. You are age four or older and need daily physical assistance to do parts of dressing and undressing.

(iv) Total. You are age four or older and totally dependent on others to do all dressing and undressing or significant time and effort is required due to the nature of your disability or behavior.

(e) Eating:

(i) Independent. You can feed self, chew and swallow solid foods without difficulty, or can feed self by stomach tube or catheter.

(ii) Minimal. You are age four or older and can feed self, chew and swallow, but need verbal prompting to maintain adequate intake; or you are age ten or older and also need assistance with such things as cutting up food, buttering bread and pouring liquids.

(iii) Substantial. You are age three or older and

(A) Can feed self but need stand-by assistance for occasional gagging, choking, or swallowing difficulty; or

(B) Need reminders/assistance with adaptive feeding equipment; or

(iv) Total. You are a child of any age who needs extraordinary time and supervision due to behavior issues or because you frequently gag or choke due to swallowing difficulties.

(f) Housework:

(i) Independent. No extraordinary housework needs.

(ii) Total. You are a child of any age who, as a result of your disability, requires extraordinary housekeeping measures such as daily extensive cleaning due to severe allergies or substantial clean up is required due to destructive behaviors.

(g) Laundry:

(i) Independent. No additional needs for laundry.

(ii) Total. You are a child of any age who has extraordinary laundry needs or clothing repairs due to excessive soiling related to your medical condition.

(h) Meal preparation:

(i) Independent. No unusual time or activities required or you are able to participate as expected in simple meal preparation.

(ii) Total. You are a child of any age and unusual time or tasks are required such as grinding food or special diet preparations; or you are age ten or older and totally dependent on others for meal preparation due to cognitive, physical or behavioral disability.

(i) Personal hygiene:

(i) Independent. You can manage personal hygiene and grooming tasks on a regular basis.

(ii) Minimal. You are age twelve or older and must be reminded and supervised at least some of the time.

(iii) Substantial. You are age eight or older and always require direct physical assistance with such tasks as combing hair, brushing teeth, menses care and shaving.

(iv) Total. You are age five or older and all personal hygiene must be done by someone else.

(j) Positioning:

(i) Independent. No positioning needed.

(ii) Minimal. You are age three or older and require assistance some of the time.

(iii) Substantial. You are age three or older and can move self, but assistance with positioning is required throughout the day such as specialized sleeping positions, sitting supports and/or minor adjustments to adaptive equipment.

(iv) Total.

(A) You are age two or older and cannot move self and require positioning by another person most or all of the time throughout the day; or

(B) You are a child of any age who requires scheduled positioning changes by another person throughout the night.

(k) Toileting:

(i) Independent. No additional help is needed.

(ii) Minimal. You are age four or older and:

(A) Require verbal cueing and/or have occasional infrequent daytime toileting accidents and/or have a toileting program that must be followed; or

(B) Need occasional physical assistance for one or more of the following: clothing adjustments, washing hands, wiping and cleansing.

(iii) Substantial. You are age four or older and cannot get to the toilet without assistance; or need substantial physical assistance at least daily with part of the task.

(iv) Total.

(A) You are age four or older and require total cleansing and are unable to use toilet or require incontinence supplies.

(B) You are a child of any age and have a medical condition requiring more frequent scheduled change of incontinence garments on a twenty-four hour basis.

(C) You are age eight or older, you are continent during the day but are incontinent at night and require incontinence garment changes during the night.

(l) Transfer:

(i) Independent. You can transfer without physical assistance.

(ii) Minimal. You are age four or older and need assistance on occasion.

(iii) Substantial. You are age four or older and need daily assistance and can bear some weight and assist with your transfer; or weigh less than thirty pounds.

(iv) Total. You are a child of any age who weighs thirty pounds or more and requires total physical support of the caregiver to transfer.

(m) Travel to medical services:

(i) Independent. No unusual transportation needs required.

(ii) Minimal. You are a child of any age and have a medical condition that requires a second adult to assist with transport to medical appointments less than monthly.

(iii) Substantial. You are a child of any age and have a medical condition that requires a second adult to assist with transport to medical appoints at least monthly.

(iv) Total. You are a child of any age and have a medical condition that requires a second adult to assist with transport to medical appoints at least weekly.

(2) The department will score functional abilities and supports.

(a) For each direct personal care service and household assistance task listed on the CA, the department must determine:

(i) Your ability to perform each activity;

(ii) Assistance available to you through alternative resources, including parents, 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 department must award points for each task based on the level of unmet need. The number of points allowable for each task is listed below under columns identified as 0 = none, M = minimal, S = substantial, and T = total:

Task 0 M S T

Eating 0 5 12 16

Toileting 0 5 12 16

Ambulation 0 8 10 12

Transfer 0 4 8 11

Positioning 0 3 5 7

Body care 0 4 5 6

Personal hygiene 0 4 6 8

Dressing 0 5 8 12

Bathing 0 4 8 10

Travel to medical services 0 1 2 3

Meal preparation 0 0 0 6

Laundry 0 0 0 4

Housework 0 0 0 5

(c) The department must add together the points awarded for each task to obtain the total score for you.

(3) The department must determine if additional hours of supervision are needed:

(a) Due to cognitive protective supervision; and

(b) For standby assistance necessary for unscheduled tasks (NOTE: Supervision hours show a child's need and may not reflect department paid hours as determined by program standards.)

(4) The department must authorize services to correspond with your assessed need according to eligibility criteria and your service plan. The department must notify you of the right to contest the department's decision and/or the results of the assessment.

[]

Reviser's note: The typographical errors in the above section occurred in the copy filed by the agency and appear in the Register pursuant to the requirements of RCW 34.08.040.
NEW SECTION
WAC 388-71-0235 What is a service plan? (1) The department must develop a service plan with you to identify ways to meet your needs with the most appropriate services, both formal and informal.

(2) The department must document:

(a) Your specific problems and needs;

(b) A plan for meeting each need;

(d) Anticipated outcomes;

(e) Dates and changes to the plan;

(f) Dates of referral, service initiation, follow-up reviews; and

(g) Your agreement to the service plan.

[]

NEW SECTION
WAC 388-71-0240 What services may I receive under MPC as a child? You may receive personal care services in your own home as defined in WAC 388-71-0215, and as applicable, assistance with personal care tasks while you are out of the home accessing community resources.

[]

NEW SECTION
WAC 388-71-0245 What services are not covered under MPC for children? MPC does not cover the following services:

(1) Teaching, including teaching how to perform personal care tasks;

(2) Development of social, behavioral, recreational, communication, or other types of community living skills;

(3) Nursing care;

(4) Personal care services provided outside of your residence, unless the services are authorized in your written service plan and meet the program criteria;

(5) Child care;

(6) Respite care:

(7) Sterile procedures, administration of medications, or other tasks requiring a licensed health professional, unless provided by a family member;

(8) Services provided over the telephone;

(9) Services provided outside the state of Washington unless you are receiving personal care assistance while temporarily traveling out of state and:

(i) Your individual provider is contracted with the state of Washington; and

(ii) The travel plans are coordinated with your social service case manager prior to departure; and

(iii) Services are authorized on your service plan prior to departure; and

(iv) Services are strictly for your personal care, which does not include your provider's travel time, expenses, lodging or subsistence;

(10) Services to assist other household members not eligible for services; and

(11) Yard care.

[]

NEW SECTION
WAC 388-71-0250 Am I eligible for MPC services? To be eligible for MPC-funded services you must:

(1) Have unmet need for substantial assistance with at least one of the following direct personal care tasks or have unmet needs for minimal assistance with three of the following direct personal care tasks:

(a) Ambulation;

(b) Bathing;

(d) Dressing;

(e) Eating;

(f) Personal hygiene;

(g) Positioning;

(h) Self-medication;

(i) Toileting; or

(j) Transfer.

