WSR 07-18-057

EMERGENCY RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed August 31, 2007, 10:37 a.m. , effective September 1, 2007 ]


     Effective Date of Rule: September 1, 2007.

     Purpose: The department is revising sections within chapter 388-106 WAC to amend the in-home classifications to allow for the additional consideration of hours for clients with complex behavioral and cognitive issues and for clients with extremely high needs for assistance with activities of daily living.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-106-0100, 388-106-0110, and 388-106-0125.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

     Other Authority: Chapter 522, Laws of 2007 (SHB 1128).

     Under RCW 34.05.350 the agency for good cause finds that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.

     Reasons for this Finding: The department must adopt rules to meet requirements of the individual provider home care worker collective bargaining agreement (CBA), approved and funded by the Washington state legislature in the 2007-09 omnibus operating budget. DSHS long-term care budget notes state "effective September 1, 2007, ...certain hours of work for providers caring for clients with complex behavioral and cognitive issues will be increased." A CR-101 was filed as WSR 07-15-048 on July 13, 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     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 3, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 3, Repealed 0.

     Date Adopted: August 16, 2007.

Stephanie E. Schiller

Rules Coordinator

3911.3
AMENDATORY SECTION(Amending WSR 05-11-082, filed 5/17/05, effective 6/17/05)

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, then the mood and behavior criteria listed in subsections (3) and (4) below determines your classification group. If you are eligible for more than one "B" group classification based on the two methodologies, CARE will place you in the highest group for which you qualify.

     (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)) of 14 or greater 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 Current, frequency 4 or more days per week
((Key:

> means greater than.

>= means greater than or equal to.))
     or

     (4) CARE places you in the mood and behavior classification group if you have a behavior point score greater than 1, your CPS score (as defined in WAC 388-106-0090) is greater than 2, and your ADL score (as defined in WAC 388-106-0105) is greater than 1.


Status Intervention Frequency Weight
Past No Intervention N/A 0
Past With Intervention N/A 0.25
Current N/A 1-3 days/wk 0.5
Current N/A 4-6 days/wk 0.75
Current N/A Daily 1

     Each current behavior (as shown in the table below) has a value from .5 to 6 depending on the severity and alterability. Each status combination (shown in the table above) has a weight from 0 to 1. Behavior points are determined by multiplying the value of each current behavior (from the list below) by the weight of the status combination (above). Behavior points for past behaviors will be determined by multiplying the easily altered value of the behavior from the table below by the appropriate weight from the table above (0 or .25).

     The list of behaviors below is divided into categories. Each category has a point limit of how many points can be counted toward the total behavior point score as detailed below. The total behavior point score is determined by totaling the weight-adjusted values for each category below.


Alterability Value
Behavior Easily Altered Not Easily Altered
1. Crying and Tearfulness .5 1
2. Easily Irritable/Agitated .5 1
3. Obsessive about health or body functions .5 1
4. Repetitive Physical Movement .5 1
5. Hiding Items .5 1
6. Hoarding/Collecting .5 1
7. Inappropriate Verbal Noise .5 1
8. Wanders, not exit seeking .5 1
Maximum total points after adjusting for status for behaviors 1-8= 2
9. Repetitive anxious complaints/questions 1 2
10. Rummaging through or takes others belongings 1 2
11. Verbally Abusive 1 2
12. Yelling/Screaming 1 2
13. Spitting 1 2
14. Unrealistic Fears 1 2
15. Accuses others of stealing 1 2
Maximum total points after adjusting for status for behaviors 9-15= 3
16. Resistive to care with words/gestures 2 3
17. Up at night 2 3
18. Unsafe cooking 2 3
19. Inappropriate toileting/menses activity 2 3
20. Unsafe smoking 2 3
21. Left home and gotten lost 2 3
22. Disrobes in public 2 3
Maximum total points after adjusting for status for behaviors 16-22= 4
23. Injures self 4 5
24. Wanders/Exit seeking 4 5
25. Sexual acting out 4 5
26. Intimidating 4 5
27. Assaultive 4 5
28. Breaks, throws items 4 5
Maximum total points after adjusting for status for behaviors 23-28= 10
29. Fire setting 5 6
30. Combative during care 5 6
31. Pica 5 6
32. Seeks vulnerable partners 5 6
Maximum total points after adjusting for status for behaviors 29-32= 12

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0100, filed 5/17/05, effective 6/17/05.]


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

WAC 388-106-0110   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; or

&sqbul; Total in Self Performance for Toilet Use.
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 by IV or tube is greater than 2 cups per day.
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.

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0110, filed 5/17/05, effective 6/17/05.]


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

WAC 388-106-0125   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, 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 388-106-0100, ADLS 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)) seventeen in-home groups.


Classification ADL or Behavior Point 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)) 25-28 D High (((12))) ((240)) 280
ADL Score 18-24 D Med-High 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 25-28 C High 200
ADL Score 18-((28))24 C Med-High (((9))) 180
ADL Score 9-17 C Med (((8))) 140
ADL Score 2-8 C Low (((7))) ((83)) 95
Group B

Mood and behavior = yes

and

Clinically complex = no

and

Cognitive performance score = 0-4

OR

Cognitive Performance score >2 and

Behavior score >1 and

ADL score >1

OR

Cognitive performance score >2

And ADL score >1

 ADL Score 15-28 B High (((6))) 155
ADL Score 5-14 B Med (((5))) 90
ADL Score 0-4 B Low (((4))) 52
Behavior Points 12 or higher B High 155
Behavior Points 7-11 B Med-High 110
Behavior Points 5-6 B Med 90
Behavior Points 1-4 B Low 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

[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0125, filed 5/17/05, effective 6/17/05.]

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