WSR 08-02-027

PROPOSED RULES

DEPARTMENT OF

SOCIAL AND HEALTH SERVICES
(Aging and Disability Services Administration)

[ Filed December 24, 2007, 8:52 a.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 07-15-048.

     Title of Rule and Other Identifying Information: The department is amending chapter 388-106 WAC, Long-term care services.

     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 February 5, 2008, at 10:00 a.m.

     Date of Intended Adoption: Not earlier than February 6, 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 February 5, 2008.

     Assistance for Persons with Disabilities: Contact Jennisha Johnson, DSHS Rules Consultant, by January 29, 2008, 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 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.

     Reasons Supporting Proposal: See above.

     Statutory Authority for Adoption: RCW 74.08.090, 74.09.520.

     Statute Being Implemented: Chapter 522, Laws of 2007 (SHB 1128).

     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: 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.

December 20, 2007

Stephanie E. Schiller

Rules Coordinator

3911.11
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.


Behavior Value
Easily Altered/Past 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, requires intervention 2 3
18. Unsafe cooking 2 3
19. Inappropriate toileting/menses activity 2 3
20. Unsafe smoking 2 3
21. Left home and became 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:

▪ Quadriplegia;

▪ Paraplegia;

▪ ALS (Amyotrophic Lateral Sclerosis);

▪ Parkinson's Disease;

▪ Multiple Sclerosis;

▪ Comatose;

▪ Muscular Dystrophy;

▪ Cerebral Palsy;

▪ Post Polio Syndrome; or

▪ 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:

▪ External catheter;

▪ Intermittent catheter;

▪ Indwelling catheter care;

▪ Bowel program; ((or))

▪ Ostomy care; or

▪ 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:

▪ Active range of motion (AROM); or

▪ 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:

▪ Active range of motion (AROM); or

▪ Passive range of motion (PROM).
AND
All of the following apply:

▪ You require IV nutrition support or tube feeding;

▪ Your total calories received per IV or tube was greater than 50%; and

▪ 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:

▪ Dialysis; or

▪ 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 score as determined under WAC 388-106-0090, clinical complexity as determined under WAC 388-106-0095, mood/behavior and behavior point score 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. CARE classification is determined first by meeting criteria to be placed into a group, then you are further classified based on ADL score or behavior point score into a classification sub-group following a classification path of highest possible base hours to lowest qualifying base hours.

     (1) If you meet the criteria for exceptional care, then CARE will place you in Group E. CARE then further classifies you into:

     (a) Group E High with 420 base hours if you have an ADL score of 26-28; or

     (b) Group E Medium with 350 base hours if you have an ADL score of 22-25.

     (2) If you meet the criteria for clinical complexity and have cognitive performance score of 4-6 or you have cognitive performance score of 5-6, then you are classified in Group D regardless of your mood and behavior qualification or behavior points. CARE then further classifies you into:

     (a) Group D High with 280 base hours if you have an ADL score of 25-28; or

     (b) Group D Medium-High with 240 base hours if you have an ADL score of 18-24; or

     (c) Group D Medium with 190 base hours if you have an ADL score of 13-17; or

     (d) Group D Low with 145 base hours if you have an ADL score of 2-12.

     (3) If you meet the criteria for clinical complexity and have a CPS score of less than 4, then you are classified in Group C regardless of your mood and behavior qualification or behavior points. CARE then further classifies you into:

     (a) Group C High with 200 base hours if you have an ADL score of 25-28; or

     (b) Group C Medium-High with 180 base hours if you have an ADL score of 18-24; or

     (c) Group C Medium with 140 base hours if you have an ADL score of 9-17; or

     (d) Group C Low with 95 base hours if you have an ADL score of 2-8.

     (4) If you meet the criteria for mood and behavior qualification and do not meet the classification for C, D, or E groups, then you are classified into Group B. CARE further classifies you into:

     (a) Group B High with 155 base hours if you have an ADL score of 15-28; or

     (b) Group B Medium with 90 base hours if you have an ADL score of 5-14; or

     (c) Group B Low with 52 base hours if you have an ADL score of 0-4; or

     (5) If you meet the criteria for behavior points and have a CPS score of greater than 2 and your ADL score is greater than 1, and do not meet the classification for C, D, or E groups, then you are classified in Group B. CARE further classifies you into:

     (a) Group B High with 155 base hours if you have a behavior point score 12 or greater; or

     (b) Group B Medium-High with 110 base hours if you have a behavior point score greater than 6; or

     (c) Group B Medium with 90 base hours if you have a behavior point score greater than 4; or

     (d) Group B Low with 52 base hours if you have a behavior point score greater than 1.

     (6) If you are not clinically complex and your CPS score is less than 5 and you do not qualify under either mood and behavior criteria, then you are classified in Group A. CARE further classifies you into:

     (a) Group A High with 78 base hours if you have an ADL score of 10-28; or

     (b) Group A Medium with 62 base hours if you have an ADL score of 5-9; or

     (c) Group A Low with 29 base hours if you have an ADL score of 0-4.


((Classification)) ((ADL 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))

((Classification)) ((ADL Score)) ((Group)) ((Base Hours of Group))
((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 18-28)) ((D High (12))) ((240))
((ADL Score 13-17)) ((D Med (11))) ((190))
((ADL Score 2-12)) ((D Low (10))) ((145))

((Classification)) ((ADL Score)) ((Group)) ((Base Hours of Group))
((Group C))

((Cognitive performance score = 0-3

and

Clinically complex = yes

and

Mood and behavior = yes or no))

 ((ADL Score 18-28)) ((C High (9))) ((180))
((ADL Score 9-17)) ((C Med (8))) ((140))
((ADL Score 2-8)) ((C Low (7))) ((83))

((Classification)) ((ADL Score)) ((Group)) ((Base Hours of Group))
((Group B))

((Mood and behavior = yes

and

Clinically complex = no

and

Cognitive performance score = 0-4))

 ((ADL Score 15-28)) ((B High (6))) ((155))
((ADL Score 5-14)) ((B Med (5))) ((90))

((ADL Score 0-4))

((B Low (4)))

((52))

((Classification)) ((ADL Score)) ((Group)) ((Base Hours of Group))
((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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