(2) Be certified as Title 19 categorically needy, as defined in WAC 388-500-0005.

(3) Be assessed by department staff or designee using a department approved comprehensive assessment and have a determination of unmet needs for services.

[]

NEW SECTION
WAC 388-71-0255 How do children remain eligible for MPC services? In order to remain eligible for services, you must:

(1) Be reassessed at least every twelve months; and

(2) Meet eligibility requirements for MPC.

[]

NEW SECTION
WAC 388-71-0260 Are there limitations to MPC services for children? The following are limitations to MPC services you can receive:

(1) MPC services may not replace other available resources, both paid and unpaid.

(2) ADSA 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 not pay for housework, laundry, or meal preparation, when you and your individual provider, agency provider, or personal aide live in the same household.

(4) The department will adjust payments to an individual provider, agency provider, or personal aide who is doing household tasks for more than one client living in the same household.

(5) MPC cannot pay for services already reimbursed with other state and federal funding.

[]

3489.5
AMENDATORY SECTION(Amending WSR 02-21-098, filed 10/21/02, effective 11/21/02)

WAC 388-71-0500 What is the purpose of WAC 388-71-0500 through 388-71-05909? A client/legal representative may choose an individual provider or a home care agency provider. The intent of WAC 388-71-0500 through 388-71-05909 is to describe the:

(1) Qualifications of an individual provider, as defined in WAC ((~~388-71-202~~)) 388-106-0010;

(2) Qualifications of a home care agency provider, as defined in WAC ((~~388-71-202~~)) 388-106-0010 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: RCW 74.08.090, 74.09.520, and 74.39A.090. 02-21-098, § 388-71-0500, filed 10/21/02, effective 11/21/02. 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.]

Reviser's note: RCW 34.05.395 requires the use of underlining and deletion marks to indicate amendments to existing rules. The rule published above varies from its predecessor in certain respects not indicated by the use of these markings.
AMENDATORY SECTION(Amending WSR 02-21-098, filed 10/21/02, effective 11/21/02)

WAC 388-71-0515 What are the responsibilities of an individual provider or home care agency provider when employed to provide care to a client? An individual provider or home care agency provider must:

(1) Understand the client's ((~~service~~)) plan of care 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 388-71-202 and 388-71-203~~)) plan of care, as defined in WAC 388-106-0010;

(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 of care;

(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, and 74.39A.090. 02-21-098, § 388-71-0515, filed 10/21/02, effective 11/21/02. 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, § 388-71-0515, 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.]

AMENDATORY SECTION(Amending WSR 04-02-001, filed 12/24/03, effective 1/24/04)

WAC 388-71-0520 Are there training requirements for an individual provider or a home care agency provider of an adult client? An individual provider or a home care agency provider for an adult client must meet the training requirements in WAC 388-71-05665 through ((~~388-71-05909~~)) 388-71-05865.

[Statutory Authority: RCW 74.39A.050, 2003 c 140, chapters 18.79, 18.88A RCW. 04-02-001, § 388-71-0520, filed 12/24/03, effective 1/24/04. Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0520, 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. 00-03-043, § 388-71-0520, filed 1/13/00, effective 2/13/00.]

AMENDATORY SECTION(Amending WSR 02-10-117, filed 4/30/02, effective 5/31/02)

WAC 388-71-0540 When will the department or AAA deny payment for services of an individual provider or home care agency provider? The department or AAA will deny payment for the services of an individual provider or home care agency provider who:

(1) Is the client's spouse, per 42 C.F.R. 441.360(g), except in the case of an individual provider for a chore services client. Note: For chore ((~~[e]~~))spousal providers, the department pays a rate not to exceed the amount of a one-person standard for a continuing general assistance grant, per WAC 388-478-0030;

(2) Is the natural/step/adoptive parent of a minor client aged seventeen or younger receiving services under ((~~this chapter~~)) Medicaid Personal Care;

(3) Has been convicted of a disqualifying crime, under RCW 43.43.830 and 43.43.842 or of a crime relating to drugs as defined in RCW 43.43.830;

(4) Has abused, neglected, abandoned, or exploited a minor or vulnerable adult, as defined in chapter 74.34 RCW;

(5) Has had a license, certification, or a contract for the care of children or vulnerable adults denied, suspended, revoked, or terminated for noncompliance with state and/or federal regulations;

(6) Does not successfully complete the training requirements within the time limits required in WAC ((~~388-71-05910 through 388-71-05952~~)) 388-71-05665 through 388-71-05865;

(7) Is already meeting the client's needs on an informal basis, and the client's assessment or reassessment does not identify any unmet need; and/or

(8) Is terminated by the client (in the case of an individual provider) or by the home care agency (in the case of an agency provider).

(9) In addition, the department or AAA may deny payment to or terminate the contract of an individual provider as provided under WAC 388-71-0546, 388-71-0551, and 388-71-0556.

[Statutory Authority: Chapter 74.39A RCW and 2000 c 121. 02-10-117, § 388-71-0540, 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, § 388-71-0540, 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, § 388-71-0540, filed 1/13/00, effective 2/13/00.]

NEW SECTION
WAC 388-71-05832 What is safety training? Safety training and applicable requirements are defined in WAC 257-05-020 through WAC 257-05-240.

[]

AMENDATORY SECTION(Amending WSR 03-06-024, filed 2/24/03, effective 7/1/03)

WAC 388-71-0704 Adult day care -- Services. ((~~(1)~~)) Adult day care is a supervised daytime program providing core services as defined ((~~under subsection (2) of this section~~)) in WAC 388-106-0800. Core services are appropriate for adults with medical or disabling conditions that do not require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician.

((~~(2) The adult day care center must offer and provide on site the following core services:~~

~~(a) The following personal care services as defined in WAC 388-71-0202, "personal care services," or its successor:~~

~~(i) Ambulation;~~

~~(ii) Body care;~~

~~(iii) Eating;~~

~~(iv) Positioning;~~

~~(v) Self-medication;~~

~~(vi) Transfer;~~

~~(vii) Toileting;~~

~~(viii) Personal hygiene at a level that ensures client safety and comfort while in attendance at the program; and~~

~~(ix) Bathing at a level that ensures client safety and comfort while in attendance at the program.~~

~~(b) Social services on a consultation basis, which may include:~~

~~(i) Referrals to other providers for services not within the scope of Medicaid reimbursed adult day care services;~~

~~(ii) Caregiver support and education; or~~

~~(iii) Assistance with coping skills.~~

~~(c) Routine health monitoring with consultation from a registered nurse that a consulting nurse acting within the scope of practice can provide with or without a physician's order. Examples include:~~

~~(i) Obtaining baseline and routine monitoring information on a client's health status, such as vital signs, weight, and dietary needs;~~

~~(ii) General health education such as providing information about nutrition, illnesses, and preventive care;~~

~~(iii) Communicating changes in the client's health status to the client's caregiver;~~

~~(iv) Annual and as needed updating of the client's medical record;~~

~~(v) Assistance as needed with coordination of health services provided outside of the adult day care program.~~

(d) General therapeutic activities that an unlicensed person can provide or that a licensed person can provide with or without a physician's order. These services are planned and provided as an integral part of the client's plan of care and are based on the client's abilities, interests and goals. Examples include:

~~(i) Recreational activities;~~

~~(ii) Diversionary activities;~~

~~(iii) Relaxation therapy;~~

~~(iv) Cognitive stimulation;~~

~~(v) Group range of motion or conditioning exercises.~~

~~(e) General health education that an unlicensed person can provide or that a licensed person can provide with or without a physician's order, including but not limited to topics such as:~~

~~(i) Nutrition;~~

~~(ii) Stress management;~~

~~(iii) Disease management skills;~~

~~(iv) Preventive care.~~

(f) A nutritional meal and snacks provided each four-hour period at regular times comparable to normal meal times, including modified diet if needed and within the scope of the program, as provided under WAC 388-71-0768;

~~(g) Supervision and/or protection for clients who require supervision or protection for their safety;~~

~~(h) Assistance with arranging transportation to and from the program; and~~

~~(i) First aid and provisions for obtaining or providing care in an emergency.~~))

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.200, 74.08.090, 74.09.520, and 74.39A.030. 03-06-024, § 388-71-0704, filed 2/24/03, effective 7/1/03.]

