WSR 07-04-091

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed February 6, 2007, 12:50 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 06-22-055.

Title of Rule and Other Identifying Information: Amends the following rules in Chapter 388-106 WAC, Long-term care services, WAC 388-106-0070 Will I be assessed in CARE?, 388-106-0095 How does the CARE tool measure clinical complexity?, and 388-106-0213 How are my needs assessed if I am a child applying for MPC?

Hearing Location(s): Blake Office Park East, Rose Room, 4500 10th Avenue S.E., Lacey, WA 98503 (one block north of the intersection of Pacific Avenue S.E. and Alhadeff Lane, behind Goodyear Tire. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6097), on March 13, 2007, at 10:00 a.m.

Date of Intended Adoption: Not earlier than March 14, 2007.

Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail schilse@dshs.wa.gov, fax (360) 664-6185, by 5:00 p.m. on March 13, 2007.

Assistance for Persons with Disabilities: Contact Stephanie Schiller, DSHS Rules Consultant, by March 9, 2007,

TTY (360) 664-6178 or (360) 664-6097 or by e-mail at schilse@dshs.wa.gov.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: This rule making:

(1) Clarifies the age guidelines and clinical complexity classifications, within the comprehensive assessment reporting evaluation (CARE) tool algorithm, to evaluate a child's needs when the child is comatose or has pain daily related to his/her disability. The algorithm within the CARE tool used to establish children's eligibility for personal care services was developed based upon self-performance codes, taking into account normal childhood milestones and typical care parents provide to their children at certain ages. For example, a child who has pain daily as a result of teething, a normal childhood milestone not related to a disability, should not be placed in a clinically complex classification based solely on teething pain. This rule making further clarifies and strengthens these guidelines to avoid placing children in incorrect classifications.

(2) Clarifies eligibility language for Medicaid personal care (MPC) and waiver services to ensure that a client has unmet or partially met needs that make the client eligible for assistance with personal care tasks.

(3) Clarifies that clients will be assessed by the department's CARE tool when applying for or receiving long-term care services as part of a managed care benefit under the Washington Medicaid integration program (WMIP) and the Medicare Medicaid integration program (MMIP).

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: Bev Lord, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2536.

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

A cost-benefit analysis is not required under RCW 34.05.328. Rules are exempt, per RCW 34.05.328 (5)(b)(vii), rules of the department of social and health services relating only to client medical or financial eligibility.

January 31, 2007

Jim Schnellman, Chief

Office of Administrative Resources

3830.2
AMENDATORY SECTION(Amending WSR 05-11-082, filed 5/17/05, effective 6/17/05)

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, or long-term care services within the MMIP or WMIP programs. You may not be assessed by forms previously used by the department once you have been assessed under CARE.

If you are under the age of eighteen and within thirty calendar days of your next birthday, CARE determines your assessment age to be that of your next birthday.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0070, filed 5/17/05, effective 6/17/05.]


AMENDATORY SECTION(Amending WSR 05-11-082, filed 5/17/05, effective 6/17/05)

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
You are <18 and you have pain related to your disability and you complain of pain or show evidence of pain daily. (If you are under eighteen and do not have pain related to your disability, you may be placed in the clinically complex classification based on other factors above.) >14
Key:

<means less than.

>means greater than.

>= means greater than or equal to.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0095, filed 5/17/05, effective 6/17/05.]


AMENDATORY SECTION(Amending WSR 06-05-022, filed 2/6/06, effective 3/9/06)

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)) The CARE tool will determine your needs as met based on the guidelines outlined in the following table:


Activities of Daily Living (ADLs)
Ages
&sqbul; = Code status as Met 0 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)) self-directed, administration required, or must be administered

&sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Locomotion in RoomNote
Independent, supervision,

limited or extensive

&sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul;
Locomotion Outside

RoomNote

Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Limited or extensive &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul;
Walk in RoomNote
Independent, supervision,

limited or extensive

&sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul;
Bed Mobility
Independent, supervision,

limited or extensive

&sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul;
Transfers
Independent, supervision,

limited, extensive or total

& under 30 pounds

&sqbul; &sqbul; &sqbul;
(Total & ((over)) 30

pounds or more = no age limit)

Toilet Use
Support provided for

nighttime wetting only

(independent, supervision,

limited, extensive)

&sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Independent, supervision,

limited, extensive

&sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul; &sqbul;
Eating
Independent, supervision,

limited, extensive, or total

&sqbul; &sqbul; &sqbul;
Bathing
Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Physical ((assistance all/part)) help/transfer only or physical help/part of bathing &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Dressing
Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Limited or extensive &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Personal Hygiene
Independent or supervision &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Limited or extensive &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Total &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Instrumental Activities of Daily Living
Ages
&sqbul; = Code status as Met 0 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; &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; &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; &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; &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; &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; &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; &sqbul;

NOTE: If the activity did not occur, the department codes self performance as total and status as met.


Ages
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Additional guidelines based

on age

Diagnosis

Is client comatose?= No

&sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Pain Daily= No &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Any foot care needs
Status= Need met &sqbul; &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; &sqbul;
Speech/Hearing
Score comprehension as

understood

&sqbul; &sqbul; &sqbul;
MMSE

can be administered = no

&sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Memory
Short term memory ok &sqbul; &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; &sqbul;
Depression
Select interview = unable to

obtain

&sqbul; &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; &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; &sqbul;
Support provided for daytime wetting - Individual Management = Does not need/use &sqbul; &sqbul; &sqbul; &sqbul; &sqbul; &sqbul;
Treatment
Passive range of motion

Need= No

&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.

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, 388-106-0213, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0213, filed 5/17/05, effective 6/17/05.]

Washington State Code Reviser's Office