WASHINGTON STATE REGISTER

WSR 07-10-024

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed April 23, 2007, 11:50 a.m. , effective June 1, 2007 ]

Effective Date of Rule: June 1, 2007.

Purpose: 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 WMIP and MMIP programs.

Citation of Existing Rules Affected by this Order: Amending WAC 388-106-0070, 388-106-0095, and 388-106-0213.

Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

Adopted under notice filed as WSR 07-04-091 on February 6, 2007.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 3, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

Date Adopted: April 20, 2007.

Stephanie E. Schiller

Rules Coordinator

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 Room^Note

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

Total &sqbul; &sqbul;

Locomotion Outside
Room^Note

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

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

Total &sqbul; &sqbul;

Walk in Room^Note

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.]

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.

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