WSR 07-24-066

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed December 4, 2007, 9:53 a.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 07-14-033.

Title of Rule and Other Identifying Information: The department is amending WAC 388-106-0130 How does the department determine the number of hours I may receive for in-home care?

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 January 8, 2008, at 10:00 a.m.

Date of Intended Adoption: Not earlier than January 9, 2008.

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 January 8, 2008.

Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS rules consultant, by December 28, 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: On May 3, 2007, the supreme court issued its decision invalidating the department's shared living rule. The majority concluded that the rule violated federal Medicaid comparability. WAC 388-106-0130 is being amended to comply with the supreme court decision pertaining to shared living.

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 necessary because of state court decision, No. 78652-6; No. 78931-2.

Name of Proponent: Department of social and health services, governmental.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Susan Engels, P.O. Box 45600, Olympia, WA 98504-5600, (360) 725-2353.

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 nonprofit organizations.

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.

November 29, 2007

Stephanie E. Schiller

Rules Coordinator

3897.7
AMENDATORY SECTION(Amending WSR 06-16-035, filed 7/25/06, effective 8/25/06)

WAC 388-106-0130   How does the department determine the number of hours I may receive for in-home care?   (1) The department assigns a base number of hours to each classification group as described in WAC 388-106-0125.

(2) The department will deduct from the base hours to account for your informal supports, as defined in WAC 388-106-0010, as follows:

(a) The CARE tool determines the adjustment for informal supports by determining the amount of assistance available to meet your needs, assigns it a numeric percentage, and reduces the base hours assigned to the classification group by the numeric percentage. The department has assigned the following numeric values for the amount of assistance available for each ADL and IADL:

Meds Self Performance Status Assistance Available Value

Percentage

Self administration of medications Rules for all codes apply except independent is not counted Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .9
1/4 to 1/2 time .7
1/2 to 3/4 time .5
>3/4 time .3
Unscheduled ADLs Self Performance Status Assistance Available

Bed mobility, transfer, walk in room, eating, toilet use Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider = 1;

Did not occur/client declined and independent are not counted.

Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .9
1/4 to 1/2 time .7
1/2 to 3/4 time .5
>3/4 time .3
Scheduled ADLs Self Performance Status Assistance Available Value

Percentage

Dressing,

personal hygiene,

bathing

Rules apply for all codes except: Did not occur/client not able and Did not occur/no provider = 1;

Did not occur/client declined and independent are not counted.

Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .75
1/4 to 1/2 time .55
1/2 to 3/4 time .35
>3/4 time .15
IADLs Self Performance Status Assistance Available Value

Percentage

Meal preparation,

Ordinary housework,

Essential shopping*

Rules for all codes apply except independent is not counted. Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .3
1/4 to 1/2 time .2
1/2 to 3/4 time .1
>3/4 time .05
IADLs Self Performance Status Assistance Available Value

Percentage

Travel to medical Rules for all codes apply except independent is not counted. Unmet N/A 1
Met N/A 0
Decline N/A 0
Partially met <1/4 time .9
1/4 to 1/2 time .7
1/2 to 3/4 time .5
>3/4 time .3
Key:

> means greater than

< means less than

*Results in 5% deduction for each IADL from the base hours. Remaining hours may be used for completion of household and personal care tasks.


(b) To determine the amount of reduction for informal support, the value percentages are totaled and ((is)) divided by the number of qualifying ADLs and IADLs needs. The result is value A. Value A is then subtracted from one. This is value B. Value B is divided by three. This is value C. Value A and Value C are summed. This is value D. Value D is multiplied by the "base hours" assigned to your classification group and the result is ((base)) the number of in-home ((care)) hours reduced for informal supports.

(3) Also, the department will adjust in-home base hours ((for the following shared living circumstances)) when:

(a) ((If)) There is more than one client receiving ADSA-paid personal care services living in the same household, the status under subsection (2)(a) of this section must be met or partially met for the following IADLs:

(i) Meal preparation((,));

(ii) Housekeeping((,));

(iii) Shopping((,)); and

(iv) Wood supply.

