Purpose: The rule incorporates language from contracts with hospice care centers (HCCs) into chapter 388-551 WAC, Hospice services; clarifies and updates hospice services definitions and rules; provides a standard for medically appropriate and fiscally responsible utilization; allows stabilization of reimbursement payments for hospice services provided to medical assistance clients; adopts rules to incorporate into rule language for the pediatric palliative care (PPC) case management/coordination services program; and repeals outdated sections in chapter 388-551 WAC regarding election periods and notification requirements.

     Citation of Existing Rules Affected by this Order: Repealing WAC 388-551-1315 and 388-551-1410; and amending WAC 388-551-1000, 388-551-1010, 388-551-1200, 388-551-1210, 388-551-1300, 388-551-1310, 388-551-1320, 388-551-1330, 388-551-1340, 388-551-1350, 388-551-1360, 388-551-1400, 388-551-1500, 388-551-1510, 388-551-1520, and 388-551-1530.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

      Adopted under notice filed as WSR 05-15-148, 05-15-149, and 05-15-150 on July 19, 2005.

     Changes Other than Editing from Proposed to Adopted Version: WAC 388-551-1010 Hospice program -- Definitions.

     "Legal representative" means an individual who has been authorized under state law to terminate medical care or to elect or revoke the election of hospice care on behalf of a terminally ill individual who is mentally or physically incapacitated.

WAC 388-551-1200 Client eligibility for hospice care.

     (5)(d) If the client is a Medicaid only client (i.e., not a medicaid-Medicare dual eligible client) and has a diagnosis other than cancer, the client's initial assessment has been reviewed and approved by the department (see WAC 388-551-1320).

     (5)(e)(d) The hospice agency...

WAC 388-551-1310 Hospice election periods, election statements, and the hospice certification process.

     (3)(a) At the time When a client elects to receive hospice care, the department requires a hospice agency to:

WAC 388-551-1320 Hospice plan of care.

     (1) ...as described in WAC 246-335-985 085, and meet the requirements in this section.

WAC 388-551-1810 Pediatric palliative care (PPC) case management/coordination services -- Client eligibility.

     (3) Have a life-limiting medical condition that requires case management and coordination of medical services due to at least three of the following circumstances. The client must:

     (a) Have An immediate medical needs during a time of crisis;

     (b) Require cCoordination with family member(s) and providers required in more than one setting (i.e. school, home, and multiple medical offices or clinics);

     (c) Have a A life-limiting medical condition...;

     (d) Have a A medical condition that with which the family is unable to cope with;

     (e) Have a A family member(s) and/or caregiver who lacks needs additional knowledge or assistance regarding with the client's medical needs; and

     (f) Have tTherapeutic goals that are focused on quality of life, comfort, and family stability.

WAC 388-551-1820 Pediatric palliative care (PPC) contact -- Services included and limitations to coverage.

     (2)(a) One visit with a registered nurse, social worker, or therapist (for the purpose of this section, the department defines therapist as a licensed physical therapist, occupational therapist, or speech/language therapist) with the client in the client's residence to address:

WAC 388-551-1840 Pediatric palliative care (PPC) case management/coordination services -- Provider requirements.

     (1)(e) Prescribe and dDocument in the client's medical record: (1)(h)(iii) Transfer to another hospice agency for pediatric palliative care services.

     (1)(i)(iv) Specific documentations of the client's response... (e.g., would the client might have required acute care or hospital emergency room visits without the pediatric palliative care services).

     A final cost-benefit analysis is available by contacting Pam Colyar, DSHS Health and Recover Services Administration, P.O. Box 45506, Olympia, WA 98504-5506, phone (360) 725-1582, fax (360) 586-1471, e-mail colyaps@dshs.wa.gov. (The preliminary analysis is unchanged and will be final.)

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

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

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 8, Amended 16, Repealed 2.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 8, Amended 16, Repealed 2.

     Date Adopted: August 26, 2005.

Andy Fernando, Manager

Rules and Policies Assistance Unit

     Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 05-19 issue of the Register.

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