PROPOSED RULES
SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)
Original Notice.
Preproposal statement of inquiry was filed as WSR 07-15-049.
Title of Rule and Other Identifying Information: The department is amending chapter 388-106 WAC, Long-term care services, and WAC 388-71-0540 When will the department, AAA, or managed care entity deny payment for services of an individual provider or home care agency provider?
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. A map or directions are available at http://www1.dshs.wa.gov/msa/rpau/docket.html or by calling (360) 664-6094), on November 6, 2007, at 10:00 a.m.
Date of Intended Adoption: Not earlier than November 7, 2007.
Submit Written Comments to: DSHS Rules Coordinator, P.O. Box 45850, Olympia, WA 98504-5850, delivery 4500 10th Avenue S.E., Lacey, WA 98503, e-mail DSHSRPAURulesCoordinator@dshs.wa.gov, fax (360) 664-6185, by 5 p.m. on November 6, 2007.
Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS Rules Consultant, by October 30, 2007, TTY (360) 664-6178 or (360) 664-6094 or by e-mail at johnsjl4@dshs.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The rule making amends WAC 388-106-0060, 388-106-0070, 388-106-0213, and 388-71-0540 to include information pertaining to children's medicaid personal care (MPC) services including information on the new DDD CARE assessment process, updates to foster care to ensure that a foster parent providing personal care to a child residing in their licensed foster care home does not get paid twice for providing personal care services, and to assess foster children for mental health therapy needs, behaviors, and depression.
This rule making also amends personal emergency response system (PERS) language in WAC 388-106-0300 and 388-106-0500 to clarify that two people who live together who are unable to secure help in an emergency may now be eligible for a PERS unit, and adds PERS medication management language.
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/Chris Imhoff, 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 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), relating only to client medical or financial eligibility.
September 27, 2007
Stephanie E. Schiller
Rules Coordinator
3919.2(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 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 Medicaid personal care;
(3) Is a foster parent providing personal care to a child residing in their licensed foster home.
(4) 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))) (5) Has abused, neglected, abandoned, or
exploited a minor or vulnerable adult, as defined in chapter 74.34 RCW;
(((5))) (6) 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))) (7) Does not successfully complete the training
requirements within the time limits required in WAC 388-71-05665 through 388-71-05865;
(((7))) (8) 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))) (9) 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, AAA, or managed care
entity 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: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-71-0540, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-71-0540, filed 5/17/05, effective 6/17/05. 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.]
| Age of person requesting an assessment for personal care services | Has the person been determined to meet DDD eligibility requirements? | Who will perform the assessment for personal care services? | What assessment will be used? |
| Under eighteen years of age | Yes | DDD | CARE/DDD Assessment per chapter 388-828 WAC |
| Under eighteen years of age | No | DDD | CARE/LTC Assessment per chapter 388-106 WAC |
| Eighteen years of age and older | Yes | DDD | CARE/DDD Assessment per chapter 388-828 WAC |
| Eighteen years of age and older | No | HCS | CARE/LTC Assessment per chapter 388-106 WAC |
[Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0060, filed 5/17/05, effective 6/17/05.]
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. 07-10-024, § 388-106-0070, filed 4/23/07, effective 6/1/07; 05-11-082, § 388-106-0070, filed 5/17/05, effective 6/17/05.]
(1) Consider and document the role of your legally responsible natural/step/adoptive parent(s).
(2) 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, 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 & 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 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; |
||||||||||||||
(((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. 07-10-024, § 388-106-0213, filed 4/23/07, effective 6/1/07. 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.]
(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;
(c) Directly benefit you medically or remedially;
(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;
(c) You don't have a caregiver (paid or unpaid) available to prepare this meal; and
(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)(a) 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))) (i) You live alone in your own home; ((or))
(((b))) (ii) You are alone, in your own home, for
significant parts of the day and have no regular provider for
extended periods of time; or
(iii) No one in your home, including you, can secure help in an emergency.
(6)(b) A medication reminder if you:
(i) Are eligible for a PERS unit;
(ii) Do not have a caregiver available to provide the service; and
(iii) Are able to use the reminder to take your medications.
(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 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;
(c) Directly medically or remedially beneficial to you; and
(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
(c) Developing necessary skills to deal with care providers.
(10) Transportation services, when the service:
(a) Provides access to community services and resources to meet your therapeutic goal;
(b) Is not diverting 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
(c) Services are provided in compliance with WAC 246-840-930.
(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. The frequency and scope of the nursing services is based on your individual need as determined by your CARE assessment and any additional collateral contact information obtained by your case manager.
(a) Nursing assessment/reassessment;
(b) Instruction to you and your providers;
(c) Care coordination and referral to other health care 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 nonemergency 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 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 diverting items such as TV, cable or VCRs.
[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-106-0300, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0300, filed 5/17/05, effective 6/17/05.]
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.
AMENDATORY SECTION(Amending WSR 06-05-022, filed 2/6/06,
effective 3/9/06)
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;
(c) Directly benefit you medically or remedially;
(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;
(c) You don't have a caregiver (paid or unpaid) available to prepare this meal; and
(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)(a) 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))) (i) You live alone in your own home; ((or))
(((b))) (ii) You are alone, in your own home, for
significant parts of the day and have no regular provider for
extended periods of time; or
(iii) No one in your home, including you, can secure help in an emergency.
(6)(b) A medication reminder if you:
(i) Are eligible for a PERS unit;
(ii) Do not have a caregiver available to provide the service; and
(iii) Are able to use the reminder to take your medications.
(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;
(c) Directly medically or remedially beneficial to you; and
(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
(c) Developing necessary skills to deal with care providers.
(10) Transportation services if you live in your own home, when the service:
(a) Provides access to community services and resources to meet a therapeutic goal;
(b) Is not diverting 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
(c) Services are provided in compliance with WAC 246-840-930.
(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. The frequency and scope of the nursing services is based on your individual need as determined by your CARE assessment and any collateral contact information obtained by your case manager.
(a) Nursing assessment/reassessment;
(b) Instruction to you and your providers;
(c) Care coordination and referral to other health care 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 nonemergency 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.
(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.
(b) Do not include rent, recreational or diverting items such as TV, cable or VCRs.
[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, § 388-106-0500, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, § 388-106-0500, filed 5/17/05, effective 6/17/05.]
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.