WSR 07-24-026

PERMANENT RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed November 28, 2007, 10:47 a.m. , effective January 1, 2008 ]


     Effective Date of Rule: January 1, 2008.

     Purpose: 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.

     Citation of Existing Rules Affected by this Order: Amending WAC 388-71-0540, 388-106-0060, 388-106-0070, 388-106-0213, 388-106-0300, and 388-106-0500.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

      Adopted under notice filed as WSR 07-20-064 on September 28, 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     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 6, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 6, Repealed 0.

     Date Adopted: November 20, 2007.

Stephanie E. Schiller

Rules Coordinator

3919.3
AMENDATORY SECTION(Amending WSR 06-05-022, filed 2/6/06, effective 3/9/06)

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?   The department, AAA, or managed care entity will deny payment for the services of an individual provider or home care agency provider who:

     (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.]


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

WAC 388-106-0060   Who must perform the assessment?   The assessment must be performed by the department. Beginning January 1, 2008, individuals requesting personal care services will be assessed as described in the following chart:


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.]


AMENDATORY SECTION(Amending WSR 07-10-024, filed 4/23/07, effective 6/1/07)

WAC 388-106-0070   Will I be assessed in CARE?   You will be assessed in CARE if you are applying for or receiving DDD services, COPES, MNIW, MNRW, MPC, chore, respite, adult day health, GAU-funded residential care, PACE, Private Duty Nursing, New Freedom 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. 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.]


AMENDATORY SECTION(Amending WSR 07-10-024, filed 4/23/07, effective 6/1/07)

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) 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;

     (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. 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.]


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

WAC 388-106-0300   What services may I receive under community options program entry system (COPES) when I live in my own home?   When you live in your own home, you may be eligible to receive only the following services under COPES:

     (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.

     (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.]


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.

     (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.]

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