AMENDATORY SECTION(Amending WSR 03-06-024, filed 2/24/03, effective 7/1/03)

WAC 388-71-0706 Adult day health -- Services. ((~~(1)~~)) Adult day health is a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services ((~~outlined in WAC 388-71-0704~~)). Adult day health services are only appropriate for adults with medical or disabling conditions that require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician.

((~~(2)~~)) The adult day health center must offer and provide on site the ((~~following~~)) services((:

~~(a) All core services under WAC 388-71-0704;~~

~~(b) Skilled nursing services other than routine health monitoring with nurse consultation;~~

(c) At least one of the following skilled therapy services: physical therapy, occupational therapy, or speech-language pathology or audiology, as those services are defined under chapter 18.74, 18.59, and 18.35 RCW, respectively; and

(d) Psychological or counseling services, including assessing for psycho-social therapy need, dementia, abuse or neglect, and alcohol or drug abuse; making appropriate referrals; and providing brief, intermittent supportive counseling)) listed in WAC 388-106-0810.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.200, 74.08.090, 74.09.520, and 74.39A.030. 03-06-024, § 388-71-0706, filed 2/24/03, effective 7/1/03.]

AMENDATORY SECTION(Amending WSR 04-16-029, filed 7/26/04, effective 8/26/04)

WAC 388-71-0708   Adult day care -- Eligibility.   ((~~(1) COPES or MNIW~~)) Clients ((~~may be~~)) are eligible for adult day care ((~~as a waiver service~~)) services if they ((are assessed as having an unmet need for one or more of the following core services identified in WAC 388-71-0704:
     (a) Personal care services;
     (b) Routine health monitoring with consultation from a registered nurse;
     (c) General therapeutic activities; or
     (d) Supervision and/or protection for clients who require supervision or protection for their safety.
     (2) COPES or MNIW clients are not eligible for adult day care if they:
     (a) Can independently perform or obtain the services provided at an adult day care center;
     (b) Have unmet needs that can be met through the COPES program more cost effectively without authorizing day care services;
     (c) Have referred care needs that:
     (i) Exceed the scope of authorized services that the adult day care center is able to provide;
     (ii) Can be met in a less structured care setting; or
     (iii) Are being met by paid or unpaid caregivers.
     (d) Live in a nursing home, boarding home, adult family home, or other licensed institutional or residential facility; or

~~(e) Are not capable of participating safely in a group care setting~~)) meet criteria outlined in WAC 388-106-0805.

[Statutory Authority: 2004 c 276 § 206 (6)(b) and Townsend vs. DSHS, U.S. District Court, Western District of Washington, No. C 00-0944Z. 04-16-029, § 388-71-0708, filed 7/26/04, effective 8/26/04. Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.200, 74.08.090, 74.09.520, and 74.39A.030. 03-06-024, § 388-71-0708, filed 2/24/03, effective 7/1/03.]

AMENDATORY SECTION(Amending WSR 03-06-024, filed 2/24/03, effective 7/1/03)

WAC 388-71-0710   Adult day health -- Eligibility.   ((~~(1)~~)) Clients are eligible for adult day health services if they meet ((all of the following criteria:
     (a) Age eighteen years or older; and
     (b) Identified on their medical assistance identification (MAID) card, or through other methods of eligibility verification, as enrolled in one of the following medical assistance programs:
     (i) Categorically needy (CNP);
     (ii) Categorically needy qualified Medicare beneficiaries (CNP-QMB);
     (iii) General assistance -- Expedited Medicaid Disability (GA-X); or
     (iv) Alcohol and Drug Abuse Treatment and Support Act (ADATSA).
     (c) Assessed as having an unmet need for skilled nursing under WAC 388-71-0712 or skilled rehabilitative therapy under WAC 388-71-0714, and:
     (i) There is a reasonable expectation that these services will improve, restore or maintain the client's health status, or in the case of a progressive disabling condition, will either restore or slow the decline of the client's health and functional status or ease related pain or suffering; and
     (ii) The client is at risk for deteriorating health, deteriorating functional ability, or institutionalization; and
     (iii) The client has a chronic or acute health condition that he or she is not able to safely manage due to a cognitive, physical, or other functional impairment.
     (d) Assessed as having needs for personal care or other core services under WAC 388-71-0708, whether or not those needs are otherwise met.
     (2) Clients are not eligible for adult day health if they:
     (a) Can independently perform or obtain the services provided at an adult day health center;
     (b) Have referred care needs that:
     (i) Exceed the scope of authorized services that the adult day health center is able to provide;
     (ii) Do not need to be provided or supervised by a licensed nurse or therapist;
     (iii) Can be met in a less structured care setting; or
     (iv) In the case of skilled care needs, are being met by paid or unpaid caregivers.
     (c) Live in a nursing home or other institutional facility; or

~~(d) Are not capable of participating safely in a group care setting~~)) the criteria outlined in WAC 388-106-0815.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.200, 74.08.090, 74.09.520, and 74.39A.030. 03-06-024, § 388-71-0710, filed 2/24/03, effective 7/1/03.]

AMENDATORY SECTION(Amending WSR 03-06-024, filed 2/24/03, effective 7/1/03)

WAC 388-71-0716 Adult day care -- Assessment and service plan. (1) The department or an authorized case manager must ((~~assess a client's need for adult day care in accordance with WAC 388-71-0203 and 388-71-0716~~)) perform a CARE assessment to determine a client's need for adult day care, per WAC 388-106-0065. Based on the assessment, the case manager determines whether the client should be referred for day care services or whether the client's needs can be met in other ways.

(2) If the case manager determines an unmet need for a core service that may be provided at a day care center, the case manager works with the client and/or the client's representative to develop a service plan that documents the needed services and the number of days per week that the services are to be provided. The case manager refers the client to a ((~~COPES~~)) waiver-contracted day care center that the client and the case manager agree can potentially meet the client's needs.

(3) Clients receiving adult day care services must be reassessed at least annually ((~~in accordance with WAC 388-71-0203 and 388-71-0716~~)).

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.200, 74.08.090, 74.09.520, and 74.39A.030. 03-06-024, § 388-71-0716, filed 2/24/03, effective 7/1/03.]

AMENDATORY SECTION(Amending WSR 03-06-024, filed 2/24/03, effective 7/1/03)

WAC 388-71-0720 Adult day health -- Assessment and service plan. (1) The department or an authorized case manager must ((~~assess a client's potential need for adult day health in accordance with WAC 388-71-0203 and 388-71-0720~~)) perform a CARE assessment to determine a client's need for adult day health, per WAC 388-106-0065. Based on the assessment, the case manager determines whether the client should be referred for day health services or whether the client's needs can be met in other ways.

(2) If the client has a department or area agency on aging case manager, the adult day health center or other referral source must notify the case manager of the client's potential adult day health service need. The case manager must assess the client's need for skilled nursing or skilled rehabilitative therapy within the department's normal time frames for client reassessments.

(3) If the client does not have a department or area agency on aging case manager, the adult day health center or other referral source must notify the department of the referral and the client's potential adult day health service need, or refer the client to the department for intake. The department's assigned case manager must assess the client's need for adult day health services within the department's normal time frames for initial client eligibility assessments.

(4) ((Based on the assessment, the department or area agency on aging case manager determines whether the client should be referred for a day health service evaluation or whether the client's needs can be met in other ways.)) The case manager may consult with the client's practitioner, department or area agency on aging nursing services staff, or other pertinent collateral contacts, concerning the client's need for skilled nursing or rehabilitative therapy.