(b) ((If)) You ((and your paid provider live in the same household, the status under subsection (2)(a) of this section must be met for the following IADLs:

(i) Meal preparation,

(ii) Housekeeping,

(iii) Shopping, and

(iv) Wood supply.

(c) When there is more than one client living in the same household and your paid provider lives in your household, the status under subsection (2)(a) of this section must be met for the following IADLs:

(i) Meal preparation,

(ii) Housekeeping,

(iii) Shopping, and

(iv) Wood supply)) are under the age of eighteen, your assessment will be coded according to age guidelines codified in WAC 388-106-0213.

(4) In addition to any determination of unmet need in (2)(a) when you are not affected by (3) above, the department will score the status for meal preparation as unmet when you adhere to at least one of the following special diets:

(a) ADA (diabetes);

(b) Autism diet;

(c) Calorie reduction;

(d) Low sodium;

(e) Mechanically altered;

(f) Planned weight change program;

(g) Renal diet; or

(h) Needs to receive nutrition through tube feeding or receives greater than twenty-five percent of calories through tube or parenteral feeding.

(5) In addition to any determination of unmet need in (2)(a) when you are not affected by (3) above, the department will score the status for housework as unmet when you are incontinent of bladder or bowel, documented as:

(a) Incontinent all or most of the time;

(b) Frequently incontinent; or

(c) Occasionally incontinent.

(6) After deductions are made to your base hours, as described in subsections (2) and (3), the department may add on hours based on your living environment:


Condition Status Assistance Available Add On Hours
Offsite laundry facilities, which means the client does not have facilities in own home and the caregiver is not available to perform any other personal or household tasks while laundry is done. Unmet N/A 8
Client is >45 minutes from essential services (which means he/she lives more than 45 minutes one-way from a full-service market). Unmet N/A 5
Met N/A 0
Partially met <1/4 time 5
between 1/4 to 1/2 time 4
between 1/2 to 3/4 time 2
>3/4 time 2
Wood supply used as sole source of heat. Unmet N/A 8
Met N/A 0
Declines N/A 0
Partially met <1/4 time 8
between 1/4 to 1/2 time 6
between 1/2 to 3/4 time 4
>3/4 time 2

(((5))) (7) In the case of New Freedom consumer directed services (NFCDS), the department determines hours as described in WAC ((388-106-1450)) 388-106-1445.

(((6))) (8) The result of actions under subsections (2), (3), ((and)) (4), (5) and (6) is the maximum number of hours that can be used to develop your plan of care. The department must take into account cost effectiveness, client health and safety, and program limits in determining how hours can be used to meet your identified needs. In the case of New Freedom consumer directed services (NFCDS), a New Freedom spending plan (NFSP) is developed in place of a plan of care.

(((7))) (9) You and your case manager will work to determine what services you choose to receive if you are eligible. The hours may be used to authorize:

(a) Personal care services from a home care agency provider and/or an individual provider.

(b) Home delivered meals (i.e. a half hour from the available hours for each meal authorized).

(c) Adult day care (i.e. a half hour from the available hours for each hour of day care authorized).

(d) A home health aide if you are eligible per WAC 388-106-0300 or 388-106-0500.

(e) A private duty nurse (PDN) if you are eligible per WAC 388-71-0910 and 388-71-0915 or WAC 388-551-3000 (i.e. one hour from the available hours for each hour of PDN authorized).

(f) The purchase of New Freedom consumer directed services (NFCDS).

[Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.030. 06-16-035, 388-106-0130, filed 7/25/06, effective 8/25/06. Statutory Authority: RCW 74.08.090, 74.09.520, 74.39A.010 and 74.39A.020. 06-05-022, 388-106-0130, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090, 74.09.520. 05-11-082, 388-106-0130, filed 5/17/05, effective 6/17/05.]

Washington State Code Reviser's Office