(5) If the department or area agency on aging case manager determines and documents a potential unmet need for day health services, the case manager works with the client and/or the client's representative to develop a service plan that documents the potential unmet needs and the anticipated number of days per week that the services are needed. The case manager refers the client to a department contracted day health center for evaluation and the development of a preliminary negotiated plan of care.

(6) The department or area agency on aging case manager must reassess adult day health clients at least annually ((~~in accordance with WAC 388-71-0203 and 388-71-0720 or its successor~~)). Clients must also be reassessed if they have a break in service of more than thirty days. The adult day center must inform the case manager of the break in service so payment authorization can be discontinued.

(7) ((~~Effective upon the adoption of these rules,~~ )) Recipients of adult day health services must be assessed by the department or an authorized case manager for continued or initial eligibility ((~~in accordance with this section. The assessment from the department will occur in conjunction with the~~)) as follows:

(a) Annual reassessment for department clients;

(b) Adult day health quarterly review for current nondepartmental clients as resources allow; and

(c) New referrals for adult day health services are to be forwarded to local department offices for intake and assessment for eligibility.

(8) The department or area agency on aging case manager must review a client's continued eligibility for adult day health services every ninety days, coinciding with the quarterly review completed by the adult day health program. At the case manager's discretion, additional information will be gathered through face to face, collateral or other contact methods to determine continued eligibility. Services will be continued, adjusted, or terminated based upon the case manager's determination during the eligibility review.

[Statutory Authority: RCW 74.04.050, 74.04.057, 74.04.200, 74.08.090, 74.09.520, and 74.39A.030. 03-06-024, § 388-71-0720, filed 2/24/03, effective 7/1/03.]

3509.1
REPEALER

The following sections of the Washington Administrative Code are repealed:

WAC 388-71-0194 Home and community services -- Nursing services.

WAC 388-71-0202 Long-term care services -- Definitions.

WAC 388-71-0203 Long-term care services -- Assessment of task self-performance and determination of required assistance.

WAC 388-71-0205 Long-term care services -- Service plan.

WAC 388-71-0400 What is the intent of the department's home and community programs?

WAC 388-71-0405 What are the home and community programs?

WAC 388-71-0410 What services may I receive under HCP?

WAC 388-71-0415 What other services may I receive under the waiver-funded programs?

WAC 388-71-0420 What services are not covered under HCP?

WAC 388-71-0425 Who can provide HCP services?

WAC 388-71-0430 Am I eligible for one of the HCP programs?

WAC 388-71-0435 Am I eligible for COPES-funded services?

WAC 388-71-0440 Am I eligible for MPC-funded services?

WAC 388-71-0442 Am I eligible for medically needy residential waiver services?

WAC 388-71-0445 Am I eligible for chore-funded services?

WAC 388-71-0450 How do I remain eligible for services?

WAC 388-71-0455 Can my services be terminated if eligibility requirements for HCP change?

WAC 388-71-0460 Are there limitations to HCP services I can receive?

WAC 388-71-0465 Are there waiting lists for HCP services?

WAC 388-71-0470 Who pays for HCP services?

WAC 388-71-0480 If I am employed, can I still receive HCP services?

WAC 388-71-0600 What are residential services?

WAC 388-71-0605 Am I eligible for residential services?

WAC 388-71-0610 Who pays for residential care?

WAC 388-71-0613 For what days will the department pay the residential care facility?

WAC 388-71-0615 If I leave a hospital, residential facility, or nursing facility, are there resources available to help me find a place to live?

WAC 388-71-0620 Am I eligible for a residential discharge allowance?

WAC 388-71-0700 What are the requirements for nursing facility eligibility, assessment, and payment?

WAC 388-71-0800 What is PACE?

WAC 388-71-0805 What services does PACE cover?

WAC 388-71-0810 Who provides these services?

WAC 388-71-0815 Where are these services provided?

WAC 388-71-0820 How do I qualify for Medicaid-funded PACE services?

WAC 388-71-0825 What are my appeal rights?

WAC 388-71-0830 Who pays the PACE provider?

WAC 388-71-0835 How do I enroll into the PACE program?

WAC 388-71-0840 How do I disenroll from the PACE program?

WAC 388-71-0845 What are my rights as a PACE client?

WAC 388-71-0900 What is the intent of WAC 388-71-0900 through 388-71-0960?

WAC 388-71-0905 What is private duty nursing (PDN) for adults?

WAC 388-71-0910 Am I financially eligible for Medicaid-funded private duty nursing services?

WAC 388-71-0915 Am I medically eligible to receive private duty nursing services?

WAC 388-71-0920 How is my eligibility determined?

WAC 388-71-0925 Am I required to pay participation toward PDN services?

WAC 388-71-0930 Are PDN costs subject to estate recovery?

WAC 388-71-0935 Who can provide my PDN services?

WAC 388-71-0940 Are there limitations or other requirements for PDN?

WAC 388-71-0945 What requirements must a home health agency meet in order to provide and get paid for my PDN?

WAC 388-71-0950 What requirements must a private RN or LPN meet in order to provide and get paid for my PDN services?

WAC 388-71-0955 Can I receive PDN in a licensed adult family home (AFH)?

WAC 388-71-0960 Can I receive services in addition to PDN?

WAC 388-71-0965 Can I choose to self-direct my care if I receive PDN?

WAC 388-71-1000 What is the Senior Citizens Services Act?

WAC 388-71-1005 Who administers the Senior Citizens Services Act funds?

WAC 388-71-1010 What services does the SCSA fund?

WAC 388-71-1015 How do I apply for SCSA-funded services?

WAC 388-71-1020 Am I eligible for SCSA-funded services at no cost?

WAC 388-71-1025 What income and resources are exempt when determining eligibility?

WAC 388-71-1030 What if I am not eligible to receive SCSA-funded services at no cost?

WAC 388-71-1035 What are my rights under SCSA?

WAC 388-71-1065 What is the purpose of the respite care program?

WAC 388-71-1070 What definitions apply to respite care services?

WAC 388-71-1075 Who is eligible to receive respite care services?

WAC 388-71-1080 Who may provide respite care services?

WAC 388-71-1085 How are respite care providers reimbursed for their services?

WAC 388-71-1090 Are participants required to pay for the cost of their services?

WAC 388-71-1095 Are respite care services always available?

WAC 388-71-1100 What is volunteer chore services (VCS)?

WAC 388-71-1105 Am I eligible to receive volunteer chore services?

WAC 388-71-1110 How do I receive information on applying for volunteer chore services?

3488.3
AMENDATORY SECTION(Amending WSR 03-13-052, filed 6/12/03, effective 7/13/03)

WAC 388-515-1540 Medically needy residential waiver (MNRW) effective March 17, 2003. This section describes the financial eligibility requirements for waiver services under the medically needy residential waiver (MNRW) and the rules used to determine a client's responsibility in the total cost of care.

(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;

(d) Requires the level of care provided in a nursing facility as described in WAC ((~~388-71-0700~~)) 388-106-0355;

(e) In the absence of waiver services described in WAC ((~~388-71-0410 and 388-71-0415~~)) 388-106-0400, 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~~)) 388-106-0410;

(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;

(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~~)) 388-106-0435;

(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~~)) 388-106-0435.

(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);

(d) Incurred medical expenses described in (4) not used to meet spenddown or reduce excess resources.

[Statutory Authority: 2001 c 269, RCW 74.09.700, 74.08.090, 74.04.050, 74.09.575 and chapter 74.39 RCW. 03-13-052, § 388-515-1540, filed 6/12/03, effective 7/13/03.]

AMENDATORY SECTION(Amending WSR 04-16-029, filed 7/26/04, effective 8/26/04)

WAC 388-515-1550 Medically needy in-home waiver (MNIW) effective May 1, 2004. This section describes the financial eligibility requirements for waiver services under the Medically Needy In-home Waiver (MNIW) and the rules used to determine a client's responsibility in the total cost of care.

(1) To be eligible for MNIW, a client must:

(a) Not meet financial eligibility for Medicaid personal care or the COPES program;

(b) Be eighteen years of age or older;

(d) Require the level of care provided in a nursing facility as described in WAC ((~~388-71-0700~~)) 388-106-0355;

(e) In the absence of waiver services described in WAC ((~~388-71-0410 and 388-71-0415~~)) 388-106-0500, 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) Have attained institutional status as described in WAC 388-513-1320;

(g) Have been determined to be in need of waiver services as described in WAC ((~~388-71-0442~~)) 388-106-0510;

(h) Be able to live at home with community support services and choose to remain at home;

(i) Not be 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) Meet the resource and income requirements described in subsections (2) through (6) of this section.

(2) The department determines a client's nonexcluded resources under MNIW as described in WAC 388-513-1350 (1) through (4)(a) and 388-513-1360;

(3) Nonexcluded resources, after disregarding excess resources described in subsection (4) of this section, 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 spenddown 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 MNIW 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;

(d) Deducts monthly health insurance premiums, except Medicare premiums, not used to reduce excess resources in subsection (4) of this section;

(e) Allows an income deduction for a nonapplying spouse, equal to the one person medically needy income level (MNIL) less the nonapplying spouse's income, if the nonapplying spouse is living in the same home as the applying person.

(6) A client whose countable income exceeds the MNIL may become eligible for MNIW:

(a) When they have or expect to have medical expenses to offset their income which is over the MNIL; and

(b) Subject to availability in WAC ((~~388-71-0465~~)) 388-106-0535.

(7) The portion of a client's countable income over the MNIL is called "excess income."

(8) A client who has or will have "excess income" is not eligible for MNIW 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.

(9) The following medical expenses may be used to meet spenddown if not already used in subsection (4) of this section to disregard excess resources or to reduce countable income as described in subsection (5)(d) of this section:

(a) 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; and

(iii) Necessary medical care covered under the state's Medicaid plan.

(b) The cost of waiver services authorized during the base period.

(i) Are not subject to third-party payment or reimbursement;

(ii) Have not been used to satisfy a previous spenddown liability;

(iii) Have not been used to reduce client responsibility toward cost of care; and

(iv) Are amounts for which the client remains liable.

(10) Eligibility for MNIW is effective the first full month the client has met spenddown.

(11) In cases where spenddown has been met, medical coverage and MNIW begin the day services are authorized.

(12) A client who meets the requirements for MNIW chooses a three or six month base period. The months must be consecutive calendar months.

(13) 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) in an amount equal to the one-person MNIL described in WAC 388-478-0070 (1)(a);

(d) Incurred medical expenses described in subsection (4) of this section not used to meet spenddown or reduce excess resources.

[Statutory Authority: 2004 c 276 § 206 (6)(b) and Townsend vs. DSHS, U.S. District Court, Western District of Washington, No. C 00-0944Z. 04-16-029, § 388-515-1550, filed 7/26/04, effective 8/26/04.]

CURRENT WAC SECTIONS IN CHAPTER 388-71 WAC	PROPOSED WAC NUMBER
HOME AND COMMUNITY PROGRAMS
388-71-0194 Home and community services -- Nursing services.	388-106-0200, 388-106-0300, 388-106-0305, 388-106-0400, 388-106-0500
388-71-0202 Long-term care services -- Definitions.	388-71-0215
388-71-0203 Long-term care services -- Assessment of task self-performance and determination of required assistance.	388-71-0230
388-71-0205 Long-term care services -- Service plan.	388-71-0235
388-71-0400 What is the intent of the department's home and community programs?	Repeal
388-71-0405 What are the home and community programs?	388-106-0015
388-71-0410 What services may I receive under HCP?	388-106-0300, 388-106-0305, 388-106-0400, 388-106-0500, and 388-106-0600
388-71-0415 What other services may I receive under the COPES program?	388-106-0300, 388-106-0305
388-71-0420 What services are not covered under HCP?	388-106-0020
388-71-0425 Who can provide HCP services?	388-106-0040
388-71-0430 Am I eligible for one of the HCP programs?	388-106-0210, 388-106-0310, 388-106-0410, 388-106-0510, and 388-106-0610
388-71-0435 Am I eligible for COPES-funded services?	388-106-0310
388-71-0440 Am I eligible for MPC-funded services?	388-106-0210
388-71-0442 Am I eligible for Medically Needy Residential waiver services?	388-106-0410
388-71-0445 Am I eligible for Chore-funded services?	388-106-0610
388-71-0450 How do I remain eligible for services?	388-106-0220, 388-106-0320, 388-106-0420, 388-106-0520, and 388-106-0620
388-71-0455 Can my services be terminated if eligibility requirements for HCP change?	388-106-0220, 388-106-0320, 388-106-0420, 388-106-0520, and 388-106-0620
388-71-0460 Are there limitations to HCP services I can receive?	388-106-0130
388-71-0465 Are there waiting lists for HCP services?	388-106-0235, 388-106-0335, 388-106-0435, and 388-106-0535
388-71-0470 Who pays for HCP services?	388-106-0225, 388-106-0325, 388-106-0425, 388-106-0525, and 388-106-0625
388-71-0480 If I am employed, can I still receive HCP services?	388-106-0230, 388-106-0330, 388-106-0430, 388-106-0530, and 388-106-0630
INDIVIDUAL PROVIDER AND HOME CARE AGENCY PROVIDER QUALIFICATIONS	Kept in chapter 388-71 WAC
RESIDENTIAL CARE SERVICES
388-71-0600 What are residential services?	388-106-0010
388-71-0605 Am I eligible for residential services?	388-106-0905
388-71-0610 Who pays for residential care?	388-106-0225, 388-106-0325, 388-106-0425, and 388-106-0525
388-71-0613 For what days will the department pay the residential care facility?	388-106-0225, 388-106-0325, 388-106-0425, and 388-106-0525
388-71-0615 If I leave a hospital, residential facility, or nursing facility, are there resources available to help me find a place to live?	388-106-0950
388-71-0620 Am I eligible for a residential discharge allowance?	388-106-0955
NURSING FACILITY CARE AND PAYMENT
388-71-0700 What are the requirements for nursing facility eligibility, assessment, and payment?	388-106-0350, 388-106-0355, and 388-106-0360
ADULT DAY SERVICES (IN CHAPTER 388-71 WAC EXCEPT FOR THE FOLLOWING)
388-71-0704 Adult day care -- Services.	388-106-0800
388-71-0706 Adult day health -- Services.	388-106-0805
388-71-0708 Adult day care -- Eligibility.	388-106-0810
388-71-0710 Adult day health -- Eligibility.	388-106-0815
PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
388-71-0800 What is PACE?	388-106-0015
388-71-0805 What services does PACE cover?	388-106-0700
388-71-0810 Who provides these services?	Repeal
388-71-0815 Where are these services provided?	Repeal
388-71-0820 How do I qualify for Medicaid-funded PACE services?	388-106-0705
388-71-0825 What are my appeal rights?	388-106-1305
388-71-0830 Who pays the PACE provider?	388-106-0710
388-71-0835 How do I enroll into the PACE program?	388-106-0705
388-71-0840 How do I disenroll from the PACE program?	388-106-0715
388-71-0845 What are my rights as a PACE client?	388-106-1300
PRIVATE DUTY NURSING
388-71-0900 What is the intent of WAC 388-71-0900 through 388-71-0960?	388-106-1000
388-71-0905 What is private duty nursing (PDN) for adults?	388-106-1005
388-71-0910 Am I financially eligible for Medicaid-funded private duty nursing services?	388-106-1010
388-71-0915 Am I medically eligible to receive private duty nursing services?	388-106-1010
388-71-0920 How is my eligibility determined?	388-106-1015
388-71-0925 Am I required to pay participation toward PDN services?	388-106-1020
388-71-0930 Are PDN costs subject to estate recovery?	388-106-1020
388-71-0935 Who can provide my PDN services?	388-106-1025
388-71-0940 Are there limitations or other requirements for PDN?	388-106-1030
388-71-0945 What requirements must a home health agency meet in order to provide and get paid for my PDN?	388-106-1035
388-71-0950 What requirements must a private RN or LPN meet in order to provide and get paid for my PDN services?	388-106-1040
388-71-0955 Can I receive PDN in a licensed adult family home (AFH)?	388-106-1045
388-71-0960 Can I receive services in addition to PDN?	388-106-1050
388-71-0965 Can I choose to self-direct my care if I receive PDN?	388-106-1055
SENIOR CITIZEN'S SERVICES
388-71-1000 What is the Senior Citizens Services Act?	388-106-0015
388-71-1005 Who administers the Senior Citizens Services Act funds?	Repeal
388-71-1010 What services does the SCSA fund?	388-106-1100
388-71-1015 How do I apply for SCSA-funded services?	388-106-1105
388-71-1020 Am I eligible for SCSA-funded services at no cost?	388-106-1110
388-71-1025 What income and resources are exempt when determining eligibility?	388-106-1115
388-71-1030 What if I am not eligible to receive SCSA-funded services at no cost?	388-106-1120
388-71-1035 What are my rights under SCSA?	388-106-1300
RESPITE CARE SERVICES
388-71-1065 What is the purpose of the respite care program?	388-106-0015, 388-106-1205
388-71-1070 What definitions apply to respite care services?	388-106-1200
388-71-1075 Who is eligible to receive respite care services?	388-106-1210
388-71-1080 Who may provide respite care services?	388-106-1215
388-71-1085 How are respite care providers reimbursed for their services?	388-106-1220
388-71-1090 Are participants required to pay for the cost of their services?	388-106-1225
388-71-1095 Are respite care services always available?	388-106-1230
VOLUNTEER CHORE
388-71-1100 What is volunteer chore services (VCS)?	388-106-0015, 388-106-0650
388-71-1105 Am I eligible to receive volunteer chore services?	388-106-0655
388-71-1110 How do I receive information on applying for volunteer chore services?	Repeal

CURRENT WAC SECTIONS IN CHAPTER 388-72A WAC	PROPOSED WAC NUMBER
APPLICATION
388-72A-0005 When do the rules in chapter 388-72A WAC apply to me?	Repeal
388-72A-0010 Does chapter 388-71 WAC apply to me?	Repeal
388-72A-0015 If the department did not use the CARE tool for my last assessment, may I have my assessments done on the assessment form used for my last assessment?	Repeal
ASSESSMENT AND SERVICE PLANNING
388-72A-0020 What is an assessment?	388-106-005
388-72A-0025 What is the process for conducting an assessment?	388-106-0065
388-72A-0030 What is the purpose of an assessment?	388-106-0055
388-72A-0035 What are personal care services?	388-106-0015
388-72A-0036 How are my needs for personal care services determined?	388-106-0075
388-72A-0037 How are self-performance and support provided for the activities of daily living (ADLs) scored?	388-106-0075
388-72A-0038 How are the ADLs bathing, body care, and medication management scored?	388-106-0075
388-72A-0039 How are self-performance and difficulty for the instrumental activities of daily living (IADLs) scored?	388-106-0075
388-72A-0042 How are ADLs and IADLs scored for children?	388-106-0213
388-72A-0043 How are other elements in CARE scored for children age seventeen and younger and foster care clients?	388-106-0213
388-72A-0045 How will the department plan to meet my care needs?	Repeal
388-72A-0050 What if I disagree with the result of the assessment or the decisions about what services I may receive?	388-106-1305
CARE ELIGIBILITY
388-72A-0053 Am I eligible for one of the HCP programs?	388-106-0210, 388-106-0310, 388-106-0410, 388-106-0510, and 388-106-0610
388-72A-0055 Am I eligible for COPES-funded services?	388-106-0310
388-72A-0057 Am I eligible for medically needy residential waiver (MNRW)-funded services?	388-106-0410
388-72A-0058 Am I eligible for medically needy in-home wavier (MNIW)-funded services?	388-106-0510
388-72A-0060 Am I eligible for MPC-funded services?	388-106-0210
388-72A-0065 Am I eligible for Chore-funded services?	388-106-0610
388-72A-0069 How does CARE use the information the assessor gathers?	388-106-0055
CLASSIFICATION FOR IN-HOME AND RESIDENTIAL CARE
388-72A-0070 What are the in-home hours and residential rate based on?	388-106-0080
388-72A-0080 What are the elements that the CARE tool evaluates for each of the criteria in WAC 388-72A-0075?	388-106-0085
388-72A-0081 How is cognitive performance measured in the CARE tool?	388-106-0090
388-72A-0082 How is clinical complexity measured within the CARE tool?	388-106-0095
388-72A-0083 How are mood and behaviors measured within the CARE tool?	388-106-0100
388-72A-0084 How are ADL scores measured within the CARE tool?	388-106-0105
388-72A-0085 How does the CARE tool evaluate for the two exceptional care classifications of in-home care?	388-106-0110
388-72A-0086 How is the information in WAC 388-72A-0081 through 388-72A-0084 used to determine the client's classification payment group for residential settings?	388-106-0115
388-72A-0087 How is the information in WAC 388-72A-0081 through 388-72A-0085 used to determine the classification payment group for in-home clients?	388-106-0125
PAYMENT METHODOLOGY FOR IN-HOME SERVICES
388-72A-0090 What are the maximum hours that I can receive for in-home services?	388-106-0135
388-72A-0092 How are my in-home hours determined?	388-106-0130
388-72A-0095 What additional criteria are considered to determine the number of hours I will receive for in-home services?	388-106-0130
388-72A-0100 Are there other in-home services I may be eligible to receive in addition to those described in WAC 388-72A-0095(3)?	388-106-0300
388-72A-0105 What would cause a change in the maximum hours authorized?	388-106-0140
HOME AND COMMUNITY PAYMENT RATES
388-72A-0110 How much will the department pay for my care?	388-106-0120
388-72A-0115 When the department adjusts an algorithm, when does the adjustment become effective?	Repeal
388-72A-0120 When a client requests a fair hearing to have the client's CARE tool assessment results reviewed and there is (are) a more recent CARE assessment(s), which CARE tool assessment does the administrative law judge review in the fair hearing?	388-106-1310

Condition	AND an ADL Score of
ALS (Lou Gehrig's disease)	>14
Aphasia (expressive and/or receptive)	>=2
Cerebral Palsy	>14
Diabetes Mellitus (insulin dependent)	>14
Diabetes Mellitus (noninsulin dependent)	>14
Emphysema & Shortness of Breath (at rest or exertion) or dizziness/vertigo	>10
COPD & Shortness of Breath (at rest or exertion) or dizziness/vertigo	>10
Explicit terminal prognosis	>14
Hemiplegia	>14
Multiple sclerosis	>14
Parkinson disease	>14
Pathological bone fracture	>14
Quadriplegia	>14
Rheumatoid Arthritis	>14
You have one or more of the following skin problems: &sqbul; Pressure ulcers, with areas of persistent skin redness; &sqbul; Pressure ulcers with partial loss of skin layers; &sqbul; Pressure ulcers, with a full thickness lost; &sqbul; Skin desensitized to pain/pressure; &sqbul; Open lesions; and/or &sqbul; Stasis ulcers. AND You require one of the following types of assistance: &sqbul; Ulcer care; &sqbul; Pressure relieving device; &sqbul; Turning/reposition program; &sqbul; Application of dressing; or &sqbul; Wound/skin care.	>=2
You have a burn(s) and you need one of the following: &sqbul; Application of dressing; or &sqbul; Wound/skin care	>=2
You have one or more of the following problems: &sqbul; You are frequently incontinent (bladder); &sqbul; You are incontinent all or most of the time (bladder); &sqbul; You are frequently incontinent (bowel); or &sqbul; You are incontinent all or most of the time (bowel). AND One of the following applies: &sqbul; The status of your individual management of bowel bladder supplies is "Uses, has leakage, needs assistance"; &sqbul; The status of your individual management of bowel bladder supplies is "Does not use, has leakage"; or &sqbul; You use any scheduled toileting plan.	>10
You have a current swallowing problem, and you are not independent in eating.	>10
You have Edema.	>14
You have Pain daily.	>14
You need and receive a Bowel program.	>10
You need Dialysis.	>10
You require IV nutritional support or tube feedings; and Your total calories received per IV or tube was at least 25%; and Your fluid intake is greater than 2 cups.	>=2
You need Hospice care.	>14
You need Injections.	>14
You need Intravenous medications.	>10
You need management of IV lines.	>10
You need Ostomy care.	>=2
You need Oxygen therapy.	>10
You need Radiation.	>10
You need and receive Passive range of motion.	>10
You need and receive Walking training.	>10
You need Suction treatment.	>=2
You need Tracheostomy care.	>10
You need a Ventilator/respirator	>10
Key: > means greater than. >= means greater than or equal to.

Behavior/Mood	AND Status, Frequency & Alterability
Assaultive	Current
Combative during personal care	Current
Combative during personal care	In past and addressed with current interventions
Crying tearfulness	Current, frequency 4 or more days per week
Delusions	In past, addressed with current interventions
Depression score >=14	N/A
Disrobes in public	Current and not easily altered
Easily irritable/agitated	Current and not easily altered
Eats nonedible substances	Current
Eats nonedible substances	In past, addressed with current interventions
Hallucinations	Current
Hiding items	In past, addressed with current interventions
Hoarding/collecting	In past, addressed with current interventions
Mental health therapy/program	Need
Repetitive complaints/questions	Current, daily
Repetitive complaints/questions	In past, addressed with current interventions
Repetitive movement/pacing	Current, daily
Resistive to care	Current
Resistive to care	In past, addressed with current interventions
Sexual acting out	Current
Sexual acting out	In past, addressed with current interventions
Spitting	Current and not easily altered
Spitting	In past, addressed with current interventions
Breaks/throws items	Current
Unsafe smoking	Current and not easily altered
Up at night and requires intervention	Current
Wanders exit seeking	Current
Wanders exit seeking	In past, addressed with current interventions
Wanders not exit seeking	Current
Wanders not exit seeking	In past, addressed with current interventions
Yelling/screaming Key: > means greater than. >= means greater than or equal to.	Current, frequency 4 or more days per week

ADL Scoring Chart
If Self Performance is:	Score Equals
Independent	0
Supervision	1
Limited assistance	2
Extensive assistance	3
Total dependence	4
Did not occur/no provider	4
Did not occur/client not able	4
Did not occur/client declined	0

Classification	ADL Score	Group
Group D Cognitive performance score = 4-6 and Clinically complex = yes and Mood/behavior = yes or no	ADL Score 18-28	D High (12)
	ADL Score 13-17	D Med (11)
	ADL Score 2-12	D Low (10)

Group C Cognitive performance score = 0-3 and Clinically complex = yes and Mood/behavior = yes or no	ADL Score 18-28	C High (9)
	ADL Score 9-17	C Med (8)
	ADL Score 2-8	C Low (7)

Group B Mood & behavior = Yes and Clinically complex = no and Cognitive performance score = 0-6	ADL Score 15-28	B High (6)
	ADL Score 5-14	B Med (5)
	ADL Score 0-4	B Low (4)

Group A Mood & behavior = No and Clinically complex = No and Cognitive performance score = 0-6	ADL Score 10-28	A High (3)
	ADL Score 5-9	A Med (2)
	ADL Score 0-4	A Low (1)

Meds	Self Performance	Status	Assistance Available	Value Percentage
Self administration of medications	Rules for all codes apply except independent is not counted	Unmet	N/A	1
		Met	N/A	0
		Decline	N/A	0
		Partially met	<1/4 time	.9
			1/4 to 1/2 time	.7
			1/2 to 3/4 time	.5
			>3/4 time	.3
Unscheduled ADLs	Self Performance	Status	Assistance Available	Value Percentage
Bed mobility, transfer, walk in room, eating, toilet use	Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider = 1; Did not occur/client declined and independent are not counted.	Unmet	N/A	1
		Met	N/A	0
		Decline	N/A	0
		Partially met	<1/4 time	.9
			1/4 to 1/2 time	.7
			1/2 to 3/4 time	.5
			>3/4 time	.3
Scheduled ADLs	Self Performance	Status	Assistance Available	Value Percentage
Dressing, personal hygiene, bathing	Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider = 1; Did not occur/client declined and independent are not counted.	Unmet	N/A	1
		Met	N/A	0
		Decline	N/A	0
		Partially met	<1/4 time	.75
			1/4 to 1/2 time	.55
			1/2 to 3/4 time	.35
			>3/4 time	.15
IADLs	Self Performance	Status	Assistance Available	Value Percentage
Meal preparation, Ordinary housework, Essential shopping	Rules for all codes apply except independent is not counted.	Unmet	N/A	1
		Met	N/A	0
		Decline	N/A	0
		Partially met	<1/4 time	.3
			1/4 to 1/2 time	.2
			1/2 to 3/4 time	.1
			>3/4 time	.05
IADLs	Self Performance	Status	Assistance Available	Value Percentage
Travel to medical	Rules for all codes apply except independent is not counted.	Unmet	N/A	1
		Met	N/A	0
		Decline	N/A	0
		Partially met	<1/4 time	.9
			1/4 to 1/2 time	.7
			1/2 to 3/4 time	.5
			>3/4 time	.3
Key: > means greater than < means less than

For each Activity of Daily Living, the minimum level of assistance required in:
	Self Performance is:	Support Provided is:
Eating	N/A	Setup
Toileting	Supervision	N/A
Bathing	Supervision	N/A
Dressing	Supervision	N/A
Transfer	Supervision	Setup
Bed Mobility	Supervision	Setup
Walk in Room OR Locomotion in Room OR Locomotion Outside Immediate Living Environment	Supervision	Setup
Medication Management	Assistance Required	N/A
Personal Hygiene	Supervision	N/A
Body care which includes: Application of ointment or lotions; Toenails trimmed; Dry bandage changes; or Passive range of motion treatment.	Need	N/A
Your need for assistance in any of the activities listed in subsection (a) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose of determining your functional eligibility.

If the number of clients receiving PDN services in an AFH is:	Then the department will authorize care provided by an RN or LPN (under the supervision of an RN) for up to:
1	16 hours of care per day
2-3	24 hours of care per day
4-6	48 hours of care per day

WAC 388-72A-0005	When do the rules in chapter 388-72A WAC apply to me?
WAC 388-72A-0010	Do chapter 388-71 WAC and WAC 388-845-1300 apply to me?
WAC 388-72A-0015	If the department did not use the CARE tool for my last assessment, may I have my assessments done on the assessment form used for my last assessment?
WAC 388-72A-0020	What is an assessment?
WAC 388-72A-0025	What is the process for conducting an assessment?
WAC 388-72A-0030	What is the purpose of an assessment?
WAC 388-72A-0035	What are personal care services?
WAC 388-72A-0036	How are my needs for personal care services determined?
WAC 388-72A-0037	How are self-performance and support provided for the activities of daily living (ADLs) scored?
WAC 388-72A-0038	How are the ADLs bathing, body care, and medication management scored?
WAC 388-72A-0039	How are self-performance and difficulty for the instrumental activities of daily living (IADLs) scored?
WAC 388-72A-0041	How are status and assistance available scored for ADLs and IADLs?
WAC 388-72A-0042	How are ADLs and IADLs scored for children?
WAC 388-72A-0043	How are other elements in CARE scored for children age seventeen and younger and foster care clients?
WAC 388-72A-0045	How will the department plan to meet my care needs?
WAC 388-72A-0050	What if I disagree with the result of the assessment or the decisions about what services I may receive?
WAC 388-72A-0053	Am I eligible for one of the HCP programs?
WAC 388-72A-0055	Am I eligible for COPES-funded services?
WAC 388-72A-0057	Am I eligible for medically needy residential waiver (MNRW)-funded services?
WAC 388-72A-0058	Am I eligible for medically needy in-home wavier (MNIW)-funded services?
WAC 388-72A-0060	Am I eligible for MPC-funded services?
WAC 388-72A-0065	Am I eligible for Chore-funded services?
WAC 388-72A-0069	How does CARE use the information the assessor gathers?
WAC 388-72A-0070	What are the in-home hours and residential rate based on?
WAC 388-72A-0080	What criteria does the CARE tool use to place a client in one of the classification groups?
WAC 388-72A-0081	How is cognitive performance measured in the CARE tool?
WAC 388-72A-0082	How is clinical complexity measured within the CARE tool?
WAC 388-72A-0083	How are mood and behaviors measured within the CARE tool?
WAC 388-72A-0084	How are ADL scores measured within the CARE tool?
WAC 388-72A-0085	How does the CARE tool evaluate for the two exceptional care classifications of in-home care?
WAC 388-72A-0086	How is the information in WAC 388-72A-0081 through 388-72A-0084 used to determine the client's classification payment group for residential settings?
WAC 388-72A-0087	How is the information in WAC 388-72A-0081 through 388-72A-0085 used to determine the classification payment group for in-home clients?
WAC 388-72A-0090	What are the maximum hours that I can receive for in-home services?
WAC 388-72A-0092	How are my in-home hours determined?
WAC 388-72A-0095	What additional criteria are considered to determine the number of hours I will receive for in-home services?
WAC 388-72A-0100	Are there other in-home services I may be eligible to receive in addition to those described in WAC 388-72A-0095(3)?
WAC 388-72A-0105	What would cause a change in the maximum hours authorized?
WAC 388-72A-0110	How much will the department pay for my care?
WAC 388-72A-0115	When the department adjusts an algorithm, when does the adjustment become effective?
WAC 388-72A-0120	When a client requests a fair hearing to have the client's CARE tool assessment results reviewed and there is (are) a more recent CARE assessment(s), which CARE tool assessment does the administrative law judge review in the fair hearing?

Task	M	S	T
Eating	5	12	16
Toileting	5	12	16
Ambulation	8	10	12
Transfer	4	8	11
Positioning	3	5	7
Body care	4	5	6
Personal hygiene	4	6	8
Dressing	5	8	12
Bathing	4	8	10
Travel to medical services	1	2	3
Meal preparation	0	0	6
Laundry	0	0	4
Housework	0	0	5

WAC 388-71-0194	Home and community services -- Nursing services.
WAC 388-71-0202	Long-term care services -- Definitions.
WAC 388-71-0203	Long-term care services -- Assessment of task self-performance and determination of required assistance.
WAC 388-71-0205	Long-term care services -- Service plan.
WAC 388-71-0400	What is the intent of the department's home and community programs?
WAC 388-71-0405	What are the home and community programs?
WAC 388-71-0410	What services may I receive under HCP?
WAC 388-71-0415	What other services may I receive under the waiver-funded programs?
WAC 388-71-0420	What services are not covered under HCP?
WAC 388-71-0425	Who can provide HCP services?
WAC 388-71-0430	Am I eligible for one of the HCP programs?
WAC 388-71-0435	Am I eligible for COPES-funded services?
WAC 388-71-0440	Am I eligible for MPC-funded services?
WAC 388-71-0442	Am I eligible for medically needy residential waiver services?
WAC 388-71-0445	Am I eligible for chore-funded services?
WAC 388-71-0450	How do I remain eligible for services?
WAC 388-71-0455	Can my services be terminated if eligibility requirements for HCP change?
WAC 388-71-0460	Are there limitations to HCP services I can receive?
WAC 388-71-0465	Are there waiting lists for HCP services?
WAC 388-71-0470	Who pays for HCP services?
WAC 388-71-0480	If I am employed, can I still receive HCP services?
WAC 388-71-0600	What are residential services?
WAC 388-71-0605	Am I eligible for residential services?
WAC 388-71-0610	Who pays for residential care?
WAC 388-71-0613	For what days will the department pay the residential care facility?
WAC 388-71-0615	If I leave a hospital, residential facility, or nursing facility, are there resources available to help me find a place to live?
WAC 388-71-0620	Am I eligible for a residential discharge allowance?
WAC 388-71-0700	What are the requirements for nursing facility eligibility, assessment, and payment?
WAC 388-71-0800	What is PACE?
WAC 388-71-0805	What services does PACE cover?
WAC 388-71-0810	Who provides these services?
WAC 388-71-0815	Where are these services provided?
WAC 388-71-0820	How do I qualify for Medicaid-funded PACE services?
WAC 388-71-0825	What are my appeal rights?
WAC 388-71-0830	Who pays the PACE provider?
WAC 388-71-0835	How do I enroll into the PACE program?
WAC 388-71-0840	How do I disenroll from the PACE program?
WAC 388-71-0845	What are my rights as a PACE client?
WAC 388-71-0900	What is the intent of WAC 388-71-0900 through 388-71-0960?
WAC 388-71-0905	What is private duty nursing (PDN) for adults?
WAC 388-71-0910	Am I financially eligible for Medicaid-funded private duty nursing services?
WAC 388-71-0915	Am I medically eligible to receive private duty nursing services?
WAC 388-71-0920	How is my eligibility determined?
WAC 388-71-0925	Am I required to pay participation toward PDN services?
WAC 388-71-0930	Are PDN costs subject to estate recovery?
WAC 388-71-0935	Who can provide my PDN services?
WAC 388-71-0940	Are there limitations or other requirements for PDN?
WAC 388-71-0945	What requirements must a home health agency meet in order to provide and get paid for my PDN?
WAC 388-71-0950	What requirements must a private RN or LPN meet in order to provide and get paid for my PDN services?
WAC 388-71-0955	Can I receive PDN in a licensed adult family home (AFH)?
WAC 388-71-0960	Can I receive services in addition to PDN?
WAC 388-71-0965	Can I choose to self-direct my care if I receive PDN?
WAC 388-71-1000	What is the Senior Citizens Services Act?
WAC 388-71-1005	Who administers the Senior Citizens Services Act funds?
WAC 388-71-1010	What services does the SCSA fund?
WAC 388-71-1015	How do I apply for SCSA-funded services?
WAC 388-71-1020	Am I eligible for SCSA-funded services at no cost?
WAC 388-71-1025	What income and resources are exempt when determining eligibility?
WAC 388-71-1030	What if I am not eligible to receive SCSA-funded services at no cost?
WAC 388-71-1035	What are my rights under SCSA?
WAC 388-71-1065	What is the purpose of the respite care program?
WAC 388-71-1070	What definitions apply to respite care services?
WAC 388-71-1075	Who is eligible to receive respite care services?
WAC 388-71-1080	Who may provide respite care services?
WAC 388-71-1085	How are respite care providers reimbursed for their services?
WAC 388-71-1090	Are participants required to pay for the cost of their services?
WAC 388-71-1095	Are respite care services always available?
WAC 388-71-1100	What is volunteer chore services (VCS)?
WAC 388-71-1105	Am I eligible to receive volunteer chore services?
WAC 388-71-1110	How do I receive information on applying for volunteer chore services